Popular antidepressant associated with a dramatic increase in suicidal thoughts amongst men

Nortriptyline, a second-generation tricyclic antidepressant, has been found to cause a 10-fold increase in suicidal thoughts in men when compared to its competitor escitalopram. These findings are published in the open access journal BMC Medicine.

The research was carried out by Nader Perroud from the Institute of Psychiatry, Kings College London, UK, who headed up GENDEP, an international team. Dr Perroud said: 'Suicidal thoughts and behaviors during antidepressant treatment have prompted warnings by regulatory bodies.' He continued '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.