#Dibenzazepine

[harkener]

Tricylic Antidepressants (TCAs)

TCAs act primarily as SNRIs (serotonin-norepinephrine reuptake inhibitors) by blocking the serotonin transporter SERT and the norepinephrine transporter NET.

They have been largely replaced by newer antidepressants such as SSRIs, SNRIs and and NRIs (norepinephrine reuptake inhibitors), but they are an option for treatment-resistant depression.

Please consult a doctor about starting tricylics if other antidepressants haven't worked for you.

Protriptyline / brand name Vivactil

• Secondary amine TCA, treats depression and ADHD (attention-deficit hyperactivity disorder)

• Energizing rather than sedating, unique among TCAs. Sometimes used for narcolepsy to promote wakefulness.

• Also reduces the incidence of recurring headaches/migraine and other types of chronic pain.

• Comes in 5 and 10mg tablets

• Ranges from 15 to 40mg a day, 60mg for severe depression

• May increase heart rate and stress on the heart

• Half life of 70 to 80 hours

Clomipramine / brand name Anafranil

• Tertiary amine TCA

• Helps with OCD, panic, depression and chronic pain

• Can be sedating

• Beta blocker, lowers blood pressure

• Made from imipramine, see next.

Imipramine / brand name Tonafranil

• Possible better alternative to clomipramine if sedation is an issue

• Prototypical TCA, the first to be marketed

• Dibenzazepine-derivative

• Less sedative and anticholinergic (inhibiting parasympathetic nerve impulses) effects than the tertiary amine TCAs, amitriptyline and clomipramine

• Reduce depression and anxiety. Also treats bedwetting.

• Works by increasing levels of serotonin and norepinephrine and by blocking certain serotonin, adrenergic, histamine and cholinergic receptors.

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