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Their implication in a large number of deaths from overdose meant that other classes of safer antidepressants such as the seratonin re-uptake inhibitors (SSRI) like fluoxetine (Prozac) found favour and largely displaced the TCAs.
Since this time the TCAs have undergone something of a resur- gence for the treatment of intractable neuropathic pain (such as trigeminal neuralgia) and migraine.
Using Tricylics for a Peaceful Death
The drugs have several characteristics that make them useful as reliable and lethal drugs. In particular they exhibit cardiotoxic and central nervous system (CNS) effects. CNS symptoms in- clude sedation and coma, but it is the cardiotoxic effects that reduce cardiac output, lower blood pressure and disrupt car- diac rhythm that bring about death.
Fig 12.1 The tricyclic antidepressant amitriptyline