A five year review of fatal self-ingested overdoses involving amitriptyline in Edinburgh 1983-'87

One hundred and twelve cases of fatal self-ingested overdoses were investigated in the Forensic Medicine Unit of the Department of Pathology of the University of Edinburgh in the period 1983-'87 (inclusive). Of these, 24 cases involved amitriptyline as either the sole agent or in combination with another drug, the most common of which was ethanol. The mean age of the latter group was 43 years with a marked female preponderance. The social history was documented with six out of the 24 cases living alone and five out of the 24 cases divorced. The number previously referred for psychiatric treatment and the number of cases where over 100 tablets of the drug had been prescribed at any one time (where known) was recorded: eight out of 24 cases. The fact that amitriptyline was by far the commonest of the tricyclic antidepressants to be encountered in a fatal overdose situation raises the important question of the prescribing of amitriptyline as a first line therapy in mental depression.