Tricyclic Antidepressants
In an earlier 15-Minute Pharmacology lecture about depressive disorders, I mention that an older medication class - tricyclic antidepressants - seem to perform better than modern medications for people with the melancholic type of depression.
The superiority of tricyclics has been shown in several studies. The first of these studies came from Danish University Antidepressant Group, who showed that tricyclic antidepressants outperformed the modern SSRI-type medications citalopram or paroxetine. Additional work by Akhondzadeh et al.; Roose et al.; and Joyce et al. support these findings. (Full citation information for each of these studies appears at the end of this post).
These medications do have their drawbacks, however. They are more likely to cause side effects, and they can be fatal in overdose. For these reasons, some clinicians have never prescribed them.
On the other hand, the tricyclic antidepressants can help people whose depression has not responded to other approaches. So in this lecture, we will discuss the tricyclic antidepressant medications, focusing on their mechanisms of action, specific indications, dosing, therapeutic drug monitoring, and side effect profile.
This talk was presented at the April 21, 2020 meeting of the SZconsult learning community.
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Danish University Antidepressant Group. Citalopram: clinical effect profile in comparison with clomipramine: a controlled multi-center study. Psychopharmacology. 1986;90:131-138.
Danish University Antidepressant Group. Paroxetine: a selective serotonin reuptake inhibitor showing better tolerance, but weaker antidepressant effect than clomipramine in a controlled multicenter study. J Affect Disord. 1990;18:289-299.
Akhondzadeh S, Faraji H, Sadeghi M, Afkham K. Double blind treatment of fluoxetine and nortriptyline in the treatment of moderate to severe major depression. J Clin Pharm Therapeut. 2003;28:379-384.
Roose SP, Glassman AH, Attia E, Woodring S. Comparative efficacy of selective serotonin reuptake inhibitors and tricyclics in the treatment of melancholia. Am J Psychiatry. 1994;151:1735-1739.
Joyce PR, Mulder RT, Luty SE, et al. A differential response to nortriptyline and fluoxetine in melancholic depression: the importance of age and gender. Acta Psychiatr Scand. 2003;108:20-23.
Tricyclic Antidepressants
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