Tricyclic antidepressants and tetracyclic antidepressants
Tricyclic antidepressants and tetracyclic antidepressantsTricyclic and tetracyclic antidepressants were among the earliest antidepressants developed. They're effective, but have generally been replaced by antidepressants that cause fewer side effects. Other antidepressants are prescribed more often, but these antidepressants are still a good option for some people. In certain cases, they relieve depression when other treatments have failed. How tricyclic and tetracyclic antidepressants workTricyclic and tetracyclic antidepressants, also called cyclic antidepressants, ease depression by affecting chemical messengers in the brain (neurotransmitters). These naturally occurring brain chemicals are used to communicate between brain cells. Most antidepressants work by changing the levels of one or more neurotransmitters. Cyclic antidepressants block the absorption (reuptake) of the neurotransmitters serotonin (ser-oh-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin), making more of these chemicals available in the brain. This seems to help brain cells send and receive messages, which in turn boosts mood. These antidepressants also affect other chemical messengers, which can lead to a number of side effects. Cyclic antidepressants approved to treat depressionTricyclic and tetracyclic antidepressants approved by the Food and Drug Administration to treat depression, with their generic names followed by brand names in parentheses, include:
Some of these medications come in forms that must be injected or as liquids (oral solutions). Sometimes, these antidepressants are used to treat conditions other than depression. Side effects of tricyclic antidepressantsSide effects of cyclic antidepressants vary somewhat from medication to medication. They can include:
Some cyclic antidepressants are more likely to cause particular side effects. For example, desipramine and protriptyline are more likely to make you sleepy than do other cyclic antidepressants. Amitriptyline and doxepin are more likely to cause weight gain than do other cyclic antidepressants. Choosing one particular cyclic antidepressant over another may help you avoid particular side effects. Safety concerns with cyclic antidepressantsThere are a number of things to consider before taking a cyclic antidepressant:
Stopping treatment with cyclic antidepressantsCyclic antidepressants aren't considered addictive. However, stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, including:
This is sometimes called discontinuation syndrome. Work with your doctor to gradually decrease your dose. Suicide risk and antidepressantsThe Food and Drug Administration (FDA) requires that all antidepressants carry a warning that some children, adolescents and young adults may be at increased risk of suicide when taking antidepressants. Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior — especially in the first few weeks after starting an antidepressant. Keep in mind, antidepressants are more likely to reduce suicide risk in the long run by improving mood. Finding the right antidepressantEach person reacts differently to a particular antidepressant and may be more susceptible to certain side effects. Because of this, one antidepressant may work better for you than another. When choosing an antidepressant, your doctor will take into account your particular symptoms, what health problems you have, what other medications you take and what has worked for you in the past. Sometimes a combination of antidepressants may be the best treatment choice. Inherited traits play a role in how antidepressants affect you. In some cases, DNA tests such as cytochrome P450 (CYP450) tests may give clues as to whether an antidepressant is likely to ease symptoms or cause side effects. DNA testing isn't widely used yet, but is becoming more common. It can take a long time to find the best treatment for depression. It takes several weeks or longer before an antidepressant is fully effective and for initial side effects to ease up. You may need to try several antidepressants before you find the right one, but hang in there. With patience, you and your doctor can find a medication that works well for you. RelatedLast Updated: 2010-12-09 © 1998-2013 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.
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