Talk:Tricyclic antidepressant

These drugs are not heterocyclic compounds, as the first sentence of the article suggests. See page on heterocycles

71.192.117.165 (talk) 05:38, 19 January 2012 (UTC)

My understanding was that it was an early MAOI, which was being used to treat tuberculosis, that was found to make patients euphoric. Anyone have a source? RoseParks

I think you might be right. Deleted the reference.

Iproniazid was the drug you're thinking of, and yes, it apparently has modest MAOI activity. I wonder if perhaps by "euphoric" (if that was indeed the word used) they meant merely that the patients seemed unusually happy (which would be curious enough, given that TB was a really horrible disease). I found this in my rather old (9th ed.) copy of Goodman & Gilman. Zeller et al. were credited with first recognizing the inhibition of MAO by iproniazid, a finding later confirmed by others. (Iproniazid has since been replaced for tx of TB with the less hepatotoxic isoniazid, BTW.) Mia229 (talk) 06:56, 29 October 2013 (UTC)

What does the word "quinidineline" (referenced in the article as a type of side effect) mean? I've tried googling for it and the word yielded about 130 matches, most of which want to give me "free" ringtones and poker games. I'm at a loss. --65.114.61.232 21:01, 27 June 2006 (UTC)

This is the first type of drug mentioned in the article Appetite enhancers yet the appetite enhancing properties are given as a side effect in this article with less than a sentence devoted to them. No criticism intended, just a reader who was interested in seeing more on a specific topic 81.146.65.109 23:01, 2 January 2007 (UTC)

What does the word "quinidineline" (referenced in the article as a type of side effect) mean? I've tried googling for it and the word yielded about 130 matches, most of which want to give me "free" ringtones and poker games. I'm at a loss. --65.114.61.232 21:01, 27 June 2006 (UTC)

I am a pharmacy tech student and I looked up quinidineline in the mosby's drug consult it is another drug that can be used and has the same effects as the tricyclic antidepressant to which you were looking at. If that is any help...(24.230.39.40 00:09, 11 February 2007 (UTC))

Perhaps a reference to the risk of induction of mania would be useful. Dixon pete 22:13, 10 May 2007 (UTC)

Discontinuation
Does anyone else find this section to be harmful and incorrect. Are we redefining the definition of withdrawal just for these types of drugs? I've had withdrawals from caffeine, alcohol, nicotine, tricyclics, ssri's, snri's, dnri's. Here's the thing, all of those I just mentioned, the withdrawal has been worse, some by a significant margin, than opioids. The language in that section is very dangerous ignorance and false. Please delete it — Preceding unsigned comment added by 50.255.241.170 (talk) 16:54, 26 February 2018 (UTC)

Difference between this and SSRIs
What would the main differences between this and SSRIs, if anyone has the knowledge? I know that MAOIs are used as a last choice, but I'm unsure why these types are being replaced, and the outstanding features of SSRIs which make this the predecessor. Daily Rubbings 03:35, 19 May 2007 (UTC)
 * Generally SSRI's replaced the TCA's because of the latter's side effects (dry mouth, drowsiness, blurred vision etc). Although subsequent random controlled studies have suggested that the difference in tolerability is not as much as commonly assumed. Also TCA's more toxic in overdosage, and so SSRIs safer to initiate in depressed patients (i.e. safer in over dosage - recognising that despite some concerns for increased tendency to attempt suicide on starting treatment, this is small compared to far larger rates of suicide from the non-treated or under-treated condition itself). That said, the less sedating TCAs eg lofepramine still have a role. The TCAs have a much greater effectiveness in low-dosages (especially amitriptyline) as pain moidifiers and migraine/headache preventers (Fluoxetine perhaps just 30% as effective according to one consultant I spoke to - but that of course does not constitute a reliable encyclopaedia source) David Ruben Talk 11:43, 19 May 2007 (UTC)

Tricyclic Antidepressants and THC
I was once prescribed tofranil when I was about 14 years old. I had stopped smoking marijuana during the month I was taking tofranil. When I began smoking again I would have hallucinations on extremely low doses of THC. Only one small puff of the lowest grade marijuana would make me experience profound and overwhelming euphoria and hallucinations. Is this just for my case? Although these experiences may be too intense for most, I thought it was great, especially due to the fact my therapist prescribed me these for depression and marijuana use. It just seems silly to give me a drug that exponentially increases the effects of a drug I was having problems stopping.

