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Tricyclic Antidepressant May Increase Suicidal Thoughts in Men

A new report states that nortriptyline, a second-generation tricyclic antidepressant has been found to cause a tenfold increase in suicidal thoughts in men when compared to an antidepressant that works as a selective serotonin reuptake inhibitor (SSRI).

Nortriptyline is marketed as Pamelor, or Aventyl HCl . Researchers compared nortriptyline to escitalopram (Lexapro, or Cipralex) and discovered the increased risk of suicidal ideation.

These findings are published in the open access journal BMC Medicine.

The research was carried out by Dr. Nader Perroud from the Institute of Psychiatry, Kings College London, who headed up GENDEP, an international team.

Dr. Perroud said “Suicidal thoughts and behaviors during antidepressant treatment have prompted warnings by regulatory bodies. The aim of our study was to investigate the emergence and worsening of suicidal thoughts during treatment with two different types of antidepressant.”

Both escitalopram and nortriptyline have their effect through the mood modulating neurotransmitter systems. The former is a selective serotonin reuptake inhibitor (SSRI), preventing serotonin from re-entering the cell and thereby prolonging its effect on nerve synapses.

The latter is a tricyclic antidepressant that inhibits the reuptake of noradrenaline, and to a lesser extent, that of serotonin.

The study was carried out on 811 individuals with moderate to severe unipolar depression.

Whilst an overall trend in reduction of suicidal thoughts was observed, men who took nortriptyline were found to have a 9.8-fold increase in emerging suicidal thoughts and a 2.4-fold increase in worsening suicidal thoughts compared to those who took escitalopram.

Perroud concludes, “Our findings that treatment-emerging and worsening suicidal thoughts may also be associated with psychomotor activation triggered by antidepressants needs to be investigated in future studies.

“The study also refutes the idea that newer antidepressants such as the SSRIs are worse than older medications in terms of increasing suicidal thoughts.”

Source: BioMed Central

Tricyclic Antidepressant May Increase Suicidal Thoughts in Men

Rick Nauert PhD

Rick Nauert, PhDDr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.

APA Reference
Nauert PhD, R. (2018). Tricyclic Antidepressant May Increase Suicidal Thoughts in Men. Psych Central. Retrieved on February 16, 2019, from
Scientifically Reviewed
Last updated: 8 Aug 2018
Last reviewed: By a member of our scientific advisory board on 8 Aug 2018
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