Tricyclic antidepressants were among the first classes of drugs approved for the treatment of depression and other mental disorders. Despite the potential risks, these drugs are still commonly used when absolutely necessary.
What are tricyclic antidepressants?
Tricyclic antidepressants (TCAs) are among the earliest antidepressant drugs introduced and developed, dating back to around 1950. To this day, these drugs are still used in the treatment of depression. and other health problems.
Despite their relatively good efficacy, TCAs are often replaced by newer antidepressant drugs that cause fewer side effects. However, TCAs may still be a good choice for some people. In some cases, they help relieve depression when other treatments don’t work.
1. Mechanism of action
Tricyclic antidepressants help relieve depression by affecting brain chemicals (neurotransmitters), specifically norepinephrine and serotonin. In it, norepinephrine helps regulate emotional responses. Serotonin is often referred to as the happy hormone.
The effect on norepinephrine and serotonin helps to transmit messages between brain cells. Thereby contributing to health, good mood and increased appetite. Moreover, it also helps to regulate the sleep-wake cycle as well as the body’s internal biological clock.
In addition, TCAs have the ability to block the action of other neurotransmitters. Examples include acetylcholine and histamine. This helps to relieve the physical symptoms of depression and other health problems.
One type of TCAs can affect these neurotransmitters more than others. This explains why some TCAs work better for conditions other than depression. Or it could potentially cause side effects such as dry mouth, constipation or sedation.
Tricyclic antidepressants are commonly used primarily to treat mood disorders. However, they can also be effective in treating personality disorders, anxiety disorders, and neurological disorders. TCAs are often used when other medications fail to work.
Mood disorders commonly treated with TCAs include:
- Bipolar disorder
- Persistent mild depression
- Major depressive disorder
Anxiety disorders that can be treated with TCAs include:
- Metabolic disorders, including eating disorders such as bulimia and anorexia nervosa
- Generalized anxiety disorder
- Obsessive Compulsive Disorder
- Panic disorder
- Post-traumatic stress disorder
Neurological disorders sometimes treated with TCAs include:
- Attention Deficit Hyperactivity Disorder
- Chronic pain
- Parkinson disease
- Nerve pain
In addition, tricyclic antidepressants may also be prescribed by your doctor to help treat a number of other health problems. Such as irritable bowel syndrome, insomnia, interstitial cystitis, bedwetting, narcolepsy and chronic hiccups.
Tricyclic antidepressants are not prescribed for the following people:
- Children under 12 years old
- People who are hypersensitive to any of the ingredients of the drug
- Pregnant and lactating women
- Patient is recovering from a heart attack
- Users who are using MAO
- People who just stopped MAO for less than 14 days
Commonly used tricyclic antidepressants
Tricyclic antidepressants require a prescription from a doctor to be used. Depending on each specific case, the doctor will consider prescribing the appropriate drugs.
Some of the types of TCAs that have been approved for use include:
- Anafranil (clomipramine)
- Asendin (amoxapine)
- Tofranil (imipramine)
- Vivactil (protriptyline)
- Pamelor (nortriptyline)
- Sinequan (doxepin)
- Surmontil (trimipramine)
- Elavil (amitriptyline)
- Norpramine (desipramine)
Tricyclic antidepressants can be very effective when used correctly. It usually takes about 2 to 3 weeks for the drug to respond to treatment (sometimes as early as 4 days and as late as 8 weeks).
The most important thing when using TCAs is to make sure you take them exactly as prescribed by your doctor. Take the correct dose, frequency and time. Never stop taking your medicine suddenly, increase/decrease the dose or change your treatment plan without your doctor’s approval. Both underuse and overdose can be potentially risky.
TCAs are not considered addictive. However, stopping treatment suddenly or missing several doses can cause withdrawal-like symptoms.
Withdrawal symptoms can vary depending on how the drug works. There can be agitation, nausea, sweating, chills and muscle aches, insomnia, lethargy, headache, etc. This is also sometimes called discontinuation syndrome. Work with your doctor to reduce your dose slowly and safely.
