Tricyclic Antidepressants (TCAs) – Antidepressants

by Pravin Shukle, MD

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    01:27 where people feel lightheaded when they move from a sitting position to a standing position.

    01:32 You can also have alpha 2 antagonism.

    01:35 They will complain of dizziness and also a reflex tachycardia so their heart rate climbs when they stand up.

    01:41 Now the older drugs have more side effects than newer drugs have fewer side effects.

    01:46 So when you take a look at the drugs on this spectrum here you can see that amitriptyline is the oldest of the drugs first used in the 1960s, and the newer drugs like desipramine have fewer side effects.

    01:58 The norepinephrine uptake inhibition can cause dry mouth, urinary retention, and tremor.

    02:06 The reuptake of serotonin can cause GI disturbances and the antagonism of serotonin can cause nausea.

    02:17 One of the big concerns that I always have with tricyclic antidepressants is that your seizure threshold is reduced so patients are going to have an increase rate of seizure that is also seen in the monoamine oxidase inhibitors.

    02:32 There's an additive effect with alcohol or ethanol.

    02:35 Depressive patients are at high risk for ethanol abuse so TCAs become particularly problematic in those group of patients.

    02:44 The other issue that we have to be very aware of with TCAs is that they may antagonize methyldopa and clonidine, so patients who are taking these drugs, methyldopa or clonidine, whether it's for blood pressure or for postmenopausal symptoms can have a significant interaction between the two sets of drugs.

    03:03 Now there are three Cs of TCA toxicity -- coma, convulsions, and cardio toxicity.

    03:12 So if you remember these about the TCAs, the three Cs are very, very important.

    About the Lecture

    The lecture Tricyclic Antidepressants (TCAs) – Antidepressants by Pravin Shukle, MD is from the course CNS - Pharmacology.

    Included Quiz Questions

    1. Lower seizure threshold
    2. Insignificant first-pass metabolism
    3. Low volume of distribution
    4. Low side effect profile
    5. Significantly dialyzable
    1. Alpha-2 antagonist: hypertension
    2. Histamine antagonist: sedation, drowsiness, weight gain
    3. Serotonin agonist: nausea
    4. Alpha-1 antagonist: priapism
    5. Acetylcholine antagonist: blurred vision, dry mouth, constipation

    Author of lecture Tricyclic Antidepressants (TCAs) – Antidepressants

     Pravin Shukle, MD

    Pravin Shukle, MD

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