Tricyclic drugs are the first antidepressants that were introduced in clinical practice for the treatment of depressive states. It is believed that use of antidepressants improves mood, reduces and (or) removes sad state, apathy, anxiety and emotional stress. Antidepressants also increase mental activity, normalize phase structure and sleep duration, restore appetite.
In clinical practice tricyclic antidepressants are prescribed mainly to treat chronic depression, major depressive disorder and treatment-resistant depression. Tricyclic antidepressants are also prescribed to treat depressive disorders such as social phobia, anxiety disorders, obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, post-traumatic stress disorder, borderline personality disorder, attention deficit hyperactivity disorder (ADHD), chronic pain, neuropathic pain, bedwetting, eating disorders (anorexia or bulimia). Tricyclic antidepressants are also used in combination therapy for the treatment of some cases of schizophrenia.
In most countries of the world tricyclic antidepressants have been replaced by newer antidepressants. However, in the treatment of chronic depression tricyclic antidepressants are alternative medications when other treatment methods have been ineffective.
For depression treatment the first tricyclic antidepressant has become Imipramine. Imipramine antidepressant is a dibenzazepine analog of Chlorpromazine. Chlorpromazine introduction in clinical practice has become a great breakthrough in the treatment of psychiatric diseases. Initially, Imipramine was not intended for depression treatment. Antidepressant effect of Imipramine was discovered in 1957. At the U.S. pharmaceutical market tricyclic antidepressant Imipramine has been first appeared under the trade name of Tofranil. Tofranil antidepressant is still available for sale at the USA market. Tricyclic antidepressant Imipramine can be bought in the USA under the trade names: Imipramine hydrochloride; Surmontil; Imipramine pamoate; Tofranil-Pm; Trimipramine maleate.
The second tricyclic antidepressant, introduced in clinical practice has become Amitriptyline. Amitriptyline antidepressant appeared in the USA under the trade name Elavil in 1961. Amitriptyline is one of the few tricyclic antidepressants, used not only for the treatment of depressive symptoms but also for pain relief, arresting of anxiety attacks and reduction of some schizophrenia symptoms. Tricyclic antidepressant Amitriptyline is also used to reduce aggression episodes during aggressive behavior.
Doxepin is one more of the most known tricyclic antidepressants. Doxepin antidepressant is known under such brands as: Aponal, Adapine, Doxal (Orion), Deptran, Sinquan, Sinequan. Doxepin has first become available for sale under the trade name Aponal (manufacturer: Boehringer-Mannheim, part of Roche). Oral Doxepin tablets and capsules are successfully used to treat sleep disorders, but topical cream of Doxepin is prescribed to treat dermatological itching.
The first effective tricyclic antidepressant for insomnia treatment is Trimipramine. Trimipramine antidepressant is also known under the trade names: Surmontil, Rhotrimine, Stangyl. Uniqueness of Trimipramine is in the fact that it has antidepressant, anxiolytic, antipsychotic, sedative and analgesic effect. Trimipramine is similar to Doxepin in therapeutic spectrum of action. Moreover, Trimipramine has a powerful sedative activity and it is the only effective tricyclic antidepressant for insomnia treatment, which does not disturb normal sleep architecture. In particular, Trimipramine does not violate the sequence of fast and slow phase of sleep.
All tricyclic antidepressants are almost equally effective in the treatment of depressive states. Therefore, choice of tricyclic antidepressants depends on a number of factors. They include: a power of antidepressant effect, the presence of associated diseases and medicines, used for the treatment of these diseases.
Therapeutic action of tricyclic antidepressants may manifest a few weeks after the use. However, the use of tricyclic antidepressants should be continued even if symptoms of depressive state disappeared. To avoid the risk of treatment-resistant depression, tricyclic antidepressant therapy is recommended to carry out within 4-6 months.
Prolonged use of tricyclic antidepressants is not addictive. However, to reduce the risk of withdrawal syndrome, the use of tricyclic antidepressants should be discontinued gradually, reducing their dosage for a few weeks.
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