Some notes when using tricyclic antidepressants
Currently, tricyclic antidepressants are no longer used so commonly as before. Although they are still effective, they have many potential side effects and health risks.
To ensure the safety of treatment with TCAs, there are a few things to keep in mind:
1. Side effects
Tricyclic antidepressants work differently, so side effects can also vary between drugs. Some side effects may go away after a certain time.
Meanwhile, other side effects may prompt a doctor to try a different drug on a patient to get a better response. The side effects of TCAs are usually dose-dependent. Higher doses are more likely to cause side effects.
Common side effects that may occur include:
- Blurred vision
- Dry mouth
- Lowers blood pressure when switching from a sitting position to a standing position
- Urinary retention
Other side effects may include:
- Weight loss
- Increase appetite
- Sweating too much
- Sexual problems
For TCAs that cause drowsiness, you need to be careful when doing activities that require alertness. Especially driving cars, operating machines, etc.
Some types of TCAs can cause side effects that affect safety. These include disorientation or confusion (especially in the elderly when doses are too high), increased or irregular heartbeat, and seizures more often than in those with seizures.
2. Poisoning with tricyclic antidepressants
TCAs poisoning is common with overdose or abrupt discontinuation of the drug. Acute poisoning often has a rapid progression and is difficult to predict.
Poisoning conditions that can occur with the use of TCAs include:
- Poisoning on the respiratory system: Common problems are vasoconstriction, bronchospasm, hypotension, acute lung injury, lung infection, etc.
- Poisoning on the cardiovascular system: Excessive use of TCAs can cause convulsions, hypotension, cardiac arrhythmias, hypoxemia, etc.
- Poisoning on the central nervous system: Possible symptoms are agitation, body convulsions, hallucinations, coma, behavioral disturbances, etc. Commonly occurring when overdose, abuse, people with traumatic brain injury, have money. seizure history.
The toxicity of TCAs is usually dramatic within the first hours. Unusual symptoms will begin to appear a few hours later. In many cases, poisoning with tricyclic antidepressants can lead to death.
If you suspect or know that you have overdosed on TCAs, you should seek medical help immediately. Timely intervention will help better protect your health and life.
3. Drug interactions
In fact, some side effects of tricyclic antidepressants can be increased when used concurrently with other drugs. In many other cases, interactions occur that can affect the concentration of the drug in the blood.
Therefore, you need to inform your doctor about any medications you are taking. This includes over-the-counter drugs, herbal remedies, supplements or stimulants.
Some drugs and substances that can interact with tricyclic antidepressants include:
- Alcohol can block the action of TCAs, so while taking TCAs, you need to avoid alcohol.
- Anticholinergics used to treat urinary incontinence can cause bowel paralysis if used concurrently with TCAs.
- Clonidine is used to treat high blood pressure, if taken with TCAs can cause dangerously high blood pressure.
- Epinephrine used to treat severe allergic reactions can also cause dangerously high blood pressure if used with TCAs.
- Monoamine oxidase (MAO) inhibitors used to treat depression can cause high fever, convulsions, or even death if taken with TCAs.
- Tagamet (cimetidine) is used to reduce stomach acid that can increase blood levels of TCAs. This increases the side effects.
5. Chronic health condition
TCAs can cause problems in people with pre-existing chronic health conditions. These include glaucoma, heart problems, an enlarged prostate, diabetes, liver disease, a history of epilepsy. Talk to your doctor about whether TCAs are really a safe option when you have a chronic condition.
6. Risk of suicide
Most FDA-approved tricyclic antidepressants are safe. However, close monitoring is required during use. Especially in children and adolescents.
In fact, children and adolescents under 25 years of age may experience an increase in suicidal thoughts and behavior when using TCAs. Especially during the first few weeks after starting the medication or when the dose is changed.
Therefore, it is important to monitor whether TCAs exacerbate depression or abnormal behavior. If you find yourself or a loved one having suicidal thoughts while taking TCAs, contact your doctor immediately or seek emergency help.
Tricyclic antidepressants are often prescribed when newer antidepressant drugs do not respond to treatment. Be sure to follow your doctor’s instructions to get the best results and avoid serious risks.