Tricyclic antidepressants history

Ciraulo DA, Jaffe JH Tricyclic antidepressants in the treatment of depression associated with alcoholism. Clin Psychopharmacol 1 146—150, 1981 Ciraulo DA, Nace E Benzodiazepine treatment of anxiety or insomnia in substance abuse patients. Am J Addict 9 276—284, 2000 Ciraulo DA, Barnhill JG, Jaffe JH, et al Intravenous pharmacokinetics of 2-hydroxy-imipramine in alcoholics and normal controls. J StudAlcohol 51 366-372, 1990 Ciraulo DA, Knapp CM, LoCastro J, et al A benzodiazepine mood effect scale reliability and validity determined for alcohol-dependent subjects and adults with a parental history of alcoholism. Am J Drug Alcohol Abuse 27 339—347, 2001 Collins MA Tetrahydropapaveroline in Parkinson s disease and alcoholism a look back in honor of Merton Sandler. Neurotoxicology 25 117-120, 2004 COMBINE Study Research Group Testing combined pharmacotherapies and behavioral interventions in alcohol dependence rationale and methods. Alcohol Clin Exp Res 27 1107-1122, 2003a... 

Nortriptyline. Nortriptyhne, a tricychc antidepressant, has been shown in double-blind, placebo-controlled randomized trials to be superior to placebo for smoking cessation (Prochazka et al. 1998). Nortriptyline appears to have efficacy comparable to that of bupropion for smoking cessation (Hall et al. 2002). The efficacy of this agent may be improved with more intensive behavioral therapies (Hall et al. 1998). Nortriptyline s mechanism of action is thought to relate to its noradrenergic and serotonergic reuptake blockade, because these two neurotransmitters have been implicated in the neurobiology of nicotine dependence. Side effects of nortiptyline are typical of tricyclic antidepressants and include dry mouth, blurred vision, constipation, and orthostatic hypotension. Nortriptyline appears to have some utility for smokers with a past history of major depression, and it can be recommended as a second-... 

Use caution in patients with a recent history of Ml or unstable heart disease. Bupropion was well tolerated in depressed patients who had previously developed orthostatic hypotension while receiving tricyclic antidepressants and was generally well tolerated in depressed patients with stable CHF. Bupropion was associated P.784... 

It is one of the ironies of Mike s long history with medications that only the very first drug he took gave him sustained relief At that time the drugs most commonly prescribed for depression belonged to a class known as tricyclic antidepressants, one of the earliest of which was... 

Contraindications Concomitant use of MAOls, history of myelosuppression, hypersensitivity to tricyclic antidepressants... 

Higherincidenceof seizures than with tricyclic antidepressants, especially in those with no previous history of seizures. 

This case report (Figures 6-4Ato 6-4C) (McDermut et al. 1995) of selective response to dihydropyridine CCBs but not a phenylalkylamine CCB is of considerable interest in relationship to the patient s history of nonre-sponsivity to multiple tricyclic antidepressants, the selective serotonin reuptake inhibitors, lithium, carbamazepine (the patient developed drug-induced hepatitis on carbamazepine and was unable to be evaluated), alprazolam, trazodone, and phenelzine. This suggests that patients with refractory mood disorders may have differential responses to various CCBs and that nonresponse to one CCB does not preclude response to another CCB, particularly if the other CCB is from a different category (Table 6-3). 

Assessment of physical, as well as psychiatric status, is also critically important. The presence of intercurrent medical disorders, as well as any medication used to manage them, increases the likelihood of an adverse outcome with an otherwise appropriate medication. With a recent history of myocardial infarction, certain tricyclic antidepressants (TCAs) or low-potency antipsychotics might be contraindicated due to potential adverse effects on cardiac function. Another example is the avoidance of carbamazepine in a bipolar patient with a persistently low white blood cell count. Finally, b-blockers are typically contraindicated in a patient with asthma. 

Even in the short clinical trials for the NDA, Prozac caused mania in slightly more than 1% of patients (Kapit, 1986c). But material that I turned up in the NDA indicates that Prozac poses a considerably greater danger of causing mania than the tricyclic antidepressants (Kapit, 1986c). In studies used for FDA approval, only 0.3% of patients on tricyclics became manic—a rate one-third that of Prozac. In addition, all the patients who became manic on tricyclics turned out to have a prior history of mania. Among the 33 reported cases of mania on Prozac, 23 occurred in patients who had never been manic before. 

Yohimbine can cause hypertension in patients taking tricyclic antidepressants. A drug history should include the use of herbal remedies before conventional treatments are prescribed. 

