TCAs may
increase the blood pressure elevating effect of epinephrine, norepinephrine,
dopamine, phenylephrine, and dobutamine.
Cimetidine (Tagamet) may reduce the
breakdown of some TCAs, for example, amitriptyline (Elavil, Endep), increasing the
level of the TCA in the body and potentially leading to increased side effects.
As mentioned previously, TCAs should not be combined with MAOIs.
TCAs are associated with a number of cardiovascular
(heart and blood vessels) effects such as orthostatic hypotension and abnormal
heart rates and rhythms. Orthostatic hypotension may lead to dizziness, falls,
and fractures. Orthostatic hypotension may be managed by reducing or
discontinuing the TCA dose, increasing salt intake, or treatment with steroids.
If abnormal heart rhythms develop, TCAs should be discontinued. TCAs are not a
good choice for patients with cardiovascular conditions.
TCAs have
anticholinergic effects which manifests as dry mouth, constipation, urinary
hesitation, sexual dysfunction, increased heart rate, and visual disturbance.
Desipramine (Norpramin)
and nortriptyline (Pamelor) cause less anticholinergic effects than other TCAs.
Sugarless gum or candy, or
pilocarpine (Salagen) oral rinse may alleviate dry mouth;
constipation may be reduced by bulk laxatives and increased hydration;
urinary
hesitation may be treated with bethanechol; and
visual disturbance may be
treated with pilocarpine eye drops.
Sexual dysfunction may be managed with sidenafil (Viagra), reducing the TCA dose or discontinuing the TCA. Yohimbine,
ginkgo, bethanechol, and neostigmine have also been used for managing TCA
induced sexual dysfunction.
TCAs should be avoided by individuals with prostatic
hypertrophy, cognitive impairment, or narrow-angle glaucoma because drugs with anticholinergic side effects can worsen
symptoms of these conditions.
TCAs also cause sedation. Amitriptyline (Elavil, Endep), doxepin (Sinequan),
and trimipramine (Surmontil) are more sedating than amoxapine and desipramine (Norpramin). Sedation may
improve after a few weeks of treatment. Sedating TCAs may be beneficial for
depressed patients who have insomnia.
Dose dependant and reversible weight gain
may occur during TCA treatment. Amitriptyline (Elavil, Endep)
causes weight gain more often than
desipramine (Norpramin).
What are selective serotonin reuptake inhibitors (SSRIs)?
SSRIs were developed after TCAs and are the most widely used class of
antidepressants. They work by increasing the level of serotonin in the brain.
Unlike MAOIs and TCAs, they do not significantly affect norepinephrine levels
in the brain. SSRIs also have fewer and milder side effects, fewer drug
interactions, and are much less likely to be effective for committing suicide
than TCAs.
Confusion, high blood pressure, tremor, hyperactivity,
coma, and death may occur when SSRIs are combined with drugs that increase brain
serotonin levels, for example, MAOIs, TCAs, sumatriptan (Imitrex), linezolid
(Zyvox), St John's Wort, tramadol (Ultram), and meperidine (Demerol).
SSRIs may increase the effect of
warfarin
(Coumadin), leading to excessive bleeding. Therefore, warfarin therapy should be
monitored more frequently in patients who are also taking SSRIs.
SSRIs cause headaches and dose-related nausea, vomiting,
and diarrhea that
improve with continued treatment.
Insomnia, restlessness, and agitation-which
decrease over time-also are associated with SSRIs. Insomnia can be treated with
low dose (50-100 mg) trazodone
(Desyrel) at bedtime and agitation may be managed by
reducing the SSRI dose or treating
with anti-anxiety drugs.
SSRIs also are associated with sexual dysfunction.
Symptoms of sexual dysfunction may be treated with
sildenafil (Viagra),
yohimbine (Pausinystalia
yohimbe),
amantadine (Symmetrel),
cyproheptadine, or
neostigmine (Prostigmin).
Over time, weight loss or weight gain has been associated with SSRIs. Patients may
experience weight loss initially but quickly regain weight.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Suicide is the process of intentionally ending one's own life. Approximately 1 million people worldwide commit suicide each year, and 10 million to 20 million attempt suicide annually.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Overactive bladder is a sudden involuntary contraction of the muscle wall of the bladder causing urinary urgency (an immediate unstoppable need to urinate). Overactive bladder is is a form of urinary incontinence. Treatment options may include Kegel exercises, biofeedback, vaginal weight training, pelvic floor electrical stimulation, behavioral therapy, and medications.
Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder characterized by the symptoms hyperactivity, impulsivity, and inattention. Treatment for ADHD may involve behavioral therapy and psychostimulant or antidepressant medication.
Orthostatic hypotension symptoms include lightheadedness, weakness, blurred vision, and syncope or passing out. Causes of orthostatic hypotension include dehydration, anemia, medication, blood loss, low blood pressure, heat related illnesses and more. Treatment of orthostatic hypotension depends on the underlying cause.
Seasonal affective disorder is a type of depression that tends to occur as the days grow shorter in the fall and winter. Symptoms of seasonal affective disorder include tiredness, fatigue, depression, irritability, body aches, poor sleep and overeating.
Separation anxiety disorder is a common childhood anxiety disorder that has many causes. Infants, children, older kids and adults can suffer from symptoms of separation anxiety disorder. Common treatment methods include therapy and medications.
Premenstrual dysphoric disorder (PMDD) is considered to be a severe form of premenstrual syndrome (PMS). PMDD has also been referred to as late luteal phase dysphoric disorder. The cause of PMDD is unknown. Some of the common symptoms of PMDD (not an inclusive list) include: mood swings, bloating, fatigue, headache, irritability, headache, breast tenderness, acne, hot flashes and more. Treatment for PMDD is with medication to treat the symptoms of PMDD.
Urinary retention (inability to urinate) may be caused by nerve disease, spinal cord injury, prostate enlargement, infection, surgery, medication, bladder stone, constipation, cystocele, rectocele, or urethral stricture. Symptoms include discomfort and pain. Treatment depends upon the cause of urinary retention.
Childhood depression can interfere with social activities, interests, schoolwork and family life. Symptoms and signs include anger, social withdrawal, vocal outbursts, fatigue, physical complaints, and thoughts of suicide. Treatment may involve psychotherapy and medication.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
Sleepwalking is a condition in which an individual walks or does other activities while asleep. Factors associated with sleepwalking include genetic, environmental, and physiological. Episodes of sleepwalking may include quiet walking to agitated running. Conditions that may have similar symptoms of sleepwalking, but are not include night terrors, confusional arousals, and nocturnal seizures. Treatment of sleepwalking generally include preventative measures. Medication may be prescribed if necessary.
Compulsive gambling is a disorder that affects millions in the U.S. Symptoms and signs include a preoccupation with gambling, lying to family or loved ones to hide gambling, committing crimes to finance gambling, and risking importance relationships and employment due to gambling. Treatment may incorporate participation in Gamblers' Anonymous, psychotherapy, and medications like carbamazepine, topiramate, lithium, naltrexone, antidepressants, clomipramine, and fluvoxamine.
Bipolar disorder, or manic-depressive illness, is a disorder that causes unusual and extreme mood changes. Symptoms of bipolar disorder in children and teens include having trouble concentrating, behaving in risky ways and losing interest in activities they once enjoyed. Treatment for bipolar disorder in children and teenagers incorporates psychotherapy and medications.
Irritable bowel syndrome (IBS) in children is a functional gastrointestinal disorder with symptoms of abdominal pain, bloating, diarrhea or constipation. The cause of IBS is unknown, however, certain foods, stress, anxiety, and depression may contribute to the symptoms of IBS. There is no cure for IBS in children; however, medications, dietary changes, and stress management may relieve symptoms.
Fast food consumption and lack of exercise are just a couple of causes of childhood obesity. Health effects of childhood obesity include type 2 diabetes, heart attack, stroke, high cholesterol, asthma, sleep apnea, gallstones, fatty liver disease, GERD, depression, and eating disorders.
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants, psychotherapy, or electroconvulsive therapy.
Munchausen syndrome by proxy (MSBP) is a mental illness (factitious disorder) in which a caregiver secretly abuses a child by faking symptoms in the child. Symptoms present in the child include suffocation, bleeding, poisoning, and induced seizures. Treatment involves maintaining the safety of the child and typically incorporates psychotherapy and psychiatric medications for both the perpetrator and victim.
Depression RSS
Healthy Living Tips
This site complies with the