[Possible cross hepatotoxicity between tricyclic and tetracyclic antidepressive agents]

The case is reported of a patient in whom acute hepatitis was induced first by a tricyclic antidepressant (dothiepin) and then by a tetracyclic antidepressant (mianserine). This observation does not confirm previous suggestions that the tricyclic ring is responsible for liver toxicity. However, this theory cannot be rejected as the mechanisms causing toxic hepatitis from tricyclic and tetracyclic antidepressants may well differ. The basis of this hepatoxicity is thus still unexplained. A spateine test was performed and this revealed that the patient was a normal metabolizer.