Tricyclic antidepressants withdrawal from

Desipramine has been used to facilitate withdrawal from chronic PCP use. The rationale is that PCP depletes norepinephrine concentrations in brain, and that this tricyclic antidepressant is the most selective blocker of norepinephrine uptake. Consequently, some of the deficiency of the neurotransmitter could be remedied. A dose of 25 to 50 mg was said to reduce craving for several hours. Six of eight patients treated with this drug were successfully withdrawn, while none of the eight offered other types of programs were successful (45). 

Tricyclic antidepressants also have a documented syndrome associated with withdrawal from medications (Petti and Law, 1981). This syndrome can mimic appendicitis or the flu, and can include such symptoms as nausea and vomiting, headache, lethargy, and abdominal pain. If a child on TCAs presents with withdrawal symptoms, questions of compliance must be addressed. 

Among the many toxicants that cause convulsions are chlorinated hydrocarbons, amphetamines, lead, organophosphates, and strychnine. There are several levels of coma, the term used to describe a lowered level of consciousness. At level 0, the subject may be awakened and will respond to questions. At level 1, withdrawal from painful stimuli is observed and all reflexes function. A subject at level 2 does not withdraw from painful stimuli, although most reflexes still function. Levels 3 and 4 are characterized by the absence of reflexes at level 4, respiratory action is depressed and the cardiovascular system fails. Among the many toxicants that cause coma are narcotic analgesics, alcohols, organophosphates, carbamates, lead, hydrocarbons, hydrogen sulfide, benzodiazepines, tricyclic antidepressants, isoniazid, phenothiazines, and opiates. 

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. 

There is clearly a need for larger controlled studies to determine the incidence and severity of withdrawal effects after withdrawal of tricyclic antidepressants. Based on uncontrolled observations, it has been suggested that the incidence varies from under a quarter to over half of all patients. 

In 190 patients taking tricyclic antidepressants that could not be discontinued before surgery, who underwent general and 61 local or regional anesthesia, there were no changes in the cardiovascular effect of halothane, induction time with pentobarbital, propanidid, or ketamine, or the duration of depolarization or recovery time (160). The general conclusion was that it is safer to continue treatment with tricyclic antidepressants than to risk potential disruption from withdrawal before surgery. 

Tyrer P. Clinical effects of abrupt withdrawal from tricyclic antidepressants and monoamine oxidase inhibitors after long-term treatment. J Affect Disord 1984 6(l) l-7. 

Tricyclic antidepressants reverse the hypotensive effects of postganglionic blocking agents, guanethidine, reser-pine, clonidine, and alpha-methyldopa, and the addition of a tricyclic can result in loss of blood pressure control (159,179). Sudden withdrawal of a tricyclic compound from a patient stabilized with these compounds can also result in serious hypotension. An additional reason for avoiding drugs such as reserpine, methyldopa, and... 

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. 

In addition, withdrawal from certain medications, such as baclofen, clonidine, corticosteroids, or tricyclic antidepressants, may cause manic symptoms. 

Tricyclics modify peripheral sympathetic effects in two ways through blockade of norepinephrine reuptake at neuroeffector junctions and through alpha adrenoceptor blockade. Sedation and atropine-like side effects are common with tricyclics, especially amitriptyline. In contrast to sedative-hypnotics, tricyclics lower the threshold to seizures. The answer is (B). Selective serotonin reuptake inhibitors cause sexual dysfunction in some patients, with changes in libido, erectile dysfunction, and anorgasmia. Tricyclic antidepressants may also decrease libido or prevent ejaculation. Of the heterocyclic antidepressants bupropion is the least likely to affect sexual performance. The drug is also used in withdrawal from nicotine dependence. The answer is (B). 

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. 

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