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Dr. Vijayakumar D.R MBBS, DPM, DNB (NIMHANS), CCST (UK)
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Cyclic Antidepressants

PATIENT INFORMATION ON CYCLIC ANTIDEPRESSANTS

The name of your medication is amitriptyline, imipramine,clomipramine etc.

Use

Cyclic antidepressants are primarily used in the treatment of major depressive disorders and depression associated with Manic Depressive Illness (Bipolar Disorder).

Certain drugs in this class have also been found effective in several other disorders including obsessive compulsive disorder, panic disorder, bulimia, management of chronic pain conditions (e. g., migraines) and enuresis in children.

How quickly will the drug start working?

Antidepressants begin to improve sleep and appetite and to increase energy within about one week; however, feelings of depression may take from 4 to 6 weeks to improve. Because antidepressants take time to work, do not decrease or increase the dose or stop the medication without discussing this with your doctor.

Improvement in symptoms of obsessive compulsive disorder, panic disorder and bulimia, pain management and enuresis also occur gradually.

How long should you take this medication?

Following the first episode of depression it is recommended that antidepressants be continued for a minimum of one year; this decreases the chance of being ill again. The doctor may then decrease the drug slowly and monitor for any symptoms of depression; if none had several episodes of depression, antidepressant medication should be continued indefinitely.

For individuals who have had several episodes of depression, antidepressant medication should be continued indefinitely.

Long-term treatment is generally recommended for obsessive compulsive disorder, panic disorder, bulimia, pain management and enuresis.

Side effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed. If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor at the next appointment include:

  • Drowsiness and lethargy-This problem goes away with time. Use of other drugs that make you drowsy will worsen the problem. Avoid driving a car or operating machinery if drowsiness persists.
  • Energizing/agitated feeling-Some individuals may feel nervous or have difficulty sleeping for a few days after starting this medication. Report this to your doctor; he/she may advise you to take the medication in the morning.
  • Blurred vision-This usually occurs at the start of treatment and tends to be temporary. Reading under a bright light or at a distance may help; a magnifying glass can be of temporary use. If the problem continues, advise your doctor.
  • Dry mouth-Sour candy and sugarless gum help increase saliva in your mouth; try to avoid sweet, calorie-laden beverages. Drink water and brush your teeth regularly.
  • Constipation-Increase bulk foods in your diet(e.g., salads, bran) and drink plenty of fluids. Some individuals find a bulk laxative (e.g., isapgul) or a stool softener helps regulate their bowels. If these remedies are not effective, consult your doctor or pharmacist.
  • Headache-This tends to be temporary and can be managed by taking analgesics ( Paracetamol, aspirin, acetaminophen) when required.
  • Nausea or heartburn-If this happens, take the medication with food. 
  • Dizziness- Get up from a lying or sitting position slowly; dangle your legs over the edge of the bed for a few minutes before getting up. Sit or lie down if dizziness persists or if you feel faint, then contact your doctor.
  • Sweating You may sweat more than usual; frequent showering, use of deodorants and talcum powder may help.
  • Muscle tremor, twitching- Speak to your doctor as this may require an adjustment in your dosage.
  • Changes in sex drive or sexual performance-Discuss this with your doctor.
  • Nightmares- Can is managed by changing the dosing schedule.

Rare side effects you should report to your doctor IMMEDIATELY include:

  • Soreness of the mouth, gums, or throat
  • Skin rash or itching, swelling of the face
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu-like symptoms
  • Yellow tinge in the eyes or to the skin; dark-colored urine
  • Inability’ to pass urine (more than 24 hours)
  • Inability to have a bowel movement (more than 2-3 days)
  • Tingling in the hands and feet, severe muscle twitching
  • Severe agitation or restlessness
  • Switch in mood to an unusual state of happiness, excitement, irritability, or a marked disturbance in sleep

Let your doctor know as soon as possible if you miss your period or suspect you may be pregnant.

What should you do if you forget to take a dose of your medication?

If you take your total dose of antidepressant in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with schedule the next day. DO NOT DOUBLE THE DOSE. If you take the drug several times a day, take the missed dose when you remember, then continue with your regular schedule.

Interactions with other medication

Because antidepressant drugs can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the-counter medication such as cold remedies. Always inform any doctor or dentist that you see that you are taking an antidepressant drug.

Precautions

  1. Do not increase or decrease your dose without consulting your doctor.
  2. Take your drug with meals or with water, milk orange or apple juice; avoid grapefruit juice as it may interfere with the effect of the drug.
  3. This drug may impair the mental and physical abilities required for driving a car or operating machinery. Avoid these activities if you feel drowsy or slowed down.
  4. This drug may increase the effects of alcohol, making you more sleepy, dizzy and lightheaded.
  5. Avoid exposure to extreme heat and humidity since this drug may affect your body’s ability to regulate temperature.
  6. Do not stop your drug suddenly as this may result in withdrawal symptoms such as muscle aches, chills, tingling in your hands or feet, nausea, vomiting, and dizziness.
  7. Report any changes in mood or behavior to your physician.
  8. This drug may interact with medication prescribed by your dentist, so let him/her know the name of the drug you are taking.
  9. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children. 

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse.