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Tricyclic Antidepressant


Tricyclic antidepressants commonly known as TCA have been prescribed since mid of 20th century for depression. Until recently TCAs were the clear first choice of physicians for the vast majority of people with major depressive disorder.

Dosulepin (dothiepin), imipramine and amitriptyline are the three most commonly used in the UK, but many related compounds have been introduced, some having fewer autonomic and cardiotoxic effects (e.g. trazodone, lofepramine). These drugs potentiate the action of the monoamines, norepinephrine (noradrenaline) and serotonin, by inhibiting their reuptake into nerve terminals. Other tricyclics in common use include nortriptyline, doxepin and clomipramine. Depending on the particular drug, normal doses are between 75 and 150 mg. Having been available for more than 40 years, there is more evidence of the effectiveness of TCAs in depressive illness than for any other group of antidepressants. They are the drugs most commonly used in severe depressive illness.

How Tricyclic Antidepressant works?

TCAs work by raising the levels of serotonin and norepinephrine in the brain by slowing the rate of reuptake, or reabsorption, by nerve cells. It may take several weeks before you see the desired result.

Tricyclic antidepressants were the first line of treatment for major depression. Most of these medications affected two chemical neurotransmitters, norepinephrine and serotonin. Though the tricyclics are as effective in treating depression as the newer antidepressants, their side effects are usually more unpleasant; thus, today tricyclics such as imipramine, amitriptyline, nortriptyline, and desipramine are used as a second- or third-line treatment.

What are the side effects of Tricyclic Antidepressant?

The most common side effects of tricyclic antidepressants, and ways to deal with them are as follows:

  • Dry mouth -it is helpful to drink sips of water; chew sugarless gum; brush teeth daily.
  • Constipation -bran cereals, prunes, fruit, and vegetables should be in the diet.
  • Bladder problems -emptying the bladder completely may be difficult, and the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be at particular risk for this problem. The doctor should be notified if there is any pain.
  • Sexual problems -sexual functioning may be impaired; if this is worrisome, it should be discussed with the doctor.
  • Blurred vision -this is usually temporary and will not necessitate new glasses. Glaucoma patients should report any change in vision to the doctor.
  • Dizziness -rising from the bed or chair slowly is helpful.
  • Drowsiness as a daytime problem -this usually passes soon. A person who feels drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and to minimize daytime drowsiness.
  • Increased heart rate -pulse rate is often elevated. Older patients should have an electrocardiogram (EKG) before beginning tricyclic treatment.

The first medication specifically approved for use in the treatment of obsessive-compulsive disorder OCD was the tricyclic antidepressant clomipramine ( Anafranil ).

Antidepressant withdrawal and Tricyclic Antidepressant

Tricyclic Antidepressant - Tricyclic antidepressants were the first line of treatment for major depression. Most of these medications affected two chemical neurotransmitters, norepinephrine and serotonin.

Antidepressants other than tricyclic antidepressant

Serotonin Syndrome - Serotonin Syndrome Symptom

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