Cyclic Antidepressants – Learning About the Possible Dangers

As cyclic antidepressants, tricyclic and tetracyclic drugs date back to the dawn of the antidepressant era. While these drugs work, antidepressants with less negative side effects have mostly displaced them.

On the other hand, cyclic antidepressants may help certain people. If previous therapies for depression haven’t worked, then these drugs may be recommended.

The number of rings in the chemical structure determines whether a cyclic antidepressant is classified as tricyclic or tetracyclic (tetra).

Cyclic Antidepressants Used for Treating Depression

The Food and Drug Administration (FDA) approved these tricyclic antidepressants to treat depression:¹

• Amitriptyline
• Amoxapine
• Desipramine (Norpramin)
• Doxepin
• Imipramine (Tofranil)
• Nortriptyline (Pamelor)
• Protriptyline
• Trimipramine

The FDA approved the tetracyclic antidepressant maprotiline to treat depression.

Sometimes cyclic antidepressants are used to treat conditions other than depression, such as obsessive-compulsive disorder, anxiety disorders or nerve-related (neuropathic) pain.

How the Antidepressants Work

Cyclic antidepressants work by altering the levels of chemical messengers (neurotransmitters) between the brain cells. To alleviate depression, cyclic antidepressants function in a similar fashion to traditional drugs that treat depression. They do this by altering chemical and electrical communication patterns in brain regions that are known to influence mood.

More specifically, cyclic antidepressants block the reabsorption of serotonin and norepinephrine, increasing the brain’s levels of the two neurotransmitters, thus improving the mood.

The FDA authorizes the use of the antidepressants for depression as well opiate use disorder, nerve-related pain, and anxiety.

Adverse Reaction and Precautions

Various cyclic antidepressants produce different side effects due to their unique actions. You and your doctor may decide to try a new medicine if you have certain unwanted side effects.

It’s possible that the intensity of adverse effects is proportional to the dose; typically, greater doses are associated with more severe reactions.

Examples of Adverse Reactions

A few examples of probable adverse reactions are:²

• Drowsiness
• Constipation
• Visual impairment
• Drops in blood pressure, when rising from a sitting position
• Problems with urination
• A higher level of hunger. leading to weight gain, or alternatively, appetite suppression, leading to weight loss

Among the tricyclic antidepressants, amitriptyline, doxepin, imipramine, and trimipramine have the greatest potential to induce drowsiness. Therefore, it’s possible that taking these meds before night may be beneficial.

Weight gain is more common with amitriptyline, doxepin, imipramine, and trimipramine than with other tricyclic antidepressants.

The negative effects of nortriptyline and desipramine seem to be more manageable than those of other tricyclic antidepressants.

If you’re taking an antidepressant that has drowsiness as a side effect, don’t drive a car or do anything else that requires full mental focus and attention, or may create a safety issue.

A lot of factors, including your symptoms and any other health conditions, may determine which antidepressant is appropriate for you. Get to know your antidepressant’s potential dangers by consulting with your doctor and pharmacist.

Safety Warnings and Risks: Tricyclic Antidepressants

In particular, tricyclic antidepressants are more likely to produce the following safety concerns than others:

• Disorientation and confusion, especially in elderly patients
• Heart rate irregularity or increases
• More seizures in epileptic patients

If you are taking any other drugs, including vitamins, herbs, or supplements, notify your doctor before starting an antidepressant. When coupled with other drugs or supplements, certain antidepressants can be extremely harmful.

Serotonin Overload

While rare, taking two antidepressants may lead to increased serotonin levels. An antidepressant combined with a headache drug or with a supplement such as St. John’s Wort may also produce this effect.

Symptoms Associated with Serotonin Syndrome

Also called serotonin syndrome, serotonin overload can produce symptoms, such as:

• Anxiety
• Fever
• Perspiration
• Tremors
• Disorientation
• Restlessness
• Problems with coordination
• Blood pressure fluctuations
• Stepped up heart rate

Consult a doctor immediately if you experience any of the above symptoms.

Risk Assessments and Medical Exams

To find the optimal dose, your doctor may perform blood tests. Therefore, the effectiveness and safety of cyclic antidepressants may vary with each individual’s dose.

Patients with specific health concerns should avoid cyclical antidepressants at all costs. To find out if a cyclic antidepressant is safe for you, tell your doctor if you have any of the following conditions:

• Glaucoma
• Enlarged prostate
• Diabetes
• Liver disease
• Heart problems
• A history of seizures

Antidepressants and Suicide Risk

Although antidepressants have a high track record for safety, the FDA mandates that they all carry boxed warnings, the strongest cautions for prescription drugs on the market. About 400 medicines currently carry these types of alerts.

There has been some evidence that antidepressant use, particularly in the initial weeks of treatment or following a change in dose, may raise the risk of suicide ideation among young people – people who are 18 to 25 years old.

It’s important to maintain close attention to anyone using an antidepressant in case their depression or behavior changes for the worse. If you or someone you know is on an antidepressant and is having suicidal thoughts, contact a doctor immediately.

Cessation of Cyclic Antidepressant Therapy

If you suddenly stop using cyclic antidepressants, you’ll experience withdrawal symptoms that may include nausea, restlessness, insomnia, sweating, lethargy, headache, and flu-like conditions.

Antidepressants might have varying effects on various people. THe medicine, for instance, may have a different effect on you than it does on someone else. And while some people may experience fewer or more adverse reactions to antidepressants than others, this is not always the case.

Results from specialized blood tests, if available, may provide insight into how your body may react to certain antidepressant medications. Although genetics have a role in how well you respond to medicine, there are other factors to consider.

It’s important to understand the dangers of cyclic antidepressants as well as learn how they can help you, especially if you want to overcome depression or treat OUD. The treatment plan you follow should be personalized to your own unique chemistry and prior medical history.

When the Drugs Are Usually Prescribed

Again, tricyclic antidepressants are frequently prescribed after a patient has tried other drugs to relieve their depression and they didn’t work. Tricyclic antidepressants increase levels of the feel-good neurotransmitters of norepinephrine and serotonin in the brain.

Other Reasons for Taking the Medications

Indeed, the drugs may be customized for use, as some tricyclic antidepressants are prescribed for off-label purposes as well, such as chronic bedwetting or obsessive-compulsive disorder (OCD). When given in low doses, the drugs treat chronic pain or help reduce panic attacks.

The Reason for Adverse Reactions

While tricyclic antidepressants have proven worthwhile when treating depression, they also are known to affect the body’s automatic muscle movements, which, in turn, can affect digestion and bodily secretions.

They may also block the chemical, histamine, in the body, which may produce unwanted reactions, including blurred vision, dry mouth, sleepiness, glaucoma, and constipation. If you experience an annoying or troublesome response to a cyclic drug, you might find improvement by switching to another cyclic antidepressant medication.

Final Thoughts

No matter how a cyclic antidepressant is used, it typically is prescribed to treat depression or a specific condition. This recommendation is based on a patient’s history, response to previous medications, or mental or physical requirements. Knowing the benefits and the drawbacks will help you review both the pros and cons of taking the medicines while considering their overall safety.

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