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Tricyclic Antidepression Drugs: Are they safe?

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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.”

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How do Tricyclic Antidepressants and SSRIs Work?

Antidepressants are a class of drugs that work on the neurotransmitters in the brain to correct their chemical imbalances and thus reduce the symptoms of depressive disorders.

Neurotransmitters are essential communication links between the nerve cells in the brain. They reside within the vesicles found in nerve cells and transmit signals from one nerve cell to another target nerve cell, muscle cell or gland cell.

When the neurotransmitters are not taken up by other nerves, they are taken back by the same nerves, and the process is called ‘reuptake’. Serotonin, dopamine, and norepinephrine (also goes by the name of noradrenaline) are the prevalent neurotransmitters in the brain associated with depression.

Antidepressants or anti-depression drugs, in general, target a specific neurotransmitter and inhibit their reuptake causing their levels to rise up around the nerves within the brain. The selective serotonin reuptake inhibitor or SSRI antidepressant drug, for example, affect the serotonin levels in the brain.

The serotonin is one of the several chemicals involved in the transmission of messages between the brain cells. It is commonly known as the ‘feel-good chemical’ as it causes a relaxed state of well-being.

Generally, serotonin circulates in the brain before being absorbed into the bloodstream. SSRIs help to prevent the absorption of serotonin in the blood due to which a higher level of serotonin is maintained in the brain. Low levels of serotonin are linked with depression, and conversely, increased levels of the chemical can help relieve depression.

One thing to note here is that SSRIs don’t make the body produce more serotonin. They only help the body to utilize it more effectively without causing major side effects. Hence, SSRIs are probably the best drugs for depression and anxiety treatment.

Some examples of tricyclic antidepressant medications are amitriptyline (Elavil), desipramine (Norpramin), nortriptyline (Pamelor), amoxapine, protriptyline (Vivactil), clomipramine (Anafranil), doxepin (Sinequan), imipramine (Tofranil), trimipramine (Surmontil).

Examples of selective serotonin reuptake inhibitors for depression treatment are citalopram (Celexa), fluvoxamine (Luvox), paroxetine (Paxil), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), sertraline (Zoloft).

SSRI Safety

SSRIs are generally prescribed by doctors before any other depression medication because they come with fewer side effects. Although there are certain side effects involved with the use of SSRIs, people can hardly cause any damage to themselves by taking an SSRI. However, it is advisable to exercise some caution while taking SSRIs, especially by children and pregnant women.

In pregnant women, SSRIs may increase the chances of heart and lung problems and certain birth defects. But leaving depression untreated can also have a negative impact on pregnancy as well. So, doctors and pregnant women need to compare the risks of taking SSRI treatment to the risks of untreated depression.

To reduce the risks, pregnant women can go for different SSRI to treat their depression. For instance, Paroxetine (Paxil) is associated with heart defects, brain disorders and breathing problems in new-borns. So, doctors recommend switching to fluoxetine (Prozac) or citalopram (Celexa) during pregnancy as they are known to produce no serious side effects.

Do we somewhere need to give a disclaimer that these are just suggestsions and educative in nature. They have to visit their doctor/ psychiatrist for advice and has to be under supervision. For this and for the others too where we have given explanation about specific drugs and effect on neurotransmittter.

Get Help

Depression is treatable and seeking help can ensure a better quality of life. It’s never too late for recovery, reach out to Cadabam’s Rehab @ +91 96111 94949.

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1. What is a tricyclic antidepressant?

A tricyclic antidepressant (TCA) is a class of antidepressant medications used to treat various mood disorders, such as depression, anxiety, and certain chronic pain conditions. TCAs work by increasing the levels of neurotransmitters like serotonin and norepinephrine in the brain, which can help improve mood. They are an older class of antidepressants and are generally considered less preferred due to their potential for more side effects.

2. Is amitriptyline an SSRI?

Amitriptyline is not an SSRI (Selective Serotonin Reuptake Inhibitor). It is a tricyclic antidepressant.

3. Who should not take tricyclic antidepressants?

Tricyclic antidepressants are generally not recommended for individuals with certain medical conditions or risk factors, including those with a history of heart problems, glaucoma, urinary retention, and those taking monoamine oxidase inhibitors (MAOIs).

4. Which is safer: SSRI or trycyclic antidepressants?

Generally, SSRIs (Selective Serotonin Reuptake Inhibitors) are considered safer than tricyclic antidepressants (TCAs). SSRIs have a lower risk of side effects, reduced potential for overdose, and are better tolerated. TCAs have a higher risk of side effects, particularly cardiac and anticholinergic effects, and can be more dangerous in overdose. 

5. What is a risk factor for trycyclic antidepressants?

A risk factor associated with tricyclic antidepressants (TCAs) is their potential to cause bone marrow suppression. This can lead to a reduction in blood cell production, resulting in anemia, leukopenia (low white blood cell count), and thrombocytopenia (low platelet count). Monitoring blood cell counts is essential during TCA therapy, as this rare side effect can be severe.

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