Cadabam's Blog

Tricyclic antidepressants such as amitriptyline, desipramine, and doxepin, may harm your heart, according to a new study conducted by researchers at University College London (UCL). This risk may extend beyond individuals who are being treated for depression, as these older antidepressants are also used to treat anxiety, sleep problems, headache, and back pain, among other conditions.
Although tricyclic antidepressants are one of the oldest classes of antidepressants, they are still used extensively, according to eMedExpert. Today, selective serotonin reuptake inhibitors (SSRIs) have replaced tricyclics as the treatment of choice for depressive disorders, primarily because patients tolerate them better and they are safer if taken in excess.
Researchers at University College London compared the use of tricyclic antidepressants with SSRIs or no antidepressant use in nearly 15,000 individuals in Scotland. Overall, the older antidepressants were linked with a 35 percent increased risk of cardiovascular disease, while use of SSRIs was not.
Based on these findings, Dr. Mark Hamer, senior research fellow in the Department of Epidemiology and Public Health at UCL remarked that they “suggest that there is an association between the use of tricyclic antidepressants and an increased risk of CVD that is not explained by existing mental illness.” The study results thus indicate that tricyclics have properties that are responsible for the greater risk.
Previous research has shown tricyclic use to be associated with a significantly higher rate of serious cardiovascular side effects, such as increased heart rate, as well as arrhythmias, blood pressure abnormalities, and congestive heart failure. They have also been linked with weight gain and diabetes, which are risk factors for cardiovascular disease.
The UCL study’s authors note that other factors may be involved in the possible link between tricyclic antidepressant use and cardiovascular disease. Hamer pointed out that individuals who take antidepressants are more likely to be overweight, smoke, and not get sufficient exercise, also risk factors for cardiovascular disease.
Before it can be determined with more certainty that tricyclic antidepressants can harm the heart, “there needs to be more research looking closely at the effects of these drugs on your heart,” notes Amy Thompson, senior cardiac nurse at the British Heart Foundation. Because antidepressants help a great many people, “it would be unwise for anyone taking them to stop based on the results of this study alone.”

Depressive disorders come in many different types, but each type has its own unique symptoms and treatments.
Major depression, the most common type of a depressive disorder, is characterized by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime. Mental health professionals use this checklist of specific symptoms to determine whether major depression exists or not. Depression is also rated by your diagnosing physician or mental health professional in terms of its severity — mild, moderate, or severe. Severe depression is the most serious type.
A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.
Another type of depressive disorder is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

Symptoms of Depression
Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.
DEPRESSION
• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being “slowed down”
• Difficulty concentrating, remembering, or making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
Symptoms of Mania (for Bipolar Disorder)
MANIA
• Abnormal or excessive elation
• Unusual irritability
• Decreased need for sleep
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased sexual desire
• Markedly increased energy
• Poor judgment
• Inappropriate social behavior

Depression is a very real and serious problem for both children and teens.
Research has shown that childhood depression often persists, recurs and continues into adulthood, especially if it goes untreated. The presence of childhood depression also tends to be a predictor of more severe illnesses in adulthood.
A child with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die. Older children may sulk, get into trouble at school, be negative and irritable, and feel misunderstood. Because these signs may be viewed as normal mood swings typical of children as they move through developmental stages, it may be difficult to accurately diagnose a young person with depression.
Before puberty, boys and girls are equally likely to develop depressive disorders. By age 15, however, girls are twice as likely as boys to have experienced a major depressive episode.
Depression in adolescence comes at a time of great personal change–when boys and girls are forming an identity distinct from their parents, grappling with gender issues and emerging sexuality, and making decisions for the first time in their lives. Depression in adolescence frequently co–occurs with other disorders such as anxiety, disruptive behavior, eating disorders or substance abuse. It can also lead to increased risk for suicide.
One research study of 439 adolescents with major depression found that a combination of medication and psychotherapy was the most effective treatment option. Researchers are developing and testing ways to prevent suicide in children and adolescents, including early diagnosis and treatment, and a better understanding of suicidal thinking.

Many people may leave the TV on at night or some sort of dim light thinking it is harmless. A new study
on hamsters is saying that it is possible that this kind of exposure to a dim light at night could create changes in the brain that lead to mental health concerns such as depression.
“People might want to try to avoid falling asleep with their TVs on all night,” said Tracy Bedrosian, a doctoral student in neuroscience at Ohio State University. “They might want to try to minimize light exposure during the night,”
Bedrosian and colleagues placed hamsters in two different settings that involved light. In one setting hamsters were exposed to 16 hours of daylight and eight hours of complete darkness each day. In the other, the animals experienced 16 hours of daylight, but at nighttime, a dim light was kept on, about the intensity of a TV screen lighting up a dark room.
What the researchers discovered was that after eight weeks the researchers would evaluated behaviors that would suggest they were depressed. For example, they looked to see whether the hamsters still engaged in activities they normally enjoy, such as drinking sugar water.
Hamsters in both groups were given a choice between drinking tap water or sugar water. The hamsters exposed to light at night drank similar amounts of tap and sugar water — they’d lost their preference for the sweet treat.
“That suggests to us that they are not getting the same pleasurable and rewarding feeling from drinking their sugar water, and that it may be interpreted as a depression-like response,” Bedrosian said.
The hamsters exposed to night light had a reduced number of so-called dendritic spines on the surface of cells in this region. Dendritic spines are hair-like protrusions that brain cells use to communicate with one another.
The findings agree with studies on humans that have found the hippocampus to be involved in depression. A patient with major depression has a smaller hippocampus, Bedrosian said.
The brain changes in the hamsters might arise from fluctuations in the production of the hormone melatonin, Bedrosian said. Melatonin signals to the body that it’s nighttime, but a light at night dampens its production. The hormone has been shown to have some antidepressant effects, and so a decrease in melatonin might spur depression symptoms, Bedrosian said.
This study adds to previous findings connecting exposure to light during sleep and depressive behavior. One study found that mice exposed to bright lights at night tend to become depressed and to gain weight.