Antidepressants are among the most common prescribed drugs in our country. Tricyclic antidepressants (TCA) are named for their chemical structure, which includes as a base two rings joined by another central ring, giving a three-dimensional structure. They are part of the cyclic antidepressants, made up of tricyclic antidepressants (three rings) and tetracyclic antidepressants (four rings). ADTs are, along with monoamine oxidase inhibitors (MAOIs), the oldest antidepressants and continue to play a relevant role in current clinical practice, however they have been very limited.
If you are interested in knowing the ADT, in this Psychology-Online article, we will explain the Tricyclic antidepressants: what they are for, names and side effects.
What tricyclic antidepressants are used for
Tricyclic antidepressants are part of the group of antidepressant drugs and their effectiveness has been demonstrated in repeated research. It has been shown that the therapeutic effect of TCAs produces a improvement or remission of depressive symptoms by more than 65% of the cases. It is important to highlight that psychopharmacotherapy does not produce a total remission of the disorder; however, there is high evidence that the combination of pharmacotherapy with certain types of psychotherapy greatly increases recovery. That is, the best option is to combine antidepressants with . Furthermore, it should be noted that the effect of tricyclic antidepressants only improves the mood in those people who have previously had depressive symptoms, so they do not raise the mood of a person who is within normal limits.
Currently, it is debated whether ADTs are primarily indicated for the most severe forms of depression, major depression. Even so, there are several disorders that are treated with tricyclic antidepressants with a specific indication for their use. The psychological disorders treated with tricyclic antidepressants are:
Drug choice
How can we choose the right antidepressant? Even keeping in mind the specific indications of certain disorders that are treated with antidepressant drugs, specifically ADT, it is difficult to select the most appropriate one, due to the extensive number of antidepressants available on the market. However, the side effects they produce drugs generally tend to be the main factor in drug choice. Furthermore, it is necessary that the variables of each drug adjust to the variables of each patient profile. The variables that must be taken into account for the correspondence between the drug and the patient are the following:
As for the patientit will be taken into account:
- Depression subtype
- Age
- Gender
- Health condition
As for the drugit will be taken into account:
- Side effects
- Security
- Price
Tricyclic antidepressants: trade names
TCAs are named based on their active ingredient, however, all of them have a trade name. Next, the active ingredient, the trade name, the therapeutic dose and the different forms of administration of each drug will be presented for each drug.
Active ingredient: Amitriptyline
- Trade name: Elavil
- Therapeutic dose (mg/day): 150-300
- Form of administration: tablets: 10, 25, 50, 75, 100 and 150 mg. or injectable: 10 mg/ml.
Active ingredient: Clomipramine
- Trade name: Anafranil
- Therapeutic dose (mg/day): 100-250
- Form of administration: capsules: 25, 50 and 75 mg.
Active ingredient: Desipramine
- Trade name: Norpramin
- Therapeutic dose (mg/day): 150-300
- Form of administration: tablets: 10, 25, 50, 75, 100 and 150 mg.
Active ingredient: Doxepin
- Trade name: Sinequan
- Therapeutic dose (mg/day): 150-300
- Form of administration: capsules: 25, 50, 75, 100 and 150 mg. or oral solution: 10mg/ml.
Active ingredient: Imipramine
- Trade name: Tofranil
- Therapeutic dose (mg/day): 150-300
- Method of administration: tablets: 10, 25 and 50 mg.
Active ingredient: Trimipramine maleate
- Trade name: Surmontil
- Therapeutic dose (mg/day): 150-300
- Form of administration: capsules: 25, 50 and 100 mg.
Active ingredient: Nortriptyline
- Trade name: Aventyl, Pamelor
- Therapeutic dose (mg/day): 50-150
- Form of administration: capsules: 10, 25, 50 and 75 mg. or oral solution: 10mg/5ml.
Active ingredient: Imipramine pamoate
- Trade name: Tofranil-PM
- Therapeutic dose (mg/day): 150-300
- Form of administration: capsules: 75, 100, 125 and 150 mg.
Active ingredient: Protriptyline
- Trade name: Vivactil
- Therapeutic dose (mg/day): 15-60
- Form of administration: tablets: 5 and 10 mg.
Side effects of tricyclic antidepressants
TCAs, today, are considered second or third choice drugs due to the difficulty in adjusting the time interval in which said medication is administered and determining the dose that should be given, as well as its toxicity implications. Furthermore, although tricyclic antidepressants generally have a lower price than other antidepressants, their benefit-cost ratio is not as good, because more consultations tend to be necessary during treatment with said drug, more tests tend to be performed. laboratory than normal and a greater intoxication due to overdose and a higher rate of discontinuation of its administration is estimated due to the side effects it generates.
The administration of ADT can entail various side effects that can be grouped into four broad categories: anticholinergic, cardiovascular, central nervous system and others. The side effects of tricyclic antidepressants are as follows:
1. Anticholinergic side effects
- dry mouth
- Constipation
- Delayed onset of urination
- esophageal reflux
- Confusion
- Difficulties with visual accommodation
2. Cardiovascular side effects
- Orthostatic hypotension
- Palpitations
- Hypertension
3. Side effects on the central nervous system
- Shaking
- Sedation
- Activation
- Myoclonic contractions
- Seizures
- Extrapyramidal symptoms
4. Other side effects
The most frequent being drowsiness, dry mouth, constipation and difficulty accommodating vision. Notably alcohol consumption is contraindicated due to the strong potentiation of the drug that it entails.
In order to prevent side effects, it is very important to administer it slowly and progressively. Additionally, some of the side effects may be alleviated by reducing the administered dose.
Overdosage of tricyclic antidepressants
In an overdose of ADT the person may present mental confusion, delusions and loss of consciousness. Furthermore, overdose of these drugs can cause death, due to a reduction in heart rate and arrhythmias that can put the person’s life in danger.
Discontinuation of treatment of tricyclic antidepressants
To properly withdraw the drug or reduce its dose prudently, it should be done in a staggered manner, reducing 25 or 50 mg every 2 or 3 days, to avoid rebound symptoms of anticholinergic side effects that may occur if it is withdrawn abruptly. . The most common symptoms in abrupt withdrawal of tricyclic antidepressants are the following:
- Nausea and vomiting
- Gastrointestinal symptoms and stomach upset
- Colic
- Sweating
- Headache
- Pain in the neck
For all these reasons, it is very important not to commit .
This article is merely informative, at Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.
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Bibliography
- Faith Bravo, M. (2002). Psychopharmacology for psychologists. Madrid: Synthesis.
- Schatzberg, A., Cole, J & DeBattista, C. (2005). Manual of clinical psychopharmacology. Barcelona: ArsMedica.
- Stahl, S. (2002). Essential psychopharmacology: neuroscientific bases and clinical applications. Barcelona: Ariel Neuroscience.