Epidemiology

In the US, tricyclic antidepressants (TCAs) are among the top 25 generic substance categories associated with the largest number of reported fatalities.[5] During 2022, the American Association of Poison Control Centers' Toxic Exposure Surveillance System reported 3269 single exposures to TCAs; 401 were classified as major exposures, 13 patients died (0.4%). Amitriptyline accounted for over half of all exposures and fatalities.[5]

A UK cohort study found that tricyclic and tetracyclic antidepressants (ICD-10 code T43.0) were the tenth most common poisoning substance, accounting for 624 (2.7%) of all common poisoning events between 1998 and 2014 (n=23,326).[6] There were 3987 deaths involving tricyclic antidepressants (TCAs) in England between 1993 and 2002; however, reduced TCA-related poisoning during the same timeframe (from 8.6 per million population to 5.3 per million population) may indicate a preference for serotonin reuptake inhibitors for high-risk patients.[7]

TCAs are associated with greater risk of toxicity and overdose compared with other antidepressants. As such, use of TCAs has declined due to the availability of selective serotonin reuptake inhibitors, which are equally effective and less toxic.[8] Despite the introduction of safer antidepressants and the resultant decrease in the number of TCA exposures, their use is still prevalent; significant numbers of TCAs are still prescribed in the UK, Germany, and Taiwan.[9][10]

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