To the Editor: Dr Jick and colleagues1 reported that the risk of suicidal behavior after initiating antidepressant treatment is similar among users of amitriptyline, fluoxetine, and paroxetine compared with the risk among users of dothiepin. This finding is relevant in countries where dothiepin is a reference antidepressant, such as the United Kingdom, but is less helpful where this agent has never been licensed, such as Italy and the United States.
In these and other countries, amitriptyline and other nondothiepin tricyclic antidepressants had been considered the standard treatment for depression, both in clinical practice and in experimental studies.2 Newer antidepressants are now available, and a crucial question is whether suicidal behavior is increased in users of selective serotonin reuptake inhibitors compared with users of amitriptyline or other reference tricyclic antidepressants. Although Jick and colleagues did not address this issue, Table 3 in their article raises a question of a difference between amitriptyline and paroxetine, showing adjusted odds ratios comparing amitriptyline (0.83), fluoxetine (1.16), and paroxetine (1.29) each to dothiepin. Because of this, it would be interesting if the authors could present their data using amitriptyline as the comparator.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.