Hormonal Tricyclic antidepressants

Levodopa or dopamine agonists produce diverse dyskinesias as a dose-related phenomenon in patients with Parkinson s disease dose reduction reverses them. Chorea may also develop in patients receiving phenytoin, carbamazepine, amphetamines, lithium, and oral contraceptives, and it resolves with discontinuance of the offending medication. Dystonia has resulted from administration of dopaminergic agents, lithium, serotonin reuptake inhibitors, carbamazepine, and metoclopramide and postural tremor from theophylline, caffeine, lithium, valproic acid, thyroid hormone, tricyclic antidepressants, and isoproterenol. 

ACE-I, angiotensin-converting enzyme inhibitor ADH, antidiuretic hormone (or vasopressin) ARB, angiotensin II receptor blocker, MESNA, sodium 2-mercaptoethanesulfonate TCA, tricyclic antidepressant Ul, urinary incontinence SUI, stress urinary incontinence UUI, urge urinary incontinence. 

Drugs that may be affected by estrogens include oral anticoagulants, tricyclic antidepressants, hydantoins, corticosteroids, and thyroid hormones. 

Steiger A, Holsboer F, Benkert O Long-term studies on the effect of tricyclic antidepressants and selective MAO-A-inhibitors on sleep, nocturnal penile tumescence and hormonal secretion in normal controls, in Sleep 86. Edited by Koella WP. Stuttgart, Fischer Verlag, 1988, pp 335-337... 

Tricyclic antidepressants increase the release of endogenous antidiuretic hormone and can therefore potentiate the... 

It has since been assumed that this is the therapeutic action of tricyclic antidepressants, which are sometimes referred to as monoamine reuptake inhibitors or MARIs. However the exact significance of this reuptake process is unknown, especially as the tricyclic antidepressants have numerous other actions and influence, directly or indirectly, almost all neurotransmitters, many neuropeptides and most hormones (Khan 1999). Further studies of reuptake by heart muscle preparations showed that chlorpromazine was a stronger reuptake inhibitor than imipramine and not all the tricyclic antidepressants had this action (Lahti Maickel 1971). In addition, it has not been possible to demonstrate that reuptake inhibition is actually correlated with increased availability or activity of noradrenalin or serotonin. In fact most evidence suggests that tricyclic drugs reduce levels of noradrenalin (Frazer Mendels 1977 Heydorn, Frazer, Mendels 1980 Schildkraut, Winokur, Applegate 1970). 

Tricyclic antidepressants increase the release of endogenous antidiuretic hormone and can therefore potentiate the antidiuretic effect of desmopressin. A hyponatremic convulsion occurred in a child who was given desmopressin and imipramine (171). 

There have been other reports of hyponatremia with SSRIs (38,39). Hyponatremia is probably more common with SSRIs than with tricyclic antidepressants and predominantly but not exclusively affects older patients. Most reports involve fluoxetine, but this might represent greater patient exposure. All SSRIs and venlafaxine can produce this adverse effect (SEDA-23,21 SEDA-25,14). According to published reports, the median time to the onset of hyponatremia is 13 days (range 3-120) and the presentation is of inappropriate secretion of antidiuretic hormone (38). Symptoms, such as lethargy and confusion, can be non-specific, so awareness of the possibility of SSRI-induced hyponatremia, particularly in elderly people, is needed. 

Interactions. Morphine (also pethidine and possibly other opioids) is potentiated by monoamine oxidase inhibitors. Any central nervous system depressant (including alcohol) will have additive effects. Patients recently exposed to neuromuscular blocking agents (unless this is adequately reversed, e.g. by neostigmine) are particularly at risk from the respiratory depressant effects of morphine. The effect of diuretic drugs may be reduced by release of antidiuretic hormone by morphine. Useful interactions include the potientating effect on pain relief of tricyclic antidepressants and of dexamfetamine. 

Antidepressants selective serotonin reuptake inhibitors, tricyclic antidepressants Antihypertensives felodipine Antibiotics quinolones, isoniazid Bronchodilators albuterol, theophylline Corticosteroids prednisone Dopa agonists levodopa Herbals ma huang, ginseng, ephedra Nonsteroidal anti-inflammatory drugs ibuprofen Stimulants amphetamines, methylphenidate, caffeine, cocaine Sympathomimetics pseudoephedrine Thyroid hormones levothyroxine Toxicity anticholinergics, antihistamines, digoxin Withdrawal alcohol, sedatives... 

Gonadotropin-releasing hormone analogs Benzodiazepines Tricyclic antidepressants Monoamine oxidase inhibitors Hz-Receptor antagonists Opioids Other Verapamil... 

Monoamine oxidase inhibitors Phencyclidine Tricyclic antidepressants Increased metabolic rate Dinitrophenol and pentachlorophenol Salicylates Thyroid hormone... 

The speed and efficacy of imipreunine in the treatment of depression were enhanced by the addition of thyroid hormone. 26 This combination was effective in patients who became resistant to the tricyclic antidepressives.27 increasing... 

A preliminary clinical paper reported that high doses of L-tryptophan produced an antidepressive response similar to that elicited by imipramine.48 imipramine caused a decrease in the rate of disappearance of norepinephrine from the rat brain after a single intraperitoneal dose, but not after long-term administration by this route. This result may explain the delayed onset of action of the tricyclic antidepressives, and suggests that thyroid hormone or pharmacological agents that increase the turnover of norepinephrine in the brain, if... 

The antidepressant response to imipramine, amitriptyline and possibly other tricyclics can be accelerated by the use of thyroid hormones. However, isolated cases of paroxysmal atrial tachycardia, thyrotoxicosis and hypothyroidism have occurred on concurrent use. 

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