1-Tricyclic & tetracyclic antidepressants (TCAs).
Inhibit the reuptake of the
neurotransmitters 5HT& NE into
their respective nerve terminals.
After serotonin and norepinephrine are released from neurons,
they are removed from the extracellular space by transporters
(also known as reuptake sites)
Indications of TCAs: Side effects of TCAs:
1) major depressive disorder: 1. Dependence.
The treatment & propohylaxis of major depression, 2. Anticholinergic effects:
also they are effective in the treatment of Dry mouth, Constipation, Urinary retention, Blurred vision,
depression in: Narrow angle glaucoma
! Bipolar I disorder Overdoses of TCAs:
! Melancholic features 3. Autonomic effects: orthostatic hypotension.
Agitation, delirium, hyperactive deep
! Major depressive episode with psychotic 4. Cardiac effects: ECG changes, Tachycardia &
features arrhythmias. tendon reflexes, convulsions,
5. Allergic & hematological effects: Skin rash in pts mydriasis, bowel & bladder
2) Mood disorder due to a general medical treated with maprotiline.
6. Neurological effects: Anticholinergic-induced
paralysis, dysregulation of blood
condition with depressive features
3) Panic disorder with agoraphobia delirium, Psychomotor stimulation, Tremors & pressure & tempreature, coma &
4) Generalized anxiety disorder Myoclonic twitches of the tongue & upper respiratory depression
5) Obsessive compulsive disorder extremities
6) Eating disorders (Bulimia & anorexia nervosa) 7. Sedation.
7) Pain disorder 8. Endocrine and sexual effects: Impotence,
8) Other disorders: as PTSD, Sleep walking hyperprolactenmia,
disorder, Childhood enuresis, Peptic ulcer galactorrhea, anorgasmia, amenorrhea & ejaculatory
Nacrolepsy, Nightmare disorder, Separation disturbances often associated with amoxapine because drug Trade name
anxiety disorder. blockade of dopamine receptors.
9. Other side effects: Weight gain, nausea, vomiting.
Management: Tofranil
1. Stop the medication, there is no specific antidote.
2. Increase fluids intake. Anafranil
3. Supportive treatment.
4. Monitor the pt for cardiac arrahythmias for 3-4 days after the over dose.
Nurse Role:-
! Reassure the patient that drowsiness ,dizziness ,hypotension usually subside after the first few
weeks.
! Alcohol can block the effects of antidepressant, ask the patient to refrain from drinking.
! Assess the patient for abdominal distension.
! Avoid sudden stopping TCAs, it can cause nausea, altered heart beat, cold sweats in 2 or
4days.
Inhibit the reuptake of the
neurotransmitters 5HT& NE into
their respective nerve terminals.
After serotonin and norepinephrine are released from neurons,
they are removed from the extracellular space by transporters
(also known as reuptake sites)
Indications of TCAs: Side effects of TCAs:
1) major depressive disorder: 1. Dependence.
The treatment & propohylaxis of major depression, 2. Anticholinergic effects:
also they are effective in the treatment of Dry mouth, Constipation, Urinary retention, Blurred vision,
depression in: Narrow angle glaucoma
! Bipolar I disorder Overdoses of TCAs:
! Melancholic features 3. Autonomic effects: orthostatic hypotension.
Agitation, delirium, hyperactive deep
! Major depressive episode with psychotic 4. Cardiac effects: ECG changes, Tachycardia &
features arrhythmias. tendon reflexes, convulsions,
5. Allergic & hematological effects: Skin rash in pts mydriasis, bowel & bladder
2) Mood disorder due to a general medical treated with maprotiline.
6. Neurological effects: Anticholinergic-induced
paralysis, dysregulation of blood
condition with depressive features
3) Panic disorder with agoraphobia delirium, Psychomotor stimulation, Tremors & pressure & tempreature, coma &
4) Generalized anxiety disorder Myoclonic twitches of the tongue & upper respiratory depression
5) Obsessive compulsive disorder extremities
6) Eating disorders (Bulimia & anorexia nervosa) 7. Sedation.
7) Pain disorder 8. Endocrine and sexual effects: Impotence,
8) Other disorders: as PTSD, Sleep walking hyperprolactenmia,
disorder, Childhood enuresis, Peptic ulcer galactorrhea, anorgasmia, amenorrhea & ejaculatory
Nacrolepsy, Nightmare disorder, Separation disturbances often associated with amoxapine because drug Trade name
anxiety disorder. blockade of dopamine receptors.
9. Other side effects: Weight gain, nausea, vomiting.
Management: Tofranil
1. Stop the medication, there is no specific antidote.
2. Increase fluids intake. Anafranil
3. Supportive treatment.
4. Monitor the pt for cardiac arrahythmias for 3-4 days after the over dose.
Nurse Role:-
! Reassure the patient that drowsiness ,dizziness ,hypotension usually subside after the first few
weeks.
! Alcohol can block the effects of antidepressant, ask the patient to refrain from drinking.
! Assess the patient for abdominal distension.
! Avoid sudden stopping TCAs, it can cause nausea, altered heart beat, cold sweats in 2 or
4days.
