Tricyclic antidepressants.
(Amitriptyline hydrochloride and dothiepin)
Indication: Tricyclic antidepressants are useful in moderate to severe endogenous depression
Dosage: needs to be adjusted according to the individual response. Tricyclics take two weeks to act.
Caution: - The tricyclics should be used with caution in the following conditions: cardiac diseases, liver failure, epilepsy, pregnancy, breast feeding, thyroid disease, mania, glaucoma, urinary retention.
Driving: drowsiness may effect performance of skilled tasks; effects of alcohol enhanced.
CI: tricyclic antidepressants are contraindicated in recent MI, heart block and arrhythmias and severe liver disease.
SE: palpitations (arrhythmias), dizziness (heart block), dry mouth, blurred vision, constipation, urinary retention, rash tremor, nausea, sedation, sweating.
The patient should be encouraged to persist with the treatment as some tolerance to these side effects develops.
Withdrawal of tricyclics should be done very slowly.