From: "eliot gelwan" <eliot.gelwan@channel1.com>
Newsgroups: alt.psychoactives
Subject: pamelor part two
Date: 1 Oct 92 03:53:53 EST
Reply-To: "eliot gelwan" <eliot.gelwan@channel1.com>
Distribution: alt
Organization: Channel 1 Communications

be inacti vated by a variety of mechanisms including reuptake into the
secreting cells.  T ricyclics impede this reuptake process so that the
monoamines remain active long er after secretion, presumably affecting
the preexisting underactivity which was responsible for the target
symptoms. Some tricyclic side effects relate to the fact that these
medications have similar effects on other neurotransmitters in the
CNS, notably histamine and acetylcholine.

What side effects can I expect if I take a tricyclic? While there are
individual differences among the agents in terms of degree, they
produce quite similar and troubling side effects (see tables 2 and 3).
With ma ny tricyclics, the most troublesome effect with ongoing use is
sedation.  They a re often administered at bedtime so that this effect
is bearable, but it may per sist into the following day.

Commonly, they cause enduring anticholinergic effects including dry
mouth or eye s (of concern particularly in patients with dental
problems and contact lenses, respectively); a peculiar taste in the
mouth; and dilation of the pupils with re sultant sensitivity to
bright light.  Disturbances in visual accommodation (the rapid
adjustment in focus necessary when the gaze is shifted from near to
far or vice versa) can cause blurry vision. Constipation or urinary
hesitancy are com mon.  These effects can occasionally be quite
serious or exacerbate underlying p roblems or tendencies in the
affected organ system, occasionally precipitating c onditions
requiring immediate medical attention such as acute glaucoma, paralyti
c ileus of the bowel or acute urinary retention.

Weight gain is a common complaint of which patients should be made
aware at the outset so that they can anticipate controlling their
intake.  It seems that the weight gain comes from a mechanism distinct
from the mere correction of the appe tite suppression that often
coincides with depression.  In men, erectile dysfunc tion or, more
rarely, difficulty achieving an ejaculation may be important and u
nderreported barriers to compliance with the tricyclics.

At the outset of treatment, people taking these medications often are
restless o r anxious, may be tremulous or feverish, may report
increased perspiration or ni ght sweats, can experience difficulty
falling asleep or restless disturbed sleep , and may report some
clouded thinking or interference with their concentration. These
symptoms are usually transitory although they may be so uncomfortable
th at they cause the patient to discontinue the drug during the first
few days or w eeks of treatment.  At about the point where the
therapeutic benefits of the med ication begin to be apparent several
weeks into the course of treatment, this cl ass of adverse reactions
has usually resolved or become tolerable.

Cardiovascular effects are also associated with these medications.
Orthostatic hypotension, i.e. dizziness upon arising or otherwise
rapidly changing posture, is common.  A rapid heartbeat is often
reported, sometimes with palpitations.  T he medications can have
deleterious effects on an unhealthy heart, e.g. causing EKG
(electrocardiogram) changes or arrhythmias (disturbances in cardiac
rhythm o r conduction); or, rarely, worsening or precipitating angina
or heart failure or precipitating a myocardial infarction (heart
attack).   These cardiac effects m ay eliminate the tricyclics from
consideration for some patients, although with close ongoing
monitoring they may often be employed to good effect.  A thorough
evaluation of their safety in the presence of reported history of
cardiac diseas e, especially a cardiac conduction defect, is always
warranted and may involve a referral for a consultation with a
cardiologist.  In all patients from middle a dulthood, it is prudent
to obtain an EKG prior to treatment and with dosage incr eases beyond
a certain extent.

It is the cardiac effects which make the tricyclics so dangerous in
overdose.  T aken at one time, a one- to two-week supply can cause
serious, potentially letha l, cardiac complications.  Tricyclic
antidepressants are now the leading cause o f death by drug overdose
in the United States. It is ironic that such effective medications for
conditions which often involve serious suicidal intent have such
potential lethality.

The tricyclics can occasionally cause seizures in patients with a
history of hea d injury, especially those with a preexisting seizure
history.  In these cases, collaboration of care between your
psychiatrist and a neurologist is often warra nted.  As with all
medications to which one has not previously been exposed, the
possibility of an allergic reaction should be borne in mind.  Once
allergy to o ne of these medications has been established, it must be
avoided by that individ ual.  Certain of these medications are very
closely related and there may be cro ss-sensitivity among imipramine,
clomipramine, desipramine and trimipramine; or among amitriptyline and
its derivatives nortriptyline and protriptyline.

As with other antidepressants, the tricyclics can cause a swing from
the depress ed to the manic state when given to a depressed patient
with manic-depressive il lness.  In someone whose manic-depressive
illness has not been recognized, it ca n declare itself in just such a
fashion when the individual presents for treatme nt of a depressive
episode.  There is some debate about whether the antidepressa nts can
precipitate mania in someone who would not otherwise have a manic
compon ent to their affective disease.

     * * * C O N T I N U E D   T O   N E X T   M E S S A G E * * *
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EZ 1.39 #178 [in Brookline MA  7:56 pm, Wednesday 09/30/92]
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Channel 1 (R)   Cambridge, MA

Newsgroups: alt.psychoactives