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medication / antidepressants / tricyclics and heterocyclics 

Tricyclics and heterocyclics

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Mental health problems ​

  • Depression

  • Prevention of recurrent depressive episodes

  • Anorexia, bulimia

  • Alcoholism, drug addiction

  • Obsessive compulsive disorders, phobias, post-traumatic stress disorder

  • Generalized anxiety, panic disorder

  • Aggressive behaviors

  • Attention Deficit Hyperactivity Disorder in Children (ADHD)

 

Physical health issues

  • Sleeping troubles

  • Migraines, chronic neuropathic pain

  • Fibromyalgia

 

Children

  • Enuresis (urinary incontinence in children)

Contraindications

 

Physical health issues ​

  • Certain problems with the heart, liver, kidneys, urinary retention

  • Closed-angle or narrow-angle glaucoma

  • Can make some breathing problems worse

  • People prone to seizures

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mental health problem

  • Bipolar affective illness (risk of triggering an episode of mania)

 

Seniors

  • Use half an adult dose

  • Confusion, disorientation and delirium when combined with other medications

  • Risk of falling due to hypotension

 

Pregnancy

  • Some are safe, consult a doctor

 

Children

  • Generally poorly tolerated

Side effects

They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.

 

Common side effects

 

Head

  • Dry mouth

  • Drowsiness, sedation (Elavil, Tofranil, Surmontil)

  • Sudden drop in blood pressure, dizziness and vertigo (Tofranil); rarer with others

  • Blurred vision

  • Concentration difficulties

  • Restlessness, anxiety

 

Weight

Weight gain (Elavil, Anafranil, Tofranil)

 

Abdomen

  • Constipation

  • Nausea

 

Heart

Increased or irregular heartbeat

 

Sexuality

Various sexual disorders

 

Skin

Marked sunburn

 

Less common side effects

 

Abdomen

  • Difficulty urinating

  • Liver-related disorders

 

Sleep

Sleep disturbances, nightmares

 

Skin

Rashes

 

Head

  • Dry eyes

  • Metallic taste in the mouth

  • Speech difficulty

  • Confusion

  • Seizures, very high risk (Ludiomil)

  • Appearance of angle-closure glaucoma in predisposed subjects

 

Members

  • Lack of coordination, tremors

  • Edema (swelling)

 

Weight

Loss of appetite

 

Blood

Decreased white blood cell count

 

Psychological

Onset of an episode of mania or hypomania

 

Others

Discontinuation symptoms if treatment stopped abruptly (e.g. dizziness, sleep disturbances, agitation, anxiety, sensory disturbances)

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Drugs interactions

 

Mental health problems

  • Anxiolytics (or tranquilizers)  and hypnotics (or sleeping pills), antipsychotics (or neuroleptics) and antihistamines increase

  • drowsiness and confusion

  • Antipsychotics (or neuroleptics)  increase difficulty urinating, constipation and a feeling of dryness in the mouth

  • The combination with another tricyclic antidepressant or MAOI should be avoided  at all costs, because it could be fatal

  • Combination with an SSRI may increase the effects of the tricyclic

 

Physical health issues

  • Meperidine (Demerol) can cause respiratory arrest

  • Drugs used to lower blood pressure: increased hypotensive effect

 

Others

  • Alcohol increases the sedative effect

  • Narcotics (heroin, morphine, methadone) can cause respiratory arrest

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Overdose Risks

 

Tricyclic antidepressants are responsible for most drug overdose deaths; fortunately, their use has greatly diminished.

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Withdrawal symptoms

Psychotropic drugs act in the brain just as they do in the rest of the body; and as we have seen, each person reacts differently. It's the same with weaning; the person's metabolism, the type of drug, the dose as well as the duration of the intake and its half-life, explain that the withdrawal effects are varied. We have listed the potential and main withdrawal symptoms of each class of psychotropic drugs. This list is incomplete, as not all withdrawal effects are listed; moreover, knowledge is rapidly evolving in this field. A person may have no withdrawal symptoms or experience one, a few, or even many. The medication reduction journey is specific to each person, just as each process is unique. For example, a person can take the same medicine twice at the same dose and the effects will be different. Gradual reduction, like removing 10  % of dose per week/month, reduces the frequency or intensity of withdrawal symptoms and the incidence of rapid relapses. It is very important to undertake this process with the collaboration of your doctor. The pharmacist also plays a key role and can provide guidance to monitor withdrawal effects for each medication. Most people who will have withdrawal symptoms will tolerate them without problems for the short duration of these symptoms.

 

Common and frequent withdrawal symptoms for all classes:  anxiety,  nervousness,  hustle,  sleeping problems,  greater need to rest, sleep,  irritability,  fatigue

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Withdrawal symptoms for tricyclic antidepressants:

Tricyclic antidepressants cause the same withdrawal effects as SSRIs, but differ in the  physical effects:

 

Flu-like effects:

  • Headaches (headaches)

  • sweating

  • Fatigue

  • General malaise

  • Muscle aches

  • Diarrhea

  • Nausea

  • Vomiting

  • Runny nose

  • Salivation

  • Palpitations

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Rarely:

Cardiac arrythmia

 

Note: Mirtazapine (Remeron) gives very few symptoms of  withdrawal, but can sometimes cause anxiety, insomnia and  nausea.

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