TCAs — Learn how this type of antidepressant works and about its side effects.
Certain brain chemicals called neurotransmitters are associated with depression, including the neurotransmitters serotonin (ser-oh-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and dopamine (DOE-puh-mene). Research suggests that abnormalities in neurotransmitter activity can affect mood and behavior.
TCAs approved to treat depression
Here are the TCAs that have been approved by the Food and Drug Administration specifically to treat depression, with their generic or chemical names followed by available brand names in parentheses:
- Amitriptyline
- Amoxapine
- Desipramine (Norpramin)
- Doxepin (Sinequan)
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
Some of these medications come in forms that must be injected or as oral solutions that must be mixed with liquids, such as water or juice.
Some of these medications may also be used to treat conditions other than depression.
Safety concerns with TCAs
In general, avoid tricyclic antidepressants if you have narrow-angle glaucoma, an enlarged prostate (benign prostatic hyperplasia) or certain types of heart disease. TCAs are associated with a higher risk of heart attack. TCAs may affect blood sugar levels. If you have diabetes, you may need to check your blood sugar more often. TCAs should be used with caution if you have a history of seizures or thyroid problems.
Suicidal feelings and TCAs
In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior, particularly early in treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring at the beginning of treatment or upon a change in treatment, or you may need to stop the medication if your symptoms worsen.
Lifestyle and home remedies
Lifestyle changes can help you prevent or slow the progression of atherosclerosis.
- Stop smoking. Smoking damages your arteries. If you smoke, quitting is the best way to halt the progression of atherosclerosis and reduce your risk of complications.
- Exercise most days of the week. Regular exercise can condition your muscles to use oxygen more efficiently. Physical activity can also improve circulation and promote development of new blood vessels that form a natural bypass around obstructions (collateral vessels). Ideally, you should exercise 30 to 60 minutes most days of the week. If you can't fit it all in one session, try breaking it up into 10-minute intervals. You can take the stairs instead of the elevator, walk around the block during your lunch hour, or do some sit-ups or push-ups while watching television.
- Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains - and low in saturated fat, cholesterol and sodium — can help you control your weight, blood pressure and cholesterol. Try substituting whole-grain bread in place of white bread, grabbing an apple, banana or carrot sticks as a snack, and reading nutrition labels to control the amount of salt and fat you eat.
- Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.
If you have high cholesterol, high blood pressure, diabetes or another chronic disease, work with your doctor to manage the condition and promote overall health.
Symptoms
Atherosclerosis develops gradually. There are usually no atherosclerosis symptoms until an artery is so narrowed or clogged that it can't supply adequate blood to your organs and tissues. Sometimes a blood clot completely obstructs blood flow, or even breaks apart and causes blood clots that can trigger a heart attack or stroke.
Atherosclerosis symptoms depend on which arteries are affected. For example:
- If you have atherosclerosis in your heart arteries, you may have symptoms similar to those of a heart attack, such as chest pain (angina).
- If you have atherosclerosis in the arteries leading to your brain, you may have symptoms such as sudden numbness or weakness in your arms or legs, difficulty speaking or slurred speech, or drooping muscles in your face.
- If you have atherosclerosis in the arteries in your arms and legs, you may have symptoms of peripheral arterial disease, such as leg pain when walking (intermittent claudication).
Sometimes atherosclerosis causes erectile dysfunction in men.
When to see a doctor
If you think you have atherosclerosis — or risk factors for hardening of the arteries — talk to your doctor. Also pay attention to early symptoms of inadequate blood flow, such as chest pain (angina), leg pain or numbness. Early diagnosis and treatment can stop atherosclerosis from worsening and prevent a medical emergency.
Risk factors
Hardening of the arteries occurs over time. In addition to simply getting older, factors that increase the risk of atherosclerosis include:
- High blood pressure
- High cholesterol
- Diabetes
- Obesity
- Smoking
- A family history of aneurysm or early heart disease
Preparing for your appointment
Your doctor will first perform a physical exam if you think you have atherosclerosis. You'll have your blood pressure checked to see if you have high blood pressure, a common sign of atherosclerosis. Your doctor may also listen to the blood flowing through your arteries using a stethoscope to see if there are any abnormalities.
One of the most common tests doctors perform when checking for atherosclerosis is a blood test to check your cholesterol level and blood sugar. You'll need to go without eating or drinking anything but water for nine to 12 hours before your blood test. Your doctor should tell you ahead of time if this test will be performed during your visit.
If your doctor thinks you have atherosclerosis, you may need more tests to confirm the diagnosis.
Treatments and drugs
Lifestyle changes, such as eating a healthy diet and exercising, are often the first line of defense in treating atherosclerosis. But sometimes, medication or surgical procedures may be recommended as well.
Various drugs can slow — or sometimes even reverse — the effects of atherosclerosis. Here are some common choices:
- Cholesterol medications. Aggressively lowering your low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, can slow, stop or even reverse the buildup of fatty deposits in your arteries. Boosting your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, may help, too. Your doctor can choose from a range of cholesterol medications, including drugs known as statins and fibrates.
- Anti-platelet medications. Your doctor may prescribe anti-platelet medications, such as aspirin, to reduce the likelihood that platelets will clump in narrowed arteries, form a blood clot and cause further blockage.
- Anticoagulants. An anticoagulant, such as heparin or warfarin (Coumadin), can help thin your blood to prevent clots from forming.
- Blood pressure medications. Medications to control blood pressure — such as beta blockers, angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers — can help slow the progression of atherosclerosis.
- Other medications. Your doctor may suggest certain medications to control specific risk factors for atherosclerosis, such as diabetes. Sometimes medications to treat symptoms of atherosclerosis, such as leg pain during exercise, are prescribed.
Sometimes more aggressive treatment is needed. If you have severe symptoms or a blockage that threatens muscle or skin tissue survival, you may be a candidate for one of the following surgical procedures:
- Angioplasty. In this procedure, your doctor inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open. Angioplasty may also be done with laser technology.
- Endarterectomy. In some cases, fatty deposits must be surgically removed from the walls of a narrowed artery. When the procedure is done on arteries in the neck (the carotid arteries), it's known as carotid endarterectomy.
- Thrombolytic therapy. If you have an artery that's blocked by a blood clot, your doctor may insert a clot-dissolving drug into your artery at the point of the clot to break it up.
- Bypass surgery. Your doctor may create a graft bypass using a vessel from another part of your body or a tube made of synthetic fabric. This allows blood to flow around the blocked or narrowed artery.
Last Updated: 12/08/2006
