STRUGGLING with DEPRESSION, ANXIETY, or BIPOLARITY? LEARNING can really HELP. Start with ARTICLES above or Topics below. Ty! Bill

Antidepressants: The Need-to-Know Series

A reader emailed me recently wanting an opinion regarding Paxil for his anxiety. And that got me to thinkin’…

Antidepressants are so common that traces of them have been found in our drinking water. There are so many of them, and they’re being prescribed for a multitude of disorders and conditions.

I believe there are millions like my email buddy – people who simply don’t know much about antidepressants. So chipur is going to fill in some blanks with a series on antidepressants. I’m thinking it’ll be three-parts, but let’s see how things go.

Important Points Going-In

  • I am not a physician. If you’re considering any of the meds discussed in the series, do your research. Being educated before chatting with your physician is crucial.
  • If you’re thinking about an antidepressant for an emotional/mental situation, please understand that meds plus therapy bring the best outcomes.
  • Antidepressants have side effects, and some can be troubling.
  • You’re asking for trouble if you suddenly stop taking an antidepressant. The unpleasant results aren’t true withdrawal symptoms, rather a discontinuation syndrome. Here’s a link to the first in a series of two chipur articles on antidepressant discontinuation syndrome.

Some Interesting History

The antidepressant saga began with the synthesis of chlorpromazine by a French pharmaceutical company in 1950. In 1955, chlorpromazine (Thorazine) became a widely used antipsychotic.

The discovery of antidepressants was actually an accident. Researchers at a Swiss asylum began working with a derivative of chlorpromazine for the treatment of schizophrenia. As it turned out, the drug induced mania; which obviously wasn’t a match for schizophrenics.

But the researchers were wise enough to connect some dots. Here was a sedative med that produced euphoria. So testing with depressed patients ensued and the results were excellent. Voila! The first antidepressant had been discovered.

That drug was the tricyclic antidepressant, imipramine (Tofranil). And, go figure, it was the first med I took for panic disorder and generalized anxiety disorder in 1989.

Tricyclic Antidepressants

The tricyclic antidepressants (TCAs) are so named because of their chemical structure – three rings of atoms. Though largely replaced by the modern neurotransmitter reuptake inhibitors, due to better side effects profiles, they’re still widely used.

Some of the better known TCAs are – amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), doxepin (Sinequan), and nortriptyline (Pamelor)

How Do They Work?

TCAs are primarily serotonin and norepinephrine reuptake inhibitors.

What’s a Reuptake Inhibitor?

Very simply, neurons (nerve cells) send messages to each other. The electrical jump from one neuron to another is called a synapse. Neurotransmitters are chemicals that facilitate a synapse. They’re secreted by the originating cell and taken in by the receiving cell. After a time, the originating cell reabsorbs the neurotransmitter. This is known as reuptake.

But sometimes reuptake happens too quickly, which can impair the electrical signal from one neuron to another. Well, a serotonin/norepinephrine reuptake inhibitor would impair the reuptake of the neurotransmitters serotonin and norepinephrine. Both are factors in the mood and anxiety disorders.

Why Would I Take a TCA?

First and foremost, TCAs are antidepressants; so they’re used in the treatment of depression. And that can include bipolar depression. These days, TCAs are typically prescribed for treatment resistant presentations.

Within the realm of the emotional/mental health disorders, the TCAs are also used in the treatment of the anxiety disorders, body dysmorphic disorder, eating disorders, the personality disorders, and more.

They’re also used to treat situations such as chronic pain, neuropathic pain, fibromyalgia, migraine headache, irritable bowel syndrome (my daughter uses amitriptyline for IBS), and bedwetting.

Any Side Effects?

Yep. Common side effects include – dry mouth, constipation, drowsiness, urinary retention, restlessness, dizziness, appetite and weight change, sexual dysfunction, and nausea. Often, these symptoms disappear with continued use; and they’re frequently minimized by starting on a low dose with a gradual increase.

Any Other Concerns?

