If you or someone you know has depression, your doctor may have prescribed you various medications. Although new medications are often used these days, sometimes you have to use older, but very important medications. There are people who get results from these. Today we are going to talk about one such, somewhat old, but indispensable class of medications, the tricyclic and tetracyclic antidepressants.
What are these tricyclic and tetracyclic antidepressants?
Simply put, these are some of the first drugs to be discovered to treat depression. They have been used since the 1950s. The difference between these two names is their chemical structure. Tricyclics have three rings (tri = three) in their chemical structure, while tetracyclics have four rings (tetra = four). But they both work in the body in the same way.
Doctors don't recommend these medications as much these days. This is because newer medications like SSRIs (Selective Serotonin Reuptake Inhibitors) have come along that have fewer side effects. But, imagine that you've tried more than one new medication and it hasn't worked. In that case, your doctor might give you a try on one of these older medications.
How do these medications affect the brain?
There are special chemicals in our brain that control mood. We call these neurotransmitters. Serotonin and norepinephrine are two of the main neurotransmitters. The levels of these can be low in the brain of someone with depression.
Tricyclic antidepressants (TCAs) work by increasing the levels of serotonin and norepinephrine in the brain. However, because these drugs also affect other neurotransmitters, they have a higher risk of side effects than newer drugs like SSRIs. Also, overdose is very dangerous.
| Commonly used tricyclic antidepressants (TCAs) |
|---|
| Amitriptyline |
| Amoxapine |
| Clomipramine |
| Desipramine |
| Doxepin |
| Imipramine |
| Nortriptyline |
| Protriptyline |
| Trimipramine |
What are the side effects of this medication?
As we discussed earlier, these medications have a lot of side effects. That's why many people don't want to use them. But not everyone gets all of these side effects.
The most important thing is to talk to your doctor about any side effects you experience. Don't stop taking the medication suddenly.
Here are some of the common side effects:
- Drowsiness
- Blurred vision
- Constipation
- Dry mouth
- A drop in blood pressure when you stand up suddenly from a standing position (this can cause you to feel dizzy)
- Irregular or rapid heartbeat
- Confusion in the elderly, especially if high doses are taken
- Incomplete urination (Urine retention)
- Increased appetite and therefore weight gain
- Sweating
- Tremor
- Sexual arousal or decreased desire
- People with seizure disorders are at increased risk of seizures .
Amitriptyline, Doxepin, Imipramine, and Trimipramine are generally more likely to cause drowsiness and weight gain. However, Nortriptyline and Desipramine have fewer side effects than the others.
Other medical conditions and TCA medications
If you have any of the following medical conditions, you should definitely tell your doctor before taking this medication.
- Glaucoma
- Enlarged prostate
- Heart disease
- Diabetes
- Liver diseases
- If the mesentery has been formed before
Also, if you are pregnant or hoping to become pregnant, be sure to talk to your doctor.
Overdose and its risks
This is the most important thing we need to be careful about with these medications. Even a small overdose of TCAs can be very dangerous to life. Therefore, doctors are often reluctant to give these medications to someone who is having suicidal thoughts. Even if they do, they give them in very small doses, like once a week.
| Symptoms of a TCA Overdose | |
|---|---|
| Heartbeat irregularities | Low blood pressure (Hypotension) |
| Excessive dryness of the mouth | Inability to urinate |
| Slow breathing | Tremors and seizures |
| Coma | |
Attention: If you suspect that someone has taken too much of this medicine, it is a medical emergency. Call 1990 Ambulance Service without delay, or take the person to the nearest hospital Emergency Department (ETU) immediately. Also, if possible, call the National Poisons Information Centre at the Colombo National Hospital for advice. When going to the hospital, do not forget to mention the name of the medicine the person has taken.
Is it dangerous to stop taking the medicine suddenly?
Yes, absolutely. Whether you feel better or the side effects are bothersome, do not stop taking this medication suddenly without consulting your doctor. Doing so can cause you to experience withdrawal symptoms.
This is not because you are addicted to the drug. This medication is not addictive. But, your body and brain are used to that chemical, so when it is suddenly gone, it takes time for the body to adjust.
Symptoms that may occur when the medication is stopped
- Irritability, irritability
- Nausea
- Sweating
- Body aches, feeling feverish
- Insomnia
- Lifeless body
- Headache
Therefore, if you need to stop taking the medication, you should do so by gradually reducing the dosage, following your doctor's instructions .
Take-Home Message
- Tricyclic antidepressants (TCAs) are an older class of medications for depression, but they are very helpful for some people.
- These have a slightly higher risk of side effects than newer medications. Talk to your doctor about this openly.
- If you have other medical conditions (such as heart disease, glaucoma), be sure to inform your doctor before taking this medication.
- Never stop taking this medication suddenly without consulting your doctor. Doing so may cause discomfort to your body.
- Overdose is very dangerous. It is a medical emergency. If you suspect such a thing, go to a hospital immediately.
- Take care of your mental health. Talk to your doctor if you have any concerns.
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