January 26, 2023

Next family vana antidepressants are the tricyclics anat try cyclic antidepressants or ki cas and these are listed for you here these are really second even third line and a depressant for reasons which we’ll talk about probably the more common ones that we see east or north tripta lean and amitriptyline they’ve been around a long time but they’ve really been replaced

By ssris and snris these drugs are listed here in the in the tan color as you can see their activity is really on the serotonin reuptake and/or norepinephrine reuptake and dopamine reuptake well not so much dopamine but serotonin and norepinephrine so they are in a sense ssris and snris however if you go to the right on the chart you see their their affinities for

Histamine alpha one and muscarinic are also relatively high compared to the ssris and snris so this is where you get into their their side effect profile their tolerability profile and the reason why t cas are really have fallen out of favor it’s another cartoon it just illustrates you know the reuptake inhibition of serotonin norepinephrine and that again it’s

Just i want to emphasize that the tricyclics antidepressants exert their effect on depression just like ssris and snris through inhibition of their reuptake of serotonin and norepinephrine the problem with these are numerous they have anticholinergic side effect so patients that take these can experience anticholinergic side effects like dry mouth constipation

Urinary retention some are worse than others the havana has dominica fex which can cause sedation delirium and older patients increased appetite and weight gain they also have some cardiovascular side effects through their alpha 1 receptor activity that can cause tachycardia and arrhythmias also induce seizures they’re absorbed well they have extensive protein

Binding it’s a little bit about their pharmacokinetics amitriptyline is metabolized to nortriptyline so that’s something to be aware of if there’s issues with liver you want to be aware that they may tripoli may not be getting metabolized to its active form nor tripling is a tricyclic antidepressant that we can actually do some clinical monitoring on if we need

To there is a therapeutic range i’m not going to ask you to remember to know it but just to be aware that if we if clinically we have to go this route and we want to use a tricyclic antidepressant we can use nortriptyline and and use lab measurements to kind of find the right or fine-tune a dose i just wanted you to be aware of that particular one no other anta

Precint really offers that ability but nortriptyline is unique safety is a real issue with tricyclic antidepressants if ten times a daily dose can be fatal it can cause death through cardiac arrhythmias seizures or cns depression comparatively so the point i want to emphasize with this is if a patient takes a tricyclic antidepressant home they get a month’s worth

And they do to their depression they make a suicide attempt and they they take their bottle of pills if their bottle of pills happens to be a tricyclic antidepressant they’ll probably die conversely if they get a prescription filled for an ssri take a whole month home feel suicidal make an attempt take their whole bottle of ssri they’ll probably have no more than

A bellyache so the safety factor is huge in the favor of these newer ssris lots of drug interactions with tricyclic antidepressants we’ll talk about what monoamine oxidase inhibitors are in just a minute but there’s all kinds of interactions you can have with over-the-counter kind of products like antihistamines they’re just very messy we want to avoid them if if

Possible and just be careful if we have to use them with other medications they are metabolized to the 2d6 sip system so we want to be careful there there’s some interaction with barbeque rats and carbamazepine through the 3a4 enzyme system and as well nicotine which is metabolized through the sip 1a2 enzyme system can have an effect on in particular tricyclic

Antidepressants that are metabolized to the one a to a lot of people with depression smoke i don’t think it’s clinically relevant but if there’s problems with a drug not working that might be a reason or a place to sort of investigate

Transcribed from video
Bupropion By Todd Brackins