Common side effects of antidepressants

1. withdrawal

gastrointestinal symptoms of nausea, vomiting and anorexia, accompanied by headache, giddiness, chills and insomnia, and sometimes by hypomania, panic-anxiety, and extreme motor restlessness may occur if an antidepressant (particularly MAOIs) is stopped suddenly after regular administration for 8 weeks or more. Therefore the dose should preferably be reduced gradually over about 4 weeks.

2. Cardiovascular side effects

Arrhythmias and heart block (tricyclic and relate antidepressants)


3. Central nervous system side effects

Convulsion (tricyclic and relate antidepressants)

4. Hepatic and renal effects

5. Other side effects

Amitriptyline Hydrochloride

structure of the amitriptyline

Indications

1. Depressive illness, particularly where sedation is required.
2. Nocturnal enuresis in children.

Cautions to be considered

1. cardiac diseases (arrhythmias)
2. Epilepsy
3. Pregnancy and breast feeding.
4. Elderly
5. Hepatic impairment
6. Thyroid diseases
7. Phaeochromocytoma
8. History of mania
9. Angle closure glaucoma
10. History of urinary retention

Contraindications (where you have to avoid Amitriptyline)

1. recent myocardial infarction
2. arrhythmias (particularly heart block)
3. severe liver disease

Side-effects

1. Dry mouth
2. sedation
3. blurred vision
4. constipation
5. cardiovascular side-effects (ECG changes, arrythmias)
6. syncope
7. behavioral disturbances
8. interference with sexual function
9. testicular enlargement
10. gynaecomastia

Dose

1. Depression; initially 75mg (elderly and adolescents 30-75mg)daily in divided doses or as a single dose at bed time increased gradually as necassary to 150-200mg; child under 16 years not recommended fordepression.
2. Nocturnal enuresis; child 7-10years 10-20mg: 11-16years 25-50mgat night. maximum period of treatment (including gradual withdrawal) 3 months, need a full physical examination before further course.

Amitriptyline preparations

1. tablets, coated, amitriptyline hydrochloride 10mg.
2. oral solution, amitriptyline hydrochloride 25mg/5ml.

Amoxapine

structure of the amoxapine

Indications

1. depressive illness

Cautions to be considered

1. cardiac diseases (arrhythmias)
2. Epilepsy
3. Pregnancy and breast feeding.
4. Elderly
5. Hepatic impairment
6. Thyroid diseases
7. Phaeochromocytoma
8. History of mania
9. Angle closure glaucoma
10. History of urinary retention

Contraindications (where you have to stop the drug)

1. recent myocardial infarction
2. arrhythmias (particularly heart block)
3. severe liver disease

Side-effects

1. tardive dyskinesia
2. menstrual irregularities
3. breast enlargement
4. galactorrhoea in women
5. Dry mouth
6. sedation
7. blurred vision
8. constipation
9. cardiovascular side-effects (ECG changes, arrythmias)
10. syncope
11. behavioral disturbances
12. interference with sexual function
13. testicular enlargement
14. gynaecomastia

Dose

Initially 100-150mgdaily in divided doses or as a single dose at bedtime increased as necessary to maximum300mg daily; ELDERLY initially 25mg twice daily increased as necessary after 5-7 days to maximum 50mg three times daily: CHILD under 16 years not recommended.

Amoxapine preparation

1. tablets, amoxapine 50mg (orange, scored)

Clomipramine Hydrochloride

Indications

1. depressive illness
2. phobic and obsessional states
3. adjuvant treatment of cataplexy associated with narcolepsy

Cautions to be considered

1. cardiac diseases (arrhythmias)
2. Epilepsy
3. Pregnancy and breast feeding.
4. Elderly
5. Hepatic impairment
6. Thyroid diseases
7. Phaeochromocytoma
8. History of mania
9. Angle closure glaucoma
10. History of urinary retention

Contraindications (where you have to avoid the drug)

1. recent myocardial infarction
2. arrhythmias (particularly heart block)
3. severe liver disease

Doses

• depressive illness

Initially 10 mg daily, increased gradually as necessary to 30 – 150 mg in divided doses or as a single dose at bed time; maximum dose 250 mg daily.
ELDERLY; initially 10 mg daily, increased carefully over approximately 10 days to 30-75 mg daily.
CHILD; not recommended.