The TCAs may ramp-up one’s response to alcohol and other drugs – prescribed and recreational. A TCA overdose can be especially dangerous. One of the reasons is it may take several hours for symptoms to present.

Tetracyclic Antidepressants (TeCAs)

Since the tetracyclic antidepressants are so closely related to the TCAs, we’re not going to go into much detail. Oh, remember how the TCAs got their name from a three atom chemical structure? Well the TeCAs up the ante to four.

Common TeCAs are mirtazapine (Remeron) and amoxapine (Asendin).

Well, that’s a wrap on part one. Come on back tomorrow and we’ll discuss the monoamine oxidase inhibitors (MAOIs), and begin our review of the selective serotonin reuptake inhibitors (SSRIs).

FYI – you may find visiting the FDA’s Information for Consumers website helpful. Here’s the link.

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  • dduke

    I have been on pristiq, a very low dose acutually and for a while, nothing! The I woke one day earlier than normal ( I used to just wanna sleep all day)and felt pretty good. After awhil I was back to normal, didn’t cars, wanted to sleep feeling whats the point in gettin on with the day. Well I informed my phychiatrist about this and of the losss of my libido.
    She then asked if I were willing to try something new in the market called viibrid and the way I was feeling ( I amost canceled my appt. that day) I was willingbto try aything at this point. She handed me two months supply and had me take half a Pristiq along with a 10mg of viibrid. After the tens, I stopped using the Pristiq and stated with the 20 mg. I a currently taking 40 mg fornabot a week and a half. I have noticed erection each morning and the want for sex. But most importantly, I am gettting out of bed at normal times feeling I want to andbnot thinking about why should I likeI used to.
    So I guess in conclusion I wouldnhave to say, so far, so good as my mark being for viibrid……but like Bill White says…..thats just how itbworked so far for me. It ma be different for others. Good luck all, and God bless!

    • Thanks dduke for your visit and participation. Man, I say it time and again. Wouldn’t it be great if there was a measure of consistency when it comes to the impact of psychotropic medications? It’s all too often a crap-shoot, isn’t it? Hey! Glad Viibryd is working well for you. Bill

  • Magda

    I’ve been trying for years to get on Anafranil with no luck. I would like to be on a medication that is used for OCD since part of my problem is the “Pure O” factor. For some reason the powers that be will not listen to me and give them a try. The powers that be threw first generation antipsychotics at me and gave me some horrible EPS for a few hours and that’s where it stands today. Would you say that TCAs or MAOIs work any better for obsession than a combo of SSRIs and antipsychotics? I guess it’s all just a roll of the dice. However, a huge part of my problem is uncontrollable rumination. I know this is just spitting in the breeze however because no one is going to give MAOIs or TCAs a chance with me. No one listens to me. They just assume that they know best– despite the fact that I have to live with this and not them. It’s funny how once you are diagnosed some professionals take all your choices away because you are considered “crazy”. I’ve literally spent sessions arguing with a certain
    “doctor” until our voices were raised. The good old doc sent me to another member of the staff who reprimanded me and told me that the doctor “only wanted the best for me” and the doc himself compared the dangers of first generation antipsychotics to Tylenol. Yeah, that fits! Because Tylenol gives me EPS, right? *groan* I know that MAOIs are often the last option because of the dietary restrictions. Perhaps nothing will work for me.

    • As you know, Megan, I know your psychiatrist “circumstances,” Yes, unfortunately there isn’t much this guy is going to creatively do for you – and that’s a shame. I am always very cautious when it comes to using an atypical antipsychotic as an augmenting agent for an antidepressant. Yes, I suppose in some cases it’s indicated; however, that’s a very fine line. It’s very difficult to offer an opinion regarding which meds work best for any given disorder – it is, indeed, such “a roll of the dice.” When it comes to psychotropics, things can so drastically change from person to person. I will say this, though – my research indicates – in general – the SSRIs work best for “Pure O.” ‘Course, therapy wouldn’t hurt either. Don’t give up, Megan. And please feel free to blow steam here anytime.


  • Megan

    Oops! I broke the internet!