Selectivity
I tried to confirm the table from other sources available on the net, but every source I dug up puts a slightly different spin on things. I ended up referencing only the source that put matters in numerical terms based on recent radioligand surveys, which seemed most authoritative, but also incomplete. If my material on secondary and tertiary amine classification is retained, it would probably be better placed in the table, but I didn't wish to mess (too much) with the MeSH claim. I did add one TCA that wasn't mentioned.

In general, it is problematic to determine whether drugs are being classified, or individual metabolites. MaxEnt 09:37, 11 October 2007 (UTC)

History
I added a chunk on the development history. The two useful sources I found were hard to mesh, and one would given a person and a time, and the other a corporation and a place, but not so as you could confidently match one to the other in declarative sentences. I intended to unearth the key patents. Google is quick to pull up an expensive source which I don't have access to. Using the free patent search I was able to get close, but was hampered by the lack of fully electronic forward/backward references in patents prior to 1976. I searched one chain backwards by hand and thought I had it (the patent for amitrip), but then I noticed it was the wrong firm. Perhaps Smith Kline licensed to Merck. I can't find any TCA introduced by Smith Kline, yet they seem to hold a patent that almost exactly describes amitrip and in roughly the right time period (plus/minus my amateur chemistry). MaxEnt 11:52, 12 October 2007 (UTC)

Histamine
"Although norepinephrine and dopamine are generally considered stimulatory neurotransmitters, tricyclic antidepressants also increase the effects H1 histamine, and thus most have sedative effects.[5]"

Makes no sense. Histamine H1 antagonists according to the wikipedia article make people sleepy - anti-histamines. Thats why allergy medication is advertised as non-drowsy these days. Perhaps it means to say "tricyclic antidepressants also decrease the effects of H1 histamine"? Would also make sense since it says it is a H1 ANTagonist. 81.104.186.166 14:46, 2 December 2007 (UTC)

TCA abuse
General reviews have determined that TCAs have no abuse potential. Rarely, in case reports, use of TCAs to "fortify" alcohol or opioids is reported. I removed such case reports per WP:MEDMOS, as they are no peer reviewed source, but letters to the editor. 70.137.151.133 (talk) 04:00, 16 February 2009 (UTC)

Reverted by sceptical chymist - I have looked at your refs before reverting. Please see discussion and respond there. We have revert/discuss. Case studies (a single case) are not appropriate material. All but one unclear are mixed use by alcoholic/junkies on methadone. Reviews and med consensus says they have no abuse potential, thats what the last ref (with the Indian woman) says itself. It also says that the case is not clear cut.(Is a depressive patient taking more pills than prescribed just desperate or an abuser?) Please see WP:MEDMOS, for the guideline to base claims on reviews and other secured material. Letters to the editor and concerns of some MD are not encyclopedic material. Besides, this is also what I find disturbing in many other articles: Claims based on a single patient who abused pills and had braindamage as indication, that the pills cause braindamage etc. Claimed causality based on this. TCAs have no abuse potential. 70.137.151.133 (talk) 12:37, 16 February 2009 (UTC)


 * Here is an excerpt from a book, Drugs of Abuse by Simon Wills: "There have been several reports of abuse of amitriptyline71-74. This is a drug with significant antimuscarinic effects and the abuse potential may derive solely from this pharmacological property." etc etc The Sceptical Chymist (talk) 00:35, 17 February 2009 (UTC)

Yes thats the handful of case reports in 30 years about such abuse. But the consensus is that they have no abuse potential. There are even people who smoke shoe polish etc. If that has the required notability? 70.137.151.133 (talk) 01:11, 17 February 2009 (UTC)

From the number of such case reports it seems to be more a fringe phenomenon than e.g. smoking shoe polish or old plastic soles or eating nutmeg.(in some prison) As LiteratureGeek said in a discussion, there are some do-all people who do really everything to get a kind of stoned feeling, and I think it is not notable, even above author only speculates that it may have to do with pharmacological properties. (Sometimes it is just a fad to try such things. Note that the reported abuse cases are almost all mixed abuse in poly drug abuse cases, where people try to fortify their methadone. In such a mix the drug may take on different properties.) 70.137.151.133 (talk) 01:23, 17 February 2009 (UTC)

The consensus expresses itself in the fact that TCAs are not scheduled in the US. The kind of antimuscarinic effect would maybe compare to diphenhydramine, which also has been abused by some people, but is OTC. 70.137.151.133 (talk) 01:33, 17 February 2009 (UTC)

I doubt the feasibility of the "Drugs of abuse" book "Sceptical Chymist" added. It is self published, sponsored by the group the author funded, and it lists "estrogen" as a drug of abuse in post-menopausal women. The withdrawal symptom it produces is called "menopause", good man! This is bizarre, one of the examples from the environment of "drug abuse industry", where money is being made from advising, counceling, treating and writing about addiction. 70.137.151.133 (talk) 09:14, 17 February 2009 (UTC)


 * Recreational use or abuse of prescription drugs is usually noted in WP articles, even if it is very rare. See, for example, featured article bupropion. As for diphenhydramine, there is a whole chapter Diphenhydramine. The "Drugs of abuse" book I referred to was published by Pharmaceutical Press (see ), a well known scientific publishing house. Pharmaceutical Press also publish Martindale, for example. To call the "Drugs of Abuse" book self-published is incorrect. The Sceptical Chymist (talk) 12:18, 17 February 2009 (UTC)

But don't you think a book that calls estrogen a drug of abuse, with the withdrawal symptom of menopause is already sectarian? If you have a hammer sure everything looks like a nail. Wrt. rare abuse, I certainly see some fringe opinions represented in WP, among them also the views of teetotalers and members of the drug recovery industry and zombies stumbling out of the fog of the Christian 12-steppers etc. And the stories w. nutmeg and the smoking of shoe soles and shoe polish are also "all true", but not notable. Well, I hope the Encyclopedia Britannica still stays around for some decades. But you are right that I missed it with Pharmaceutical Press, at least if pharmacists are not themselves a fringe sect of concerned teetotalers... :) 70.137.151.133 (talk) 16:42, 17 February 2009 (UTC)

And besides I have removed inappropriate material like the recipe "how-to" cook nasal inhalers in vinegar to EAT THEM, including dosage information, per WP:MEDMOS, and I got the HOWLING of the outraged followership and many "asshole"s for that. But I really don't think that kind of chatroom material is encyclopedic and belongs here. 70.137.151.133 (talk) 16:47, 17 February 2009 (UTC)

Very small number of abuse cases
The "Drugs of Abuse" ref pp213 says:(about antidepressants in general) "However the number of cases reported in the past 30 years is very small". If you think several is equally good... 70.137.151.133 (talk) 02:17, 19 February 2009 (UTC)

It also says there it is controversial, "given the tiny risk of abuse", if the patient should be made aware of this, because of a resulting risk of non-compliance and suicide. ibd.

But we can't stop the drug recovery industry and the pharm skeptics to augment every article with warnings "abuse, abuse"! And eventually with some behavioral therapy advice as well as a hint to surrender to a higher being and join the 12-steppers. The poor depressive patient, turned "addict" may then better hang himself before living with the stigma. 70.137.151.133 (talk) 14:07, 19 February 2009 (UTC)

What are your thoughts on TCAs versus SSRIs? I have read that the lower toxicity of SSRIs make them less likely to cause harm, should a suicidal patient try to overdose.

