{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:31:31Z","timestamp":1790310691794,"version":"4.1.0"},"reference-count":55,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Clin Pharmacol"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Tricyclic antidepressants (TCAs) are commonly prescribed despite no longer being a NICE\u2010recommended first\u2010line treatment for depression and their recognized toxicity in overdose. This study examined prescribing, mortality, hospital admissions and clinical TCA data to quantify the use and impact of TCAs in England and Wales.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Primary care prescription data for the eight TCAs currently licensed in England and Wales were analysed alongside hospital admission and mortality data relating to TCAs over the study period (January 2016\u2013December 2020 inclusive). Monthly Toxbase\u2122 accesses regarding TCAs during the study period for each TCA were quantified. National Poisons Information Service (NPIS) enquiry data involving TCA exposure were obtained and patient demographics, circumstance, dose ingested and poisoning severity were analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>English and Welsh mean monthly TCA prescriptions per 100\u2009000 people significantly increased during the study period, both driven by amitriptyline 10\u00a0mg tablets (95% confidence interval [CI] 3.49\u20134.59 and 6.36\u20137.92, respectively). Deaths from poisoning where a TCA was mentioned on the death certificate fell. Toxbase\u2122 accesses increased for amitriptyline and nortriptyline but decreased for all other TCAs. NPIS telephone enquiries relating to TCAs decreased. Hospital admission data did not demonstrate an increase in admissions related to TCAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Reduced TCA poisoning mortality in England and Wales was seen despite increased dispensing of TCAs in both nations. The prescribing of low\u2010dose amitriptyline formulations was associated with increased consultation with Toxbase\u2122 but not increased hospital admissions or NPIS enquiries, suggesting a fall in TCA poisoning severity resulting from their changing pattern of usage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bcp.16400","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:55:28Z","timestamp":1738198528000},"page":"1727-1738","source":"Crossref","is-referenced-by-count":7,"title":["Trends in tricyclic antidepressant prescribing and poisoning in England and Wales 2016\u20132020"],"prefix":"10.1111","volume":"91","author":[{"given":"Laurence","family":"Gray","sequence":"first","affiliation":[{"name":"National Poisons Information Service Cardiff University Hospital Llandough  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Beddard","sequence":"additional","affiliation":[{"name":"Centre for Healthcare Evaluation, Device Assessment and Research (CEDAR) Cardiff and Vale University Health Board  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Jones","sequence":"additional","affiliation":[{"name":"National Poisons Information Service Cardiff University Hospital Llandough  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asiyah","family":"Begum","sequence":"additional","affiliation":[{"name":"School of Pharmacy and Pharmaceutical Sciences Cardiff University  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noraini B.","family":"Azhar","sequence":"additional","affiliation":[{"name":"School of Pharmacy and Pharmaceutical Sciences Cardiff University  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6751-9438","authenticated-orcid":false,"given":"Paul","family":"Deslandes","sequence":"additional","affiliation":[{"name":"All Wales Therapeutics and Toxicology Centre, NHS Wales  Cardiff UK"},{"name":"Faculty of Life Sciences and Education Department University of South Wales  Pontypridd UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9919-3487","authenticated-orcid":false,"given":"James","family":"Coulson","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology Cardiff University  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Bradberry","sequence":"additional","affiliation":[{"name":"NPIS Birmingham, National Poisons Information Service  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6508-7288","authenticated-orcid":false,"given":"Euan A.","family":"Sandilands","sequence":"additional","affiliation":[{"name":"NPIS Edinburgh, National Poisons Information Service  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7543-6026","authenticated-orcid":false,"given":"Ruben H.","family":"Thanacoody","sequence":"additional","affiliation":[{"name":"NPIS Newcastle, National Poisons Information Service  Newcastle UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8736-395X","authenticated-orcid":false,"given":"Matthew O.","family":"Ivory","sequence":"additional","affiliation":[{"name":"School of Pharmacy and Pharmaceutical Sciences Cardiff University  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2012.06.007"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.86a.19005"},{"key":"e_1_2_11_4_1","volume-title":"CG90: Depression in adults: recognition and management","author":"NICE","year":"2009"},{"key":"e_1_2_11_5_1","volume-title":"NG222: Depression in adults: treatment and management","author":"NICE","year":"2022"},{"key":"e_1_2_11_6_1","volume-title":"CG23: Depression: management of depression in primary and secondary care","author":"NICE","year":"2004"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.109.070219"},{"key":"e_1_2_11_8_1","first-page":"101","article-title":"Addressing the side effects of contemporary antidepressant drugs: a comprehensive review","volume":"54","author":"Wang