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

The elderly are particularly susceptible to the range of side effects
noted abov e.  They often require treatment on lower dosages of these
medications for comfo rt and safety; fortunately, such lower doses can
also be therapeutic for them. The tricyclics should be used in
pregnancy, as the Physician's Desk Reference pu ts it, "only if the
clinical condition clearly justifies potential risk to the f etus."  A
woman taking these medications should not nurse an infant, as the medi
cation may be excreted in the breast milk.

With what other medications that I may be taking will the tricyclics
interact?

You should always inform any physicians involved in prescribing for
you of what medications you are already taking.  Your primary care
doctor, any specialists, surgeons and dentists involved in your care
should be aware of the fact that you are taking a tricyclic; your
prescribing psychiatrist should know all the other medications you
take.

The effects of anticholinergic and sympathomimetic medications
(employed in anae sthesia, treatment of gastrointestinal disturbances
and certain ophthalmological conditions, allergy and cold remedies)
may be additive with the side effects of the tricyclics described
above.  Certain blood pressure medications may interac t with them as
well, or their effectiveness may be inhibited by the presence of the
tricyclic. Cimetidine (Tagamet), ranitidine (Zantac) and other similar
medi cations used in peptic ulcer disease may raise the tricyclic
levels in your body and thus increase the frequency and severity of
adverse reactions.  If you are receiving thyroid supplements for
hypothyroidism, tricyclics may make you more s ensitive to their
adverse effects, especially on the heart and circulatory syste m, and
should be more closely monitored.

The tricyclics amplify the CNS depressant effects of alcohol and other
 sedatives (tranquilizers and sleeping medications), so these
 medications should be used c autiously by someone receiving a
 tricyclic.  You may find a reduced tolerance fo r excess caffeine
 while taking these medications. Except for the cold remedies noted
 above, no difficulty is presented by combining the tricyclics with
 any ove r-the-counter remedies, vitamin and other food supplements,
 or foods.

What are the preliminaries to starting on a tricyclic? A thorough
medical screening including bloodwork is required to be sure that a m
edical illness is not being mistaken for the psychiatric diagnosis.
It is cruci al as well to determine whether you have the types of
cardiac conduction disease which would make the use of a tricyclic
dangerous.  These can be detected with an EKG, which should be a
routine precursor to beginning on a tricyclic for pati ents over 40
years of age or anyone with a history of heart disease.  When doubt s
about the safety of these drugs arise, a cardiology consultation is
prudent.


Other medical conditions which can make the use of the tricyclics
dangerous, suc h as narrow-angle glaucoma, should be ruled out in
preliminary history, examinat ion and if necessary consultation.

 How will my doctor choose among the various tricyclics? None of the
antidepressants has been proven more effective or more rapidly-actin g
than another, although this is a marketing claim that is often made
for variou s ones. The grounds for choice among them is therefore
largely based on their si de effect profile. There are two broad
chemical classes of tricyclics. The tert iary amines (amitriptyline,
imipramine, trimipramine and doxepin), which have pr oportionally more
effect in boosting serotonin than norepinephrine, produce more
sedation, anticholinergic effects and orthostatic hypotension.
Amitriptyline an d doxepin are especially sedating. Secondary amines
(nortriptyline, desipramine, and protriptyline) tend more toward
enhancement of norepinephrine levels and he nce toward irritability,
overstimulation and disturbance of sleep.  The tertiary amines, thus,
are more useful where depression is accompanied by sleep disturba nce,
agitation and restlessness; whereas the secondary amines may be
preferable where the depressed patient is fatigued, withdrawn,
apathetic and inert.  The p sychiatrist's initial evaluation,
therefore, must go into extensive detail about the pattern of
depressive symptoms you have experienced, to tailor the agent to the
condition.  An impression about which side effects you would best
tolerate (or even benefit from) will enter into the physician's choice
of tricyclic as we ll.  Overall, desipramine and nortriptyline are
perhaps the most benign in term s of patient tolerance, and are often
the initial tricyclic of choice.

However, these are just the broadest guidelines, and treatment must be
individua lized in terms of agent and dose in a trial-and-error
fashion. Since there is r eason to believe that many of the
tricyclic-responsive conditions have a heredit ary component, all
other things being equal, starting on the same agent to which a
genetically-related family member with the same disorder has responded
favora bly in the past will usually be apt.  You may wish to make
inquiries about this within your family if you are under consideration
for medication treatment.  Of course, where you yourself have
previously responded favorably and tolerably to a particular agent, it
should generally be the drug of choice again.

     * * * 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