Depression trimipramine

Trimipramine is a tricyclic antidepressant with sedative properties that is used in the management of depression. As with other tricyclic antidepressants, trimipramine has antimuscarinic activity and therefore side-effects include dry mouth, blurred vision, constipation and urinary retention. 

As with imipramine, it is used for depression of various etiology. In terms of efficacy, it is analogous to imipramine. Surmontil is a synonym of trimipramine. 

Seven TCA drugs are available in the United States for treatment of major depression. They are generally categorized as tertiary or secondary amines. Tertiary amines include imipramine (Tofranil), amitriptyline (Elavil), trimipramine (Surmontil), and doxepin (5m-equan). Desipramine (Norpramin), nortriptyline (Pam-elor), and protriptyline (Vivactil) are secondary amines. 

Ware JC Increased deep sleep after trazodone use a double-blind placebo-controlled study in healthy young adults. J Clin Psychiatry 519 (suppl) 18-22, 1990 Ware JC, Brown FW, Morad PJ, et al Effects on sleep a double blind study comparing trimipramine to imipramine in depressed insomniac patients. Sleep 12 537-549, 1989... 

Rickels K, Gordon PE, Weiss CC, et al. Amitriptyline and trimipramine in neurotic depressed patients a collaborative study. Am J Psychiatry 1970 127 208-218. 

Pecknold JC, Luthe L (1989) Trimipramine, anxiety, depression and sleep. Drugs 38 (Suppl 1) 25-31 discussion 49-50... 

Trimipramine is contraindicated in patients with known hypersensitivity to tricyclic antidepressants, trazodone, and related compounds in the acute recovery phase of myocardial infarction (MI), because the drug depresses cardiac function and causes dysrhythmia in patients in coma or severe respiratory depression (additive CNS and respiratory depression) and during or within 14 days of therapy with monoamine oxidase inhibitors. 

Overdosage with trimipramine causes CNS stimulation followed by CNS depression. The first 12 hours after acute ingestion are a stimulatory phase characterized by excessive anticholinergic activity (agitation, irritation, confusion, hallucinations, parkinsonian symptoms, seizure, urinary retention, dry mucous membranes, pupillary dilatation, constipation, and ileus). This is followed by CNS depressant effects, including hypothermia, decreased or absent reflexes, sedation, hypotension, cyanosis, and cardiac irregularities (including tachycardia, conduction disturbances, and quinidine-like effects on the ECG). 

Antidepressants with sedation as a side effect often are used to treat insomnia. The antidepressants most frequently associated with sedation as a side effect are the tricyclics (amitryptyline, imipramine, nortriptyline, trimipramine, doxepin, amoxapine, and protriptyline), nontricyclics (maprotiline and mirtazepine), trazodone, and nefazodone (55), which are discussed in greater detail in Chapter 21. Of these drugs, trazodone, doxepin, and mirtazepine have been shown to be effective in the treatment of insomnia in patients with depression (1). The effectiveness of these drugs to treat insomnia in nondepressed patients, however, has not been proven. The mechanism by which this occurs is unknown, but most of these drugs have some activity as H2 antagonists that may contribute to the effect (56). 

Tricyclics are the most commonly prescribed drag to treat major depression. Tricyclics include clomipramine HCl (Anafranil), desipramine HCl (Norpramin, Pertofrane), doxepin HCl (Sinequan), imipramine HCl (Tofranil), NortriptyMne HCl (Aventyl), Protriptyline HCl (Vivactil), and trimipramine maleate (Surmontil). 

In contrast, there are a number of other uncontrolled studies and reviews describing the beneficial use of an MAOI with a tricyclic antidepressant. In addition, one study has reported switching 178 patients from tricyclics to MAOIs within 4 days or less. Of these patients, 63 were given the MAOI while still being tapered from the tricyclic, all without any apparent problems. Nevertheless, in a 6-week randomised doubleblind trial, the combinations of phenelzine or isocarboxazid plus trimi-pramine were less effective than trimipramine alone in patients with mild to moderate depression. Similarly, in a smaller randomised open study, the combination of amitriptyline and tranylcypromine was no more effective than either drug alone. ... 

Young JPR, Lader MH, Hughes WC. Controll trial of trimipramine, monoamine oxidase inhibitors, and combined treatment in depressed outpatients. BMJ ( 979) 2,1315-17. 

A depressed woman taking trimipramine 125 mg daily developed high plasma levels of 546 micrograms/L while taking diltiazem 60 mg three times daily. Two weeks later they reached 708 micrograms/L, despite a reduction in the trimipramine dosage to 75 mg daily. She showed no toxicity and her ECG was normal. ... 

A 25-year-old woman taking venlafaxine 150 mg daily and trimipramine 50 mg daily for depression developed seizures within 11 days of the trimipramine dose being increased to 100 mg daily. Both drugs were stopped and the patient had no further seizures. ... 

Hemmeter U, Annen B, Bischof R, Bruderlin U, Hatzinger M, Rose U, Holsboer-Trachsler E (2001) Polysomnographic effects of adjuvant Ginkgo biloba therapy in patients with major depression medicated with trimipramine. Pharmacopsychiatry 34(2) 50-59. doi 10.1055/s-2001-15182... 

Tricyclic antidepressants (TCAs) Clomipramine Doxepin Imipramine Lofepramine Nortriptyline Trimipramine (Amitriptyline, Dosulepin) Nocte See BNF See BNF See BNF For depression clomipramine used in OCD Liquids and tablets available Very toxic in overdose (amitriptyline and dosulepin no longer recommended for depression due to OD risk) Caution in CVD and many physical conditions Tolerance to side effects may develop Anticholinergic side effects ... 

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