• Phobic and obsessional states

Phobic and obsessional states, initially 25 mg daily (elderly; 10 mg daily) increased over 2 weeks to 100-150 mg daily. CHILD not recommended.

• adjuvant treatment of cataplexy associated with narcolepsy

initially 10 mg daily gradually increased until satisfactory response (range 10-75 mg daily)

Clomipramine preparation

1. capsules; 10 mg
2. tablets (slow release); 75 mg

Dosulepin Hydrochloride

Indications

1. Depressive illness, especially where sedation is required.

Cautions to be considered

1. cardiac diseases (arrhythmias)
2. Epilepsy
3. Pregnancy and breast feeding.
4. Elderly
5. Hepatic impairment
6. Thyroid diseases
7. Phaeochromocytoma
8. History of mania
9. Angle closure glaucoma
10. History of urinary retention

Contraindications (where you have to avoid the drug)

1. recent myocardial infarction
2. arrhythmias (particularly heart block)
3. severe liver disease

Doses

Initially 75 mg (ELDERLY 50-75 mg) daily in divided doses or as a single dose at bed time. Increased gradually as necessary to 150 mg daily (ELDERLY 75 mg may be sufficient); up to 225 mg daily in some circumstances (eg. Hospital use). CHILD not recommended.

Dosulepin preparations

1. capsule; 25 mg
2. tablets; 75 mg

Doxepin

Indications

1. Depressive illness, particularly where sedation is required.

Cautions to be considered

1. cardiac diseases (arrhythmias)
2. Epilepsy
3. Pregnancy and breast feeding.
4. Elderly
5. Hepatic impairment
6. Thyroid diseases
7. Phaeochromocytoma
8. History of mania
9. Angle closure glaucoma
10. History of urinary retention

Contraindications (where you have to avoid the drug)

1. recent myocardial infarction
2. arrhythmias (particularly heart block)
3. severe liver disease

Doses

Initially 75 mg daily in divided doses or as a single dose at bed time, increased as necessary to maximum 300 mg daily in three divided doses (up to 100 mg may be given as a single dose)

ELDERLY; initially 10-50 mg daily, range of 30-50 mg daily may be adequate

CHILD; not recommended

Doxepin preparations

1. capsule; 10 mg

Imipramine Hydrochloride (a Tricyclic antidepressant)

Indications

1. depressive illness
2. nocturnal enuresis of children


Cautions to be considered

1. cardiac diseases (arrhythmias)
2. Epilepsy
3. Pregnancy and breast feeding.
4. Elderly
5. Hepatic impairment
6. Thyroid diseases
7. Phaeochromocytoma
8. History of mania
9. Angle closure glaucoma
10. History of urinary retention

Contraindications (where you have to avoid the drug)

1. recent myocardial infarction
2. arrhythmias (particularly heart block)
3. severe liver disease

Doses

1. depression

Initially up to 75 mg daily in divided doses increased gradually to 150-200 mg (up to 300 mg in hospitalized patients); up to 150 mg may be given as a single dose at bed time.

ELDERLY; initially 10 mg daily, increased gradually up to 30-50 mg daily.

CHID; not recommended for depression.

2. nocturnal enuresis

CHILD up to 7years 25 mg, 8-11 years 25-50 mg, over 11 years 50-75 mg at bed time. Maximum period of treatment (including gradual withdrawal) 3 months, full physical examination before further course.

Preparations

1. tablets, red brown, 10 mg and 25 mg.