Non sedating tricyclic antidepressants

Tricyclic antidepressants are available only with a physician's prescription and are sold in tablet, capsule, liquid, and injectable forms.Some commonly used tricyclic antidepressants are amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil).

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TCAs may also cause problematic adverse effects especially in the elderly.

In this article we point out that TCAs are still valuable in the management of depression and neuropathic pain.

Like other antidepressant drugs, they reduce symptoms such as extreme sadness, hopelessness, and lack of energy.

Some tricyclic antidepressants are also used to treat bulimia, cocaine withdrawal, panic disorder, obsessive-compulsive disorders, certain types of chronic pain, and bed-wetting in children.

Table 1: Comparison of Adverse Effects of TCAs From; Drug Information Handbook, 11th Ed. American Pharmaceutical Association *Clomipraminehas significant serotonergic properties and is usually reserved for specific indications such as Obsessive Compulsive Disorder. ** Restricted to Hospital Pharmacy Specialist TCAs have numerous clinically significant drug interactions.

Some of these involve additive effects when co-prescribed with sedatives, hypnotics and drugs with hypotensive and anticholinergic properties.

Different drugs in this family have different effects, and physicians can choose the drug that best fits the patient's symptoms.

For example, a physician might prescribe Elavil for a person with depression who has trouble sleeping, because this drug is more likely to make people feel calm and sleepy.

Although amitriptyline may be preferred if sedative effects are specifically required, nortriptyline will often give the desired hypnotic effect with less risk of undesirable effects, if given at night time.

TCAs are effective agents for the treatment of various types of neuropathic pain and are usually considered first-line agents.

TCA withdrawal has resulted in cardiac arrhythmias in some patients and seems to be more severe and more common in children.

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