In the first part of this article we will describe first 3 most popular antidepressants and to begin we should from two of the most famous in the past 20th century antidepressants, with Amitriptyline and Imipramine. Both of these drugs belong to a class of so-called tricyclic antidepressants – that is, if you draw their chemical formula then it will always be present with three connected rings. The principle of operation they have the same: to prevent nerve cell membrane in the region of joining two neurons (in the synapse) too fast to carry out this synaptic cleft neurotransmitters – mainly tricyclics prevent the reuptake of norepinephrine and serotonin. Let it stay a little longer – the person will have more fun to live.
Amitriptyline is the gold standard of antidepressants with sedative action. According to the mechanism – basically prevents reuptake from the synaptic cleft of noradrenaline, dopamine and serotonin. Because the effect on depressed mood it is combined with sedative and hypnotic effects Amitriptyline usually is prescribed (and continue to appoint) under the species of heavy depression accompanied by insomnia, anxiety and suicide risk. However, with it can be treated moderate and light depressive episodes like depressive neurosis – but after half an hour a patient can feel a desire to sleep after the patient’s receiving. By the way, not always: someone who takes it especially for a long time said that Elavil only slightly calms them or brakes. Everything as always depends on the individual biochemistry of the brain and the sensitivity of the individual.
Yes, it is a powerful drug and begins to act quickly. So what prevented to stop on it, forcing to look for other solutions? First of all it is a bouquet of side effects, more often than not fatal but quite unpleasant. This is a dry mouth, blurred vision and accommodation (with difficulty to focus, read), caused constipation, urinary retention and others. And yet – lowering of blood pressure (up to orthostatic collapse, that is, sudden fainting when standing up) and irregular heartbeat which is especially unpleasant and threatening for patients who already have heart problems.
Specifically imipramine was opened as one of the first antidepressants. It is also tricyclic – but, unlike amitriptyline, tricyclic of stimulating action. Perhaps due to the fact that the reuptake from the synaptic cleft of the same neurotransmitter as Amitriptyline blocks but in slightly different proportions particularly delaying those that provide stimulation.
Accordingly, the use of Imipramine for depression is accompanied by lethargy, apathy, loss of strength. Alternatively, when the treatment of severe depressive episode, anxiety and insomnia has already begun it gives lasting effect and now should be returned to the patient quality of life, to make as it were, the finishing touches before discharge from the hospital. The main danger – a reverse phase: that is, the person was treated for depression then he feels abruptly better and in a day – bam and here he has hypomania or even maximized manic state.
One of the ways to use Tofranil (not its main purpose) which took place once is a children’s functional enuresis. Were used small doses. And by reducing the depth of sleep (the effect is stimulating!) as well as some urinary retention which are capable of giving tricyclics – voila, the bed is dry. But now with the advent of new drugs and treatment strategies this method went down in history. Side effects that may occur (and by the way, may not be manifested) while taking Imipramine – basically the same as that of Amitriptyline. Plus, its stimulating effect may stimulate anxiety, psychomotor agitation and cause insomnia – which is why, incidentally, Tofranil traditionally taken in the first half of the day (if we do not treat enuresis).
If we compare the tricyclic antidepressants by the way they soothe or stimulate then Clomipramine would be somewhere in a middle position between Imipramine stimulant and sedative Amitriptyline, perhaps a little closer to the latter. From the whole set of neurotransmitters it is best to delay serotonin in the synaptic cleft. Not as hypnotic as Amitriptyline but rather gently soothing – despite the fact that on the depressed mood is also acts and quite quickly. Without the stimulus and spurring unnecessary anxiety and arousal effect as Imipramine, in some cases, sluggish, apathetic depression. It has approximately the same set of side effects as all tricyclics – but softer than Imipramine and Amitriptyline.
American doctors and pharmacists have noted cases when Clomipramine caused women orgasm during yawn – but this side effect, I think, gave to antidepressant only additional advertising but unfortunately Anafranil erection does not cause.
That was first 3 from top 6 antidepressants.