The Course of Tricyclic Antidepressants
Liu (2013) states TCAs are first-line agents for neuropathic pain treatment; they have strong serotoninergic and noradrenergic reuptake inhibition. According to Advokat, TCAs block presynaptic reuptake transporters for the neurotransmitters norepinephrine and serotonin; since they block both, it was considered the first dual action antidepressant. In order to cause their therapeutic effects, TCAs attach to norepinephrine and serotonin presynaptic transporter proteins. Thought they have been proven effective they also have limitations. Three of their main limitations are they have a slower rate of onset, they have more side effect than current antidepressant medications, and finally, in any case of overdose, they can cause cardiac arrhythmias, proving to be fatal (Advokat). Advokat also mentions TCAs block postsynaptic receptors for histamine and acetylcholine; therefore causing their side effects. The side effects consist of drowsiness, sedation, confusion, memory/ cognitive impairments, dry mouth and blurred vision, increased heart rate, and urinary retention (Advokat). It is possible depending on the type of TCA take there is also an additional side effect of weight gain (Liu). Liu states nortriptyline is known to have fewer side effects than amitriptyline, as it has less anticholinergic activity. TCAs may not only be used as antidepressants, they are also good for pain medications. Tricyclic antidepressants can aid with headaches, fibromyalgia, chronic back pain, myofascial pain, and chronic fatigue (Advokat). Reed (2012) states fibromyalgia is a constant and widespread pain, fatigue and stiffness, which also causes depression, anxiety, and cognitive dysfunction. Though TCAs can be used for relieving pains, it is not common, and, in fact, the use of TCAs is actually declining (Reed).