The large number of antidepressants available provides a wide range of choice. While clinical effectiveness is the most important consideration, toxicity in overdose must be considered in the risk-benefit assessment of each antidepressant. There are almost 300 deaths each year in Britain from tricyclic overdose, and very few deaths from newer antidepressants. Fluvoxamine appears to have low toxicity in overdose. Symptoms are often minimal: nausea, vomiting, dizziness and somnolence. There is one reported case of prolonged cerebral depression after ingestion of 5.5 g. Overdoses of up to 9 g have produced minimal symptoms and full recovery. No deaths from overdose with fluvoxamine alone have been reported in the literature, although one death certificate in Britain has mentioned fluvoxamine as the cause of death. Fluvoxamine appears to be a valuable alternative to the tricyclic antidepressants, and has a high margin of safety in overdose.