Tofranil depression

Antidepressants. In the early 1980s, the recognition that depression is a frequent comorbid feature of BN coupled with the observation that appetite changes are a common feature of depression led researchers to evaluate antidepressant treatment for BN. Since that time, a series of controlled studies have demonstrated efficacy for a wide assortment of antidepressants including the TCAs imipramine (Tofranil) and desipramine (Norpramin), the MAOl phenelzine (Nardil), the SSRl fluoxetine (Prozac), and the atypical antidepressants trazodone (Desyrel) and bupropion (Wellbutrin). Overall, approximately two-thirds of antidepressant-treated patients with bulimia experience symptomatic improvement while nearly one-third achieves complete remission of binging and purging. In addition, the improvement in the symptoms of BN is not dependent on the presence of comorbid depression. 

Tricyclic Antidepressants (TCAs). The TCAs have been nsed to treat ADHD for 30 or more years. Most often used are imipramine (Tofranil) and desipramine (Norpramin), mainly becanse they are the TCAs that most specihcally increase norepinephrine activity. Remember, boosting norepinephrine activity in the brain shonld improve attention. Other TCAs, namely, amitriptyline (Elavil, Endep) and nortriptyline (Pamelor), have been used, though they also increase norepinephrine activity. TCAs do offer a modest benefit for both the inattention and the hyperactivity of ADHD. In addition, they are often effective at doses mnch lower than those required to treat depression. However, their effectiveness nsnally falls short of the stimulant medications. In addition, TCAs have considerable side effects including dry mouth, constipation, drowsiness, weight gain, and adverse cardiac effects. 

Tricyclic Antidepressants (TCAs). TCAs were introduced in the 1950s and over the years have become the mainstay of treatment for cataplexy and the other REM-related symptoms. The doses used are usually less than the doses required in the treatment of depression. Imipramine (Tofranil) is the most widely used TCA for narcolepsy and is usually effective at doses from 10 to 75 mg given once a day. Some doctors prefer the TCA protriptyline (Vivactil) because it has mild stimulant effects, but it has not been as widely used or as thoroughly studied in narcolepsy. The common side effects of TCAs are drowsiness, dry mouth, and constipation, but these are usually not a problem at the lower doses used for narcolepsy. Patients should receive a baseline electrocardiograph (EKG) before starting a TCA and should have blood levels of the medication checked periodically. 

Imipramine is the primary representative of typical tricyclic antidepressants. It acts by blocking the mechanism of renptake of biogenic amines. It does not inhibit MAO activity. Imipramine lessens sadness, lethargy, improves mood, and improves the mental and overall tone of the body. It is nsed in depression of varions etiology accompanied by motor cinmsiness and ennresis in children and Parkinson s disease. Primary synonyms of this drag are tofranil, snrplix, imizin, melipramin, and others. 

Imipramine (Tofranil) [Antidepressant/TCA] WARNING Close observation for suicidal thinking or unusual changes in behavior Uses Depres-sion, enuresis, panic attack, chronic pain Action TCA t CNS synaptic serotonin or norepinephrine Dose Adults. Hospitalized Initial 100 mg/24 h PO in doses T over several wk 300 mg/d max Output Maint 50-150 mg PO hs, 300 mg/24 h max Peds. Antidepressant 1.5-5 mg/kg/24 h daUy-qid Enuresis >6 y 10-25 mg PO qhs T by 10-25 mg at 1-2-wk int vals (max 50 mg for 6-12 y, 75 mg for >12 y) Rx for 2-3 mo, then tap Caution [D, /-] Contra Use w/ MAOIs, NAG, acute recovery from MI, PRG, CHF, angina, CVD, arrhythmias Disp Tabs, caps SE CV Sxs, dizziness, xerostomia, discolored urine Interactions t Effects W/ amiodarone, anticholinergics, BBs, cimetidine, diltiazem, Li, OCPs, quinidine, phenothiazines, ritonavir, verapamil, EtOH, evening primrose oil t effects OF CNS depressants, hypoglycemics, warfarin T risk of serotonin synd W/MAOIs 4-... 

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. 

Shortly after iproniazid was shown to have antidepressant properties, imipramine was introduced as the first tricyclic antidepressant. These drugs received the name tricyclic because their structure contains three molecular rings. At first, imipramine was investigated as a possible treatment for the psychotic episodes associated with schizophrenia, a severe mental disorder that causes hallucinations and delusions, because it was chemically similar to another effective anti-schizophrenia drug. Imipramine did not reduce the severity of psychotic episodes, but it did elevate the mood of the patients who took it. In the late 1950s, it was released in the United States under the name Tofranil for the treatment of depression. 

Angst J A clinical analysis of the effects of Tofranil in depression. Psychopharma-cologia 2 381-407, 1961... 

The industry also helped to disseminate and reinforce the view that the new drugs were disease-specific treatments. Advertisements for antidepressants in the British Medical Journal and the American Journal of Psychiatry stress their specificity. Illustration 4.1 shows an early advertisement for Tofranil (imipramine), for example, asserting that it is a "specific" treatment for depression. 

Sim M, Armitage GH, Davies WH, Gordon EB. The treatment of depressive states a comparative trial of dibenzepin (Noveril) with imipramine (Tofranil). Clin Trial J 1971 1 29. 

Antidepressants Pharmaceutical drugs prescribed for the treatment of persistent and severe depression. Imipramine (Tofranil), amitriptyline (Elavil), and fluoxetine (Prozac) are examples. 

Fortunately, most patients will not experience all of these side effects. Each type of TCA acts somewhat differently on different people, depending on lifestyle, genetic makeup, and the kind of depression that is being treated. Each TCA also has slightly varying actions, too. For instance, a number of clinical studies report that over 60 percent of patients taking Tofranil (imipramine), a TCA that has a dual action on norepinephrine and serotonin, experience two or more... 

Elavil amitripyline tricyclic antidepressant depression same as Tofranil but less frequent... 

Tofranil imipramine tricyclic antidepressant ADHD, eating disorders, enuresis, depression sedation, dry mouth, changes in blood pressure, constipation... 

Imipramine (brand name Tofranil) Often referred to as the grandfather of all antidepressants. It is the oldest tricyclic antidepressant available and has traditionally been used for the treatment of depression and for those who have panic attacks. It is sometimes used now to assist with withdrawal from cocaine addiction and in obsessive-compulsive disorder. 

The dibenzapine derivatives are called tricyclic antidepressants and include imipramine (Tofranil), desipramine (Norpramin), amitriptyline (Elavil), nortriptyline (Aventyl), protriptyline (Vivactil), and doxepin (Adapin). Amitriptyline is indicated in depression major depression with melancholia or psychotic symptoms depressive phase of bipolar disorder depression associated with organic disease, alcoholism, schizophrenia, or mental retardation anorexia or bulimia associated with depression (see Figure 20). 

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). 

The client with major depressive disorder is suicidal. The client was prescribed the tricyclic antidepressant imipramine (Tofranil) 3 weeks ago. Which priority intervention should the nurse implement ... 

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