Tricyclic antidepressants are used to treat depression.
Now, it's been around a really long time but they can be effective for certain patients.
Tricyclic antidepressants work by blocking the neuronal reuptake of 2 monoamine transmitters:
norepinephrine and serotonin.
Now, we shorten norepinephrine to NE there
so you'll recognize it as we go through the rest of this presentation.
We've got examples of the names listed there for you that you can --
so you can recognize those in the future.
Again, you've got the brand name in the parenthesis and you've got the generic name outside of it.
Make sure you place emphasis on memorizing the generic names as examples of tricyclic antidepressants.
We use it to treat depression which is why we're talking about the antidepressant section
but here's something that's different for TCAs.
It's very useful for some patients with chronic pain.
So just because a patient's on a TCA, don't assume that it's for depression.
Ask the patient to assess if they know why they're on that medication and work with them
so you get a really complete picture of their plan of care.
That applies for any medication because multiple medications have different clinical applications.
So you wanna assess both if your patient understands why they're taking a medication
and make sure you're clear on that.
That's how you can accurately evaluate the effectiveness of their treatment.
Now, we can also use this as a sedative hypnotic, they're all equally effective,
you just have to pick which one is more tolerable for the patient based on the side effects.
Tricyclic antidepressants have the risk of sedation and particularly with our elderly clients,
there can be problems with confusion so they usually need to have smaller doses
maybe even up to half of the dose.
Now, moving into the cardiovascular system,
they can have problems with orthostatic hypotension or some arrhythmias.
It can be also difficult on the heart. So that's not common.
It's rare but you want to know that it could happen but if I take an elderly client
and they're on this medication, it increases their confusion and their orthostatic hypotension.
I've really put them at an increased risk for falls.
Just like the SSRIs, the TCAs can cause weight gain.
They also have challenges with anticholinergic effects that also came along with the SSRIs.
Now, urinary retention can also be a problem with this medication
so it's -- along with that anticholinergic effect theme, this may good --
be a good idea to take it at bedtime when the urinary retention shouldn't be as big a problem.