What are tricyclic antidepressants?

Depression is an increasingly common mental illness today. There are many different medications to treat depression, and the most common are tricyclic antidepressants. This drug is named for its chemical structure containing three aromatic rings.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition 2013 (DSM-5), depressive illness is classified into many different types, including:
Major depressive disorder Weak: characterized by the patient having one or more depressive episodes, accompanied by at least 5 common major symptoms. At least 1 of 2 symptoms must be present, mainly low mood and loss of most interests or hobbies. The minimum duration of depressive episodes is 2 weeks. At the same time, other factors must be excluded such as history of substance use, abuse (such as alcohol, drugs, drugs) and actual disease (such as traumatic brain injury). Mood disorder: characterized by disease The patient's mood is decreased and there are some symptoms of mild depressive disorder, the abnormal duration must be continuous for at least 2 years. At the same time, there was not any episode lasting more than 2 months in which the patient was free of signs of depression; Substance-induced depression: i.e. the patient must have had one or more depressive episodes but the cause is determined to be due to the use of a substance (such as alcohol, drugs, or anti-inflammatory corticosteroids) Depression due to an underlying medical condition Damage: defined as a patient with at least one depressive episode defined as a result of an underlying medical condition (eg, peptic ulcer disease, polyarthritis, hypertension, diabetes). Disconnect the road ...).

Today, tricyclic and 4-cyclic antidepressants are still the most commonly used antidepressants. Among the tricyclic antidepressants currently available, amitriptyline is the drug with good antidepressant efficacy and has economic advantages when it is relatively inexpensive.
Tricyclic antidepressants (TCAs) are effective on both the norepinephrine and serotonin systems. At the same time, other neurotransmitter systems such as acetylcholine, histamine, epinephrine, dopamine, muscarin are also affected, so in addition to the treatment effect of depression, this antidepressant also causes many unwanted effects.
The effectiveness of TCA in treating depression is due to the fact that the drug inhibits serotonin and norepinephrine receptors, the main causes of depression.

Tricyclic antidepressants are used more because they have more benefits than SSRIs, especially in depressed patients with many physical symptoms such as insomnia, anorexia, fatigue, headache , abdominal pain, joint pain...
The effect of tricyclic antidepressants usually appears late, after about 2-4 weeks of using the drug. Therefore, in the period of waiting for the drug to take effect, the patient must not change the dosage as well as the way to use this antidepressant.
Besides, doctors should guide patients about drug-related information so that patients can cooperate better in the treatment of depression.

In addition to blocking norepinephrine and serotonin receptors, tricyclic antidepressants also inhibit many other chemical mediators, so they cause many undesirable effects such as:
Dry mouth feeling, constipation, visual disturbances, Difficulty urinating, cognitive disorders in the elderly Lower blood pressure orthostatic position causes dizziness, nausea, this is an undesirable effect causing very uncomfortable feeling and difficult for patients to adapt. Cardiovascular toxicity due to tricyclic antidepressants inhibiting the acetylcholine, noradrenaline and adrenalin systems. Signs suggestive of myocardial toxicity are electrocardiogram prolongation of the PQ segment, low amplitude QT and T waves, skin allergy, swelling Sedation causing drowsiness, decreased cognitive ability, mania, decreased contraction threshold Seizures in epilepsy Weight gain Decreased sex drive in women, decreased erection ability and delayed ejaculation in men.

4.1. Amitriptyline Antidepressant Amitriptyline has a strong sedative effect, calms nerves, reduces anxiety, so it is indicated for depressed patients with anxiety or psychomotor agitation.
In addition, tricyclic antidepressants can cause drowsiness, so they are suitable for treating depression with severe insomnia. Some cases should not use Amitriptylin:
Elderly patients, people with a history of cardiovascular diseases or men with prostate enlargement This depression drug is toxic to the heart muscle, so it is contraindicated for patients with suicidal ideation and behavior due to the patient's ability to accumulate drugs to commit suicide Amitriptyline drug greatly affects the sexual function of the patient. The dose of the tricyclic antidepressant Amitriptyline is 75-200 mg/day. The average dose is 100 mg/day, divided into 2 oral doses.
Amitriptylin is available in 25mg oral dosage form. For outpatient depression treatment, it is recommended to start the treatment at the weekend to limit the side effects of the drug affecting work.

4.2. Clomipramine This is a tricyclic antidepressant that acts primarily on serotonin. Therefore, in addition to treating depression, Clomipramine is also very effective in the treatment of obsessive disorders. The antidepressant and obsessive effects of clomipramine appear more rapidly and better than that of other tricyclic antidepressants and SSRIs.
Undesirable effects of this depression drug are on the stomach and intestines (such as nausea, vomiting, bloating, indigestion...) and patients usually adapt after 1-2 weeks of using the drug.
In addition, another side effect of Clomipramine is affecting the patient's sexual function such as loss or decrease in libido, difficulty in erection, delayed ejaculation ...
When using, the patient should be Gradually increase the dose so that the body can adapt to the drug. The initial dose is usually 25 mg/day, then increased until a therapeutic dose is reached (approximately 50-150 mg/day). Clomipramine has a long half-life, so patients can take it once a day.
Clomipramine is available in 25mg and 75mg tablets.

4.3. Tianeptine This is a tricyclic antidepressant that acts primarily on serotonin. The advantage of this drug is its good tolerability, few side effects, so it can be prescribed for the elderly and patients with real diseases.
The antidepressant Tianeptine has very few side effects related to sexual ability, so it is used as an alternative to other tricyclic antidepressants when patients complain of impaired sexual ability. much.
The biggest minus point of Tianeptine is that the half-life is too short (only 2 hours), so patients have to take the drug at least 3 times a day, causing a lot of inconvenience and increasing the risk of patients not following the time. taking the drug, leading to a decrease in the effectiveness of the treatment.
Depression is a psychological disease, in addition to the use of drugs, the effectiveness of treatment also depends greatly on the ability of the psychologist. Therefore, people with depression need to be examined and treated at reputable addresses, with highly specialized and experienced doctors.