When reading the article on management of trigeminal neuralgia in GM December 2008, I was surprised that it did not mention use of tricyclic antidepressants. The authors recommend carbamazepine as treatment of first choice. Locally, I do not think it is even second or third choice. I have seen very few patients ever prescribed carbamazepine, including for diagnoses other than trigeminal neuralgia. As the authors mention, carbamazepine is known to cause side-effects more often in elderly patients, exactly the age group most likely to have post herpetic pain or trigeminal neuralgia.