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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