S\u2010M","year":"2018","journal-title":"CMJ"},{"key":"e_1_2_11_9_1","volume-title":"CG173: Neuropathic pain in adults: pharmacological management in non\u2010specialist settings","author":"NICE","year":"2013"},{"key":"e_1_2_11_10_1","volume-title":"NG193: Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain","author":"NICE","year":"2021"},{"key":"e_1_2_11_11_1","volume-title":"British National Formulary","author":"Joint Formulary Committee","year":"2021"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-027663"},{"key":"e_1_2_11_13_1","article-title":"Antidepressants for pain management in adults with chronic pain: a network meta\u2010analysis","volume":"5","author":"Birkinshaw H","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_11_14_1","volume-title":"Poisoning & Drug Overdose","author":"Benowitz NL","year":"2018"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph15050928"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004850-199611020-00001"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp18X698897"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.310.6974.221"},{"key":"e_1_2_11_19_1","first-page":"7","volume-title":"Dosulepin: measures to reduce risk of fatal overdose","author":"MHRA","year":"2007"},{"key":"e_1_2_11_20_1","volume-title":"National Prescribing Indicators 2013\u20132014","author":"AWMSG","year":"2013"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpt.12376"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bjp.0707253"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.2165\/00139709-200524030-00013"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1006949816036"},{"key":"e_1_2_11_25_1","volume-title":"Goldfrank's toxicologic emergencies","author":"Liebelt EL","year":"2015"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291701004548"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.184.1.41"},{"key":"e_1_2_11_28_1","first-page":"22","volume-title":"Antidepressant prescribing in England: patterns and costs","author":"Heald AH","year":"2020"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadr.2021.100205"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40199-021-00390-z"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdm085"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsps.2022.06.025"},{"key":"e_1_2_11_33_1","first-page":"18","article-title":"Fatal toxicity of antidepressants in England and Wales, 1993\u20132002","author":"Morgan O","year":"2004","journal-title":"Health Stat Q"},{"key":"e_1_2_11_34_1","unstructured":"NHS England.NHS Data Model and Dictionary: Consultant Episode (Hospital Provider).2024."},{"key":"e_1_2_11_35_1","volume-title":"2020 registrations edition","author":"ONS","year":"2021"},{"key":"e_1_2_11_36_1","volume-title":"Number of drug\u2010related poisonings that were suicides and non\u2010suicides by sex and selected substances, England and Wales, deaths registered between 2015 and 2020","author":"ONS","year":"2021"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.3109\/15563659809028940"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1080\/10618600.2019.1695624"},{"key":"e_1_2_11_39_1","unstructured":"WickhamH FR HenryL M\u00fcllerK VaughanD.dplyr: A Grammar of Data Manipulation.2023."},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v027.i03"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-98141-3"},{"key":"e_1_2_11_42_1","first-page":"3","article-title":"STL: a seasonal\u2010trend decomposition","volume":"6","author":"Cleveland RB","year":"1990","journal-title":"J Off Stat"},{"issue":"2","key":"e_1_2_11_43_1","first-page":"S1","article-title":"THE CONCISE GUIDE TO PHARMACOLOGY 2023\/24: introduction and other protein targets","volume":"180","author":"Alexander SPH","year":"2023","journal-title":"Br J Pharmacol"},{"key":"e_1_2_11_44_1","volume-title":"Suicide rates in the UK","author":"ONS","year":"2024"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-89700-8"},{"key":"e_1_2_11_46_1","volume-title":"Depression and other common mental disorders: global health estimates","author":"WHO","year":"2017"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2013.11.013"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2007.08.013"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2005.11.008"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010364"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2022.100579"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2125.2003.01910.x"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2009.03458.x"},{"key":"e_1_2_11_54_1","volume-title":"Coronavirus and the social impacts on Great Britain","author":"ONS","year":"2020"},{"key":"e_1_2_11_55_1","volume-title":"TOXBASE","author":"TOXBASE","year":"2022"},{"key":"e_1_2_11_56_1","volume-title":"Deaths related to drug poisoning in England and Wales: 2023 registrations","author":"ONS","year":"2024"}],"container-title":["British Journal of Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bcp.16400","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/bcp.16400","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bcp.16400","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T13:51:33Z","timestamp":1782481893000},"score":1,"resource":{"primary":{"URL":"https:\/\/bpspubs.onlinelibrary.wiley.com\/doi\/10.1111\/bcp.16400"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":55,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1111\/bcp.16400"],"URL":"https:\/\/doi.org\/10.1111\/bcp.16400","archive":["Portico"],"relation":{},"ISSN":["0306-5251","1365-2125"],"issn-type":[{"value":"0306-5251","type":"print"},{"value":"1365-2125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]}}}