Tricylic Compounds include-
      Tertiary amines - Amitriptyline,Clomipramine,Doxepin,Imipramine,Trimipramine
      Secondary amines - Amoxipine, Desipramine, Nortriptyline,Portriptyline
      Refer - Amitriptyline

Severe hyperpyretic reactions with MAOIs.Hence should not be used concomittantly or within 2 weeks of stopping MAOIs.

Potentiates hypertensive effect of noradrenaline and anticoagulant action of coumarins.

Phenothiazines raise blood levels. Interferes with anticonvulsant control.

Depression 

     Tricylic Compounds include-
      Tertiary amines - Amitriptyline,Clomipramine,Doxepin,Imipramine,Trimipramine
      Secondary amines - Amoxipine, Desipramine, Nortriptyline,Portriptyline
      Refer - Amitriptyline

Agranulocytosis. Raises heart rate,slows conduction and prolongation of P-R interval, Lowers seizure threshold, Peripheral neuropathy,

Dry mouth,constipation,urinary hesitancy, Confusion and blurred vision. Rarely cholestatic jaundice.

Hypersens,recent M.I.,children below 6 years.

Special precautions:

Epilepsy,BHP,closed angle glaucoma, CVS disease.

Depression

Dosage-

1 tablet 3-4 times daily Children not recommended

EVIDENCE BASED MEDICINE (April 2003)

Depression

Comparitive effectiveness of various interventions

Beneficial

1. Tricyclic and heterocyclic antidepressants

2. Selective serotonin reuptake inhibitors and related drugs

3. Monamine oxidase inhibitors

4. Interpersonal therapy (mild to moderate depression)

Likely to be beneficial

1. St.Johns wort in mild to moderate depression

2. Problem solving therapy in mild to moderate depression

3. Combining drug psychological treatment in severe depression

4. Maintenance drug treatment may prevent recurrence

Unknown efectiveness

1. Excercise

2. Bibliotherapy (advising patients to read material on mood therapy)

3. Non-directive counselling

4. Psychological treatment in severe depression

5. Clinician colloboration and patient education.

KEY POINTS

1. Several treatments are effective in the treatment of mild to moderate depression. These include anti-depression drugs, cognitive therapy and interpersonal therapy. Less robust RCTs have found that problem solving therapy and St Johns wort are also effective.Specific psychological treatments such as cognitive and interpersonal therapy have been shown to be as effective as drugs and there is no significant difference between anti-depressant drugs, although they vary in adverse effects and costs.

2. There is limited evidence that other treatments such as excercise, bibliography and non-directive counselling may be effective, but further research is needed.

3. There is no reliable evidence that one type of treatment (drug or non-drug) is superior to another. Limited evidence suggest that combing drug and psychological treatments may be effective in severe but not in moderate depression.

4. Of the interventions examined, anti-depressants drugs are the only treatment for which there is good evidence of effectivenes in severe psychotic depressive disorders. There are no trials comparing drug and non-drug treatments in severe depressive disorder.

5. Continuing anti-depressants drug treatment for four to five months after recovery reduces the risk of relapse, and maintenace therapy in recurrent depressive disorder reduces the risk of recurrence.

6. There is no evidence of a difference in long-term benefits between treatments

Tricyclic antidepressants include - Amitriptyline, Doxepin, Nortriptyline, Dothiepin, Amineptine, Imipramine, Clomipramine, Mianserin

Refer- Amitriptyline

Refer amitriptyline

Not reported.

Refer amitriptyline.