summary A 74-year old man was admitted to a psychiatric hospital because he had been suffering for 1,5 years from a depressive disorder with psychotic features and had not responded positively to treatment with three selective serotonin reuptake inhibitors and mirtazapine in combination with risperidone, olanzapine and haloperidol. Because he had cardiovascular problems he had not been treated with tricyclic antidepressants. Treatment with nortriptyline did not relieve the depression, but upon the addition of lithium, the patient recovered almost completely and experienced only minor cardiovascular side-effects. The patient also suffered from mild subcortical dementia. Risks to the cardiovascular system arising from treatment with tricyclic antidepressants are largely overestimated.