Montgomery S A, Baldwin D, Green M
St. Mary's Hospital Medical School, London, United Kingdom.
Acta Psychiatr Scand Suppl. 1989;354:47-53. doi: 10.1111/j.1600-0447.1989.tb03046.x.
Data from different analyses of reported deaths from overdose with antidepressants in the U.K. reveal that amitriptyline and dothiepin are the antidepressants most likely to be associated with death from overdose. All widely used tricyclic antidepressants (TCAs) except clomipramine and lofepramine appear to be dangerous in overdose, whereas the newer antidepressants such as mianserin, trazodone, viloxazine and the TCA lofepramine appear to be relatively safe. The toxicity of amitriptyline and dothiepin appears to be greater than all antidepressants including other TCAs and it is important to try to understand why. A number of explanations will be considered: 1. Dothiepin and amitriptyline may be inherently more toxic than other TCAs. 2. Dothiepin and amitriptyline may induce suicide more than other antidepressants. It is assumed that antidepressants are neutral with regard to inducing suicide but this may not be true. There is, for example, evidence that alprazolam and other benzodiazepines induce suicidal behaviour. 3. Amitriptyline and dothiepin are often presented in subtherapeutic and ineffective doses and it is possible that increased suicides may result from inadequately treated depression. 4. There may be a selective overreporting of deaths with amitriptyline and dothiepin. 5. Amitriptyline and prothiaden may be selectively given to the suicide prone on the mistaken assumption that they are safe.
英国针对抗抑郁药过量致死情况的不同分析数据显示，阿米替林和多塞平是最有可能与过量致死相关的抗抑郁药。除氯米帕明和洛非帕明外，所有广泛使用的三环类抗抑郁药（TCA）过量时似乎都有危险，而米安色林、曲唑酮、维洛沙嗪等新型抗抑郁药以及三环类抗抑郁药洛非帕明似乎相对安全。阿米替林和多塞平的毒性似乎大于所有抗抑郁药，包括其他三环类抗抑郁药，因此有必要弄清楚原因。将考虑多种解释：1. 多塞平和阿米替林可能本质上比其他三环类抗抑郁药毒性更大。2. 多塞平和阿米替林可能比其他抗抑郁药更易诱发自杀。一般认为抗抑郁药在诱发自杀方面是中性的，但可能并非如此。例如，有证据表明阿普唑仑和其他苯二氮䓬类药物会诱发自杀行为。3. 阿米替林和多塞平通常以低于治疗剂量且无效的剂量给药，治疗不充分的抑郁症可能导致自杀率上升。4. 可能存在对阿米替林和多塞平致死情况的选择性过度报告。5. 可能会错误地认为阿米替林和丙硫异烟胺安全，从而将它们选择性地开给易自杀的人群。
