Nature of Tricyclic Drugs

These antidepressant drugs are named tricyclic due to their chemical architecture. They were older class of antidepressants and were the preferred drug choice till new class of drugs are developed and released. Tricyclic antidepressants (TCAs) are a category of antidepressants that give relief from the symptoms of depressive disorders, such as sadness and irritability, etc. Tricyclic drugs are antidepressants which are administered in the treatment of major depression. It can also be used for dysthymia.

Certain brain substances known as neurotransmitters are associated with symptoms of depression. These neurotransmitters are serotonin, norepinephrine, and dopamine. These help in flow of communication between nerve cells. In depressed people, the levels of these chemicals will be affected and they are in reduced quantities than normal. Studies show that extreme alterations in levels of neurotransmitter activity can bring mood changes. Antidepressants help in increasing the levels of these chemicals. The user will get relief from depressive symptoms. TCAs restrain re-absorption of these chemicals from the system and help maintain required balance.

The Tricyclic Drugs

TCA medications include tertiary amines such as amitriptyline, trimipramine, Imipramine, clomipramine, doxepin, and metabolized secondary amines such as desipramine, nortriptyline, protriptyline, etc. These categories of anti-depressants are more commonly and safely used medications, compared to benzodiazepines, phenothiazines, barbiturates, etc., drugs. Many of these drugs inhibit re-absorption of serotonin and norepinephrine in the nervous system. These increased levels will help in increased communication among nerve cells, which help in a person returning to normalcy.

But TCAs also cause some trouble while dealing with depressive symptoms in a person. They also affect nerve cell communications in other parts of the brain. The more parts they affect, the more severe the side effects will be. TCAs also affect histamine responses in the body. Increased histamine activity will dislocate normal histamine activity such as cardiac stimulation, gastric secretion, vasodilation, etc., and affect organs such as liver, kidneys, gall bladder, etc. These medications are administered in the cases of panic attacks, phobia, neurosis, inherent depression, etc.

TCA Treatment and Dosage

The physical condition of the patient will be checked before any tricyclics are prescribed. General and routine examinations, such as blood tests, electrocardiogram, etc., will be monitored and a safe TCA will be chosen and given to treat depression. Whatever may be the tricyclic medication, it will be started with small doses, observed for efficacy and side effects, and increased gradually to full dosage levels. Same is the case with duration. The duration will be adjusted with the responsiveness of the ingested medication.

Dosages and types of medications vary depending upon the type of disorder and its severity. Some medications may inhibit only one type of neurotransmitter, while some may block both the neurochemicals. Doses vary widely. The job of a doctor is to see whether a patient’s symptoms call for use of tricyclics at all. Some patients may be allergic to TCAs. If a patient was using, say, MAOI medications and these medications were found to be ineffective, then the doctor would obviously give a reasonable gap before replacing MAOIs with TCAs as the side effects will be very severe.

Enough dosage of tricyclic antidepressants is to be taken as otherwise the patient will become tolerant even before the problem is addressed and higher dosages may be required to treat. Generally, it takes some two to three weeks before TCAS show some effect and may require about six weeks to get full benefit from the medication. But the side effects show almost immediately and body may adjust itself to these effects in the long run. People who suffer from recurrent depression may have to take maintenance dosages for many years or even for life-long duration.

Advice: TCAs interfere and worsen certain physical conditions in a patient. So, before starting YCA medication, the concerned doctor should be made aware of the following problems and habits:

• Schizophrenia
• Seizures or spasms
• Manic depression
• Alcoholism
• Allergies
• Asthma
• Thyroid problems
• Blood disorders
• High blood pressure
• Heart disease
• Liver diseases
• Gastric problems
• Intestinal problems
• Renal and urinary problems
• Prostate enlargement
• Glaucoma
• Contact lenses
• Glaucoma

TCAs and Side-effects

The main side-effects or after-effects of TCAs are mouth dryness, irregular bowel movement, hazy sight, body mass increase, high heart rate, sleepiness, urinary retention, sexual impairment, decreased blood pressure, and giddiness, etc.