In a retrospective chart review of 167 patients with a variety of anxiety disorders, excluding patients with evidence of current or previous mood disorder, manic episodes were recorded in five patients, a rate of 3% (20). While this might suggest a clear effect of SSRIs to induce mania, two of the patients were taking clomipramine, a tricyclic antidepressant, albeit a potent serotonin reuptake inhibitor. In addition, all the affected patients had additional diagnoses of histrionic or borderline personality disorder, known to be associated with mood instability. It is still therefore plausible that SSRIs cause mania only in patients with an underlying predisposition, although this may be more subtle than a personal or family history of bipolar illness. 

Adverse effects include constipation, dry mouth and insonmia which occur in > 10% of users. Less commonly, nausea, tachycardia, palpitations, raised blood pressure, anxiety, sweating and altered taste may occur. Blood pressure should be monitored closely throughout its use (twice weekly in the first 3 months). Contraindications include severe h3q>er-tension, peripheral occlusive arterial or coronary heart disease, cardiac arrhythmia, prostatic hypertrophy and those with severe hepatic or renal impairment. It should not be used to treat obesity of endocrine origin or those with a history of major eating disorder or psychiatric disease. Concomitant use with tricyclic antidepressants should be avoided (CNS toxicity). 

History of bone marrow depression hypersensitivity to carbamazepine and tricyclic antidepressants concomitant use of monoamine oxidase (MAO) inhibitors. Discontinue MAO inhibitors for 2 14 days before carbamazepine administration. 

Similar caution should be exercised with biogenic amine uptake blockers such as tricyclic antidepressants. Amphetamine is contraindicated in advanced arteriosclerosis symptomatic cardiovascular disease moderate to severe hypertension hyperthyroidism hypersensitivity or idiosyncrasy to the sympathomimetic amines glaucoma agitated states history of drug abuse and during or within 14 days following administration of monoamine oxidase (MAO) inhibitors. 

Toxic Effects of Acute Overdoses Acute poisoning with tricyclic antidepressants or MAO inhibitors is potentially hfe-threatening. Fatalities are much less common since modern antidepressants have widely replaced these drugs however, suicide rates have not declined consistently as clinical usage of modern antidepressants has increased. Deaths have been reported with acute doses of 2 g of imipramine, and severe intoxication can be expected at doses >1 g, or about a week s supply. If a patient is severely depressed, potentially suicidal, impulsive, or has a history of substance abuse, prescribing a relatively safe antidepressant agent with close clinical follow-up is appropriate. If a potentially lethal agent is prescribed, it is best dispensed in small, sublethal quantities, with the risk that sustained adherence to recommended treatment may be compromised. 

CBZ should be used with caution in patients with a history of congestive heart failure or cardiac arrhythmias (because it may aggravate them) and with a history of hematologic reactions to other drugs or hypersensitivity to tricyclic antidepressants. Blood levels should be monitored in patients with renal or hepatic impairment. 

Ginkgo biloba54n positive response in depressed elderly patients with mild-to-moderate cognitive dysfunction and non-response history to therapeutic trials on tricyclic antidepressants additional research ongoing to clarify mechanism, efficacy in depression... 

Opioids (especially methadone and heroin) are the most common cause of serious neonatal drug withdrawal symptoms. Other dmgs for which a withdrawal syndrome has been reported include phencyclidine (POP), cocaine, amphetamines, tricyclic antidepressants, phenothiazines, benzodiazepines, barbiturates, ethanol, clonidine, diphenhydramine, lithium, meprobamate, and theophylline. A careful dmg history from the mother should include illicit drugs, alcohol, and prescription and over-the-counter medications, and whether she is breast-feeding. 

Diagnosis. A noncyclic antidepressant overdose should be suspected in patients with a history of depression who develop lethargy, coma, or seizures. These agents do not generally affeot cardiac conduction, and QRS interval prolongation should suggest a tricyclic antidepressant overdose (see p 90). 

Clonidine should be used with caution in patients with cerebral, or coronary insufficiency, Raynaud s disease or throraboangitis obliterans, or with a history of depression. The hypotensive effect may be antagonised by tricyclic antidepressants, and enhanced by thiazide diuretics. Clonidine cause drowsiness and patients should not drive or operate machinery where loss of attention could be dangerous. The effect of other central nervous system depressants may be enhanced, withdrawal of clonidine therapy should be gradual as sudden discontinuation may cause rebound hypertension which may be severe. Agitation,... 

Exacerbation of depression has been seen in some patients given fenfluramine and several cases of withdrawal depression have been observed in patients taking amitriptyline and fenfluramine, following episodes of severe depression. The manufacturers have advised that fenfluramine should not be used in patients with a history of depression or in those being treated with antidepressants. On the other hand it has also been claimed that fenfluramine can be used safely and effectively with tricyclic antidepressants." One report describes a rise in the plasma levels of amitriptyline when fenfluramine 60 mg daily was given to patients taking amitriptyline 150 mg daily. ... 

---