Amitriptyline is an efficacious antidepressant drug .
It is , however , also associated with a number of side effects .
Degree of placebo response and severity of depression at baseline may moderate drug-placebo efficacy differences
BACKGROUND Amitriptyline is a tricyclic antidepressant that was synthesis ed in 1960 and introduced as early as 1961 in the USA , but is still regularly used .
It has also been frequently used as an active comparator in trials on newer antidepressants and can therefore be called a ' benchmark ' antidepressant .
However , its efficacy and safety compared to placebo in the treatment of major depression has not been assessed in a systematic review and meta- analysis .
OBJECTIVES To assess the effects of amitriptyline compared to placebo or no treatment for major depressive disorder in adults .
Drugs in Depressive Illness
SIR,-We wish to record a further instance of fatal paraquat poisoning . So far as we can ascertain , this is the tenth reported fatality caused by this widely used herbicidal preparation."q In December 1965 a 42-year-old male accidentally drank a small quantity of " weed-killer "  from an  unlabelled stout bottle . It was later estimated that the quantity of fluid consumed was about threequarters of a teaspoonful . The nature of the substance could not be immediately ascertained , but it was subsequently identified as Gramaxone 19 % ' w/w paraquat ion ) by the laboratories of I.C.I. Ltd. On admission to hospital a few hours after taking the poison , the patient complained of a  burning sensation in the throat and repeated -vomiting . Despite immediate gastric lavage , prophylactic penicillin , and abundant oral and intravenous fluids , there was progressive clinical deterioration . At three days the tongue was severely ulcerated and two days later haemoptysis occurred . On the eighth day jaundice , pyrexia , tachycardia , and a blood urea of 375 mg./100 ml . were recorded . The patient died some hours later . The outst and ing necropsy findings included focal myocardial necrosis , -severe pulmonnary haemorrhage and oedema , dense eosinophilic alveolar membrane , and proliferation of fibroblast-like cells in the alveolar septa . It is apparent from this and other reports that the lethal dose of paraquat may be very small . Further fatalities will -nly be avoided by proper , care in the storage and use of this valuable -but potentially dangerous compound . A detailed and illustrated clinico-pathological report is being prepared for publication.-We are , etc .
Amitriptyline is an efficacious antidepressant drug .
It is , however , also associated with a number of side effects .
Degree of placebo response and severity of depression at baseline may moderate drug-placebo efficacy differences
BACKGROUND Amitriptyline is a tricyclic antidepressant that was synthesis ed in 1960 and introduced as early as 1961 in the USA , but is still regularly used .
It has also been frequently used as an active comparator in trials on newer antidepressants and can therefore be called a ' benchmark ' antidepressant .
However , its efficacy and safety compared to placebo in the treatment of major depression has not been assessed in a systematic review and meta- analysis .
OBJECTIVES To assess the effects of amitriptyline compared to placebo or no treatment for major depressive disorder in adults .