The editorial is here: http://www.bmj.com/content/350/bmj.h1771 http://www.bmj.com/content/350/bmj.h1771 Some of it I agree with, some I don't; I'm going to b

The editorial is here: http://www.bmj.com/content/350/bmj.h1771 http://www.bmj.com/content/350/bmj.h1771 Some of it I agree with, some I don't; I'm going to bed, but my primary objection relates to why the tricyclic antidepressants fell out of use. First of all, they're not gone; if you go to a psychiatrist and ask for amitryptyline or imipramine, you might just get it. But they're only used in depression which doesn't respond to SSRIs, because in some patients tricyclics can cause mania, hallucinations, and muscle twitching in addition to the infamous weight gain and sexual anhedonia seen on SSRIs. As such they were rarely prescribed even when they were the only drugs available. Otherwise I agree, but the question "why don't we use tricyclics?" has a lot of excellent answers.