Your depression and anxiety were getting the best of you, so the doc recommended an antidepressant. You’re more than willing to think it over. Problem is, you don’t know the first thing about them. Let’s see what we can do about that…

If you’re thinking about an antidepressant for an emotional/mental situation, please understand that meds plus therapy bring the best outcome.

Antidepressants are so common that traces of them have been found in our drinking water. Still, millions of people don’t know much about them. So, it’s time to fill in some blanks.

I’m thinking we’ll need four parts to take care of business.

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 doc is crucial.
  • If you’re thinking about an antidepressant for an emotional/mental situation, please understand that meds plus therapy bring the best outcome.
  • Antidepressants have side effects, and some can be troubling.
  • Suddenly stopping an antidepressant isn’t a good idea. The unpleasant results aren’t true withdrawal symptoms, rather a discontinuation syndrome.
  • The FDA has ordered that all antidepressants carry a Black Box Warning indicating that they are associated with an increased risk of suicidal thinking, feeling, and behavior in children and adolescents. A warning is also given for an increased risk of suicidal symptoms in young adults, ages 18-24.
  • Alcohol, drug, and supplement interaction is always a concern. Chat with your physician regarding the meds or supplements you’re taking or considering, as well as your alcohol intake.

Antidepressant history

The antidepressant saga began with the synthesis of chlorpromazine (Thorazine) by a French pharmaceutical company in 1950. In 1955, chlorpromazine 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 patients with schizophrenia.

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 with agoraphobia in 1989.

Speaking of the tricyclics…

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 effect profiles, they’re still widely used.

Some of the better known TCAs: 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 impede 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, and bedwetting.

Any side effects?

Yep. Common side effects: 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.

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

Since the tetracyclic antidepressants (TeCAs) 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.

Better known TeCAs: mirtazapine (Remeron) and amoxapine (Asendin).

‘Til next time

Well, that’s a wrap on part one. Be sure to check-out part two. We’ll be discussing the monoamine oxidase inhibitors (MAOIs).

FYI: you may find visiting the FDA’s Information for Consumers and Patients site helpful.

And you’ll find the hundreds of Chipur articles helpful as well.

Bill White is not a physician and is providing the contents of this article for information purposes only, not to serve as a recommendation. Contact your physician with questions and for advice. 

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