Signed for 161.150.2.55


 * Tricyclics are much more dangerous in overdose - they are cardiotoxic and people can have a cardiac arrest which is resistant to reversion with paddles. Abuse as such with these drugs is extremely rare. Casliber (talk · contribs) 19:56, 20 February 2009 (UTC)

Tricyclic/tetracyclic antidepressant
Are these topics be treated on a single page, or separately? In all the pharm books I've read so far, the term "tetracyclic" almost never is used (they're usually called "atypical tricyclics", or given some more precise name discussing their mechanism.) --Arcadian (talk) 03:12, 22 November 2009 (UTC)
 * I've seen them referred to separately. Regardless though, they are separate entities, and hence I believe should be separate. They have both a markedly different chemical structure as well as quite different pharmacology. el3ctr0nika (Talk | Contribs) 20:35, 24 November 2009 (UTC)
 * Please provide a source supporting the idea that tricyclics have a common pharmacology, and that tetracyclics have a common pharmacology that is distinct from the tricyclics. --Arcadian (talk) 22:28, 24 November 2009 (UTC)
 * Eh it doesn't matter. It's obvious they're different. None of them have any significant SRI actions, they tend to have higher a2-adrenergic affinity, some of them lack anticholinergic activity, and a few are potent 5-HT3 antagonists. They also lack the ion channel-regulating effects of the TCAs and so forth. Anyway, can I please revert the pages back? el3ctr0nika (Talk | Contribs) 12:08, 1 December 2009 (UTC)

TCA abbreviation
Does TCA in this context mean "tricyclic antidepressant" or "tricyclic amine" ?? I understood TCA to refer to the chemical entity (that is, tricyclic amine), and it was entirely coincidental (and nice) that antidepressant also starts with the letter 'a'. --98.70.128.14 (talk) 22:18, 17 October 2013 (UTC)
 * TCA stands for TriCyclic Antidepressant.TL36 (talk) 21:58, 26 July 2014 (UTC)

pharmacokinetics!
I looked up desipramine (the TCA I'm trying to find something out about) and could not find anything about its pharmacokinetics, so I checked imipramine, which in addition to being an AD in its own right is a pro-drug from desipramine. (All it said under "Metabolism" was that desipramine is a metabolite of imipramine, which I obviously knew already since it was the reason I had dared hope to find something useful there.) So, pleeeeeeeeeeeze. Someone must know something about this. Really, all the individual drug articles and this article should include sections. I was frankly shocked to find a Wikipedia article so lacking on so major a subject. (True, others are lacking, but a lot of those have to do with celebrities. While I admit to using that sort of stuff occasionally, I strongly believe that science (including medicine and other applied sciences) articles ought to be given priority over this sort of thing.  Mia229 (talk) 07:11, 29 October 2013 (UTC)

binding affinities are somewhat wrong
For instance, until I edited it with HCR data from a recent journal, Desipramine was listed as having a weaker (higher number) Norepi transport affinity than Nortriptyline, which is wrong. I fixed desipramine's, but I would not be surprised if there are other inaccuracies. Best the use the most recent HCR data, as pre-HCR data was either guesses or based on animal experiments rather than on human cells. starting point: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014120/ — Preceding unsigned comment added by 73.71.74.53 (talk) 18:32, 29 February 2016 (UTC)

Praise P.K. Gillman! :=) --77.187.90.18 (talk) 13:25, 27 October 2017 (UTC)

Clomipramine and Muscarinic acetylcholine receptor receptors
Acorrding to this study, clomipramine does not bind to muscarinic receptors

https://estudogeral.uc.pt/bitstream/10316/104522/1/pharmaceutics-15-00230.pdf

Accordingly, muscarinic acetylcholine recepto r is not affected by Clomipramine other than M1

https://www.psychdb.com/meds/antidepressants/tca/home Leskzzmmet (talk) 02:55, 1 October 2023 (UTC)