Tricyclic antidepressants cognitive effects

The older tricyclic antidepressants and monoamine oxidase inhibitors also cause withdrawal mania and a variety of other adverse withdrawal effects, including cognitive and emotional disturbances and psychosis. Many of them have strong anticholinergic effects and therefore produce severe anticholinergic rebound on withdrawal, including cardiovascular and gastrointestinal symptoms. I have seen patients who have taken tricyclics for many years and then been unable to withdraw from them. 

Because of the concern expressed about the use of tricyclic antidepressants in elderly people, MAO inhibitors have been studied in this population (39). Patients with dementia benefited in mood (but not cognition), and some non-demented patients also improved. Adverse effects were considered less frequent or troublesome than those due to tricyclic compounds, although one patient taking tranylcypromine became paranoid and... 

Antidepressants do not appear to elevate mood in healthy volunteers (see Chapter 10), but neither, as we have seen, is there good evidence that they do so in depressed patients. Although reports of effects of SSRIs suggest that effects on sleep may sometimes differ between patients and volunteers (Mayers Baldwin 2005), in general side effects of antidepressants in patient trials are consistent with those found in healthy volunteers. For example, tricyclics show sedation and cognitive impairment (Deptula Pomara 1990 Herrmann McDonald 1978), while SSRIs show gastrointestinal upset and drowsiness in both patients and volunteers (Dumont et al. 2005). 

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