Anti-Ds- especially Tricyclics Flashcards
Tricyclic anti-ds-
3 ringed structure.
Treating melancholia
first drug Impramine- Roland Kuhn 1956
-first tested ppl with Sz with no effect, later tested on Melancholia. -worked within month, patients responded in days.
-most successful drug after Amitriptyline-
TCAs successful marketing- sponsored distribution of book about detecting depress, still used in modern medicine, have bade side effects.
Stimulant Tricyclics
- Desipramine- similar to psychostims- amphetamine.
- -similar MAOIs- Phenelzine.
Emotion-stabilizing- TCA-
- Clomipramine- effective in OCD, similar effect so SSRIs
- Impramine & Amitriptyline- effect increase Noradrenaline & Serotonin.
Psychological effects (Impramine & Amitriptyline)
-mainly affect phy symps- psycho symps impvoe as consequence of this.
TCAs act mainly on physical “vital” symps
- -occur rapidly in hours/days. -improved sleep/appetite.
- reduced fatigue, painful sens.
- have “tonic” effect- building up patient resources- analgesic effect.
- –unpleasant feelings of depress- TCAs used as painkiller for chronic pain, migraine, nerve pain & terminal cancer.
-mood may take weeks to normalize- grad improve as phy probs helped, mood may lag behind a bit.
Chemical effects TCAs
reuptake inhib Neurotransmitters in synapse.
-reduce removal of NTs= increase concentration.
- 10 years after discovery of TCAs- theory depress effects due reuptake inhibition of noradrenaline.
- -later theory- dop & sero added for reason of effect= AMINE THEORY. -depress due to monoamine imbalance.
Side effects
weight gain, impotence- can’t get hard or orgasm.
- anticholinergic effect- sedation, delirium, dry mouth, constipation.
- toxic to heart- can’t give elderly with sign heart disease or rhythm prob.
- toxic in OD.
- doesn’t work with psychotic depress.
- can trigger manic eps- if give person with BD or Sz.
Today
anti-ds refer SSRIs- Prozac, Fluoxetine.
-chemically related to TCAs but essentially quite diff- don’t work in severe hospital depress.
