The Meds...Part 2. Tricyclic Antidepressants | Episode 196

We talked last time about monoamine oxidase inhibitors. That was really kind of the first situational depression, anxiety drug that was used for other things (which was a good thing). We keep an open mind if we realize that sometimes drugs can be used for reasons not necessarily considered their first line intention, but overall have a real application to other, almost unexpected positive outcomes. 

We saw that with gabapentin originally, which was used for a seizure disorder. It was found to be really good with other types of pain disorders.

Tricyclic Antidepressants

So entered tricyclic antidepressants in the 60’s and 70’s era, it was discovered in the 40s, but really the tricyclics eventually the tetracyclics, of the 70s, came along to help with mixed depressive disorder, or tough problems that you have with situational depression and anxiety that just can't be managed conservatively with diet, exercise and that sort of thing. It's got to take an extra move.

Well as a desirable side effect, not all side effects are bad, was that it helped with pain. It also helped with sleep. It helped a great deal with sleep, muscle pain, and fibromyalgia type pain. It was a really good drug that had a use that seemed to be with fewer side effects than MAOI inhibitors. I'm not sure if that's correct, but many people felt that the 50s psychopharmacology boom was in its natural progression. And we see that with the next class of drug. Selective serotonin reuptake inhibitors and norepinephrine reuptake inhibitors and mixed agents. This is a really good drug. It is used as not only an antidepressant with a very narrow therapeutic window (in other words, you have to get the dose just right). But it's also used sometimes as an antipsychotic. It's used for sleep. Some of its analogues are used for seizures. Carbamazepine 65 was introduced there, and it's even been used in schizophrenia.

But the point is, this is a really good drug that has its place. If used correctly, it helps with fibromyalgia. Neuropathic pain, and can help with chronic pain syndrome. I guess it's been applied to dementia. I haven't really seen any help there. That's not saying it doesn't work, it’s a clinical problem. You have to talk it over with the qualified healthcare professional. I'm sure it's one of the options in the armamentarium. 

Tricyclic Antidepressant Side Effects

Now, the side effects are many, as most drugs have side effects with headache, nausea, vomiting. This one has dry mouth, dry eyes. It’s an anticholinergic side effect, a topic for another day. It has to do with the serotonin reuptake problems, that’s also a topic for another day. But the point is, there are side effects. 

If you take too much of this, you can get delirium, you can get muscle problems, and one called rhabdomyolysis, where the muscle kind of burns and hurts the kidneys and the like, and it can even cause cardiac conduction problems. Now, that is a huge risk factor that has to be discussed with the primary care or other qualified health professional. If you have any inkling toward question marks there, please bring that up. You should never abruptly stop this drug. You can get withdrawal symptoms. 

How do Tricyclic Antidepressants work? 

They work on a sodium and potassium channel, on the NMDA or N-methyl-D-aspartate receptor as an antagonist. Its use there is going to be helpful with the neuropathic pain. NMDA antagonists are helpful in pain disorders, the tough non-opioid, or opioid resistant problems. This drug has a very important clinical application. 

It can be used alone, it can be used in combination with other agents, it can be used alone or with other agents for depression, pain, sleep, a number of issues. It's an important drug. The important thing is to keep an open mind, but keep the questions coming. If you have any questions about this drug or have side effects, those should not be ignored, they should be documented on a piece of paper, I don't care if it's a Post-It note, either call your healthcare provider, or call the  appropriate phone number.

Keep Your Medications Put Away

This brings an important thing up. I think anybody that takes medication should have the hotline available. Let's face it, anything can happen. I've had my dogs eat medicines that I wasn't sure what to do, but that's one thing, but let's say it's a toddler, that's another thing. You know anytime medicines are around, keep them put away. Especially these potent medications. Protect them and also protect yourself. 

That's a pretty good start with tricyclic antidepressants. It's an older medication, but that doesn't mean it doesn't work and it it's not useful. Age of a drug doesn't matter. 

Tongue-in-cheek, as in the last podcast I talked about the “TV dinner” era it's a way to remember. This is kind of the JFK era, these tricyclic drugs. It led into the 70s and we were finding new uses all the time. Eventually it was not necessarily replaced, but either used as an adjunct, a co-med option, or else something that an SSRI or SNRI reuptake inhibitor serotonin drug eventually found to be there. It's not necessarily going to replace it, but it might be a good one plus one equals three drug, or adjunct. It should be considered. It should not be abruptly discontinued, like I said, even if you've taken it for pain or low-dose sleep or something. Don't abruptly discontinue this drug without talking to somebody.

I think that's a pretty good start with tricyclic antidepressants . We will go into SSRIs and SNRIs with the next podcast, but I think that these medications deserve a standalone podcast because they're so important. 

MAOIs, TCAs or tricyclic antidepressants, and the serotonin drugs are important to improve function and quality of life, restorative sleep capacity and just to have a better way.

Exercise and Brain Derived Neurotrophic Factor (BDNF)

I think that there's nothing like hearing from an individual that they got up and they felt good. They just felt good and like they wanted to get up and get moving. I say get moving because we do know that exercise and activity increases Brain Derived Neurotrophic Factor (BDNF). BDNF does increase those mood chemicals in the brain, those neurotransmitters and neurochemicals, and increases the drugs that we find so useful by a synergistic effect.