Tricyclic antidepressants: An update

Authors

DOI:

https://doi.org/10.33448/rsd-v13i4.45539

Keywords:

Tricyclic antidepressive agents; Mental disorders; Psychotropic drugs; Therapeutic uses; Drug-related side effects and adverse reactions.

Abstract

Tricyclic antidepressants (TCAs) are a class of psychotropic medications primarily used in the treatment of major depressive disorders, although their indications extend to a variety of psychiatric and neurological conditions. This class of medications was one of the first to be developed for the treatment of depression, marking a revolution in the management of this condition in the mid-20th century. The aim of this study is to present a narrative review in the form of an update on the pharmacokinetic properties, pharmacodynamics, indications, and side effects of tricyclic antidepressants. For this purpose, a narrative review in the format of an update was carried out, which analyzed 42 manuscripts. TCAs have various pharmacological and therapeutic properties, low cost, but their major limitation is their side effects. Since the clinical trials for this class were conducted well before the launch of new antidepressants, new research is needed to allow comparison of these groups within the same methodology and with more up-to-date statistics.

References

Aigner, M., Treasure, J., Kaye, W., Kasper, S., & Disorders, W. T. F. O. E. (2011). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of eating disorders. World J Biol Psychiatry, 12 (6), 400-443. https://doi.org/10.3109/15622975.2011.602720

Arroll, B., Macgillivray, S., Ogston, S., Reid, I., Sullivan, F., Williams, B., & Crombie, I. (2005). Efficacy and tolerability of tricyclic antidepressants and SSRIs compared with placebo for treatment of depression in primary care: a meta-analysis. Ann Fam Med, 3 (5), 449-456. https://doi.org/10.1370/afm.349

Bakker, A., van Balkom, A. J., & Spinhoven, P. (2002). SSRIs vs. TCAs in the treatment of panic disorder: a meta-analysis. Acta Psychiatr Scand, 106 (3), 163-167. https://doi.org/10.1034/j.1600-0447.2002.02255.x

Baldaçara, L. (2021). Emergências Psiquiátricas. In A. G. da Silva, A. E. Nardi, & A. P. Diaz (Eds.), Programa de Educação Continuada em Psiquiatria (PEC-ABP). Temas fundamentais (1 ed., pp. 267-282). Artmed.

Baldaçara, L., Cordeiro, D. C., Calfat, E. L. B., Cordeiro, D. C., & Chung, T. C. (2019). Emergências Psiquiátricas (2, Ed.). Elsevier.

Baldaçara, L., & da Silva, A. G. (2021). Suporte em Emergências Psiquiátricas (SEP) (1 ed.). AMPLA.

Baldaçara, L., Grudtner, R. R., Leite, V. S., Porto, D. M., Robis, K. P., Fidalgo, T. M., Rocha, G. A., Díaz, A. P., Meleiro, A., Correa, H., Tung, T. C., Malloy-Diniz, L. F., & da Silva, A. G. (2021). Brazilian guidelines for the management of suicide behavior. Part 2. Screening, intervention, and prevention. Braz J Psychiatry, Forthcoming 2020.

Baldaçara, L., Pettersen, A. G., Leite, V. D. S., Ismael, F., Motta, C. P., Freitas, R. A., Fasanella, N. A., Pereira, L. A., Barros, M. E. L., Barbosa, L., Teles, A. L. S., Palhano, R., Guimaraes, H. P., Braga, M. A., Castaldelli-Maia, J. M., Bicca, C., Gligliotti, A., Marques, A., & da Silva, A. G. (2022). Brazilian Psychiatric Association Consensus for the Management of Acute Intoxication. General management and specific interventions for drugs of abuse. Trends Psychiatry Psychother. https://doi.org/10.47626/2237-6089-2022-0571

Baldaçara, L., Rocha, G. A., Leite, V. D. S., Porto, D. M., Grudtner, R. R., Diaz, A. P., Meleiro, A., Correa, H., Tung, T. C., Quevedo, J., & da Silva, A. G. (2021). Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment. Braz J Psychiatry. https://doi.org/10.1590/1516-4446-2020-0994

Baldaçara, L., & Tung, T. C. (2020). Condutas em psiquiatria. Manole.

Baldaçara, L., Weber, C. A. T., Gorender, M., Grudtner, R. R., Peu, S., Teles, A. L. S., Cavalcante, I. P., Quevedo, J., & da Silva, A. G. (2022). Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 3. Suicide prevention hotlines. Braz J Psychiatry. https://doi.org/10.47626/1516-4446-2022-2536

Bandelow, B. (2008). The medical treatment of obsessive-compulsive disorder and anxiety. CNS Spectr, 13 (9 Suppl 14), 37-46. https://doi.org/10.1017/s1092852900026924

Bandelow, B., Reitt, M., Rover, C., Michaelis, S., Gorlich, Y., & Wedekind, D. (2015). Efficacy of treatments for anxiety disorders: a meta-analysis. Int Clin Psychopharmacol, 30 (4), 183-192. https://doi.org/10.1097/YIC.0000000000000078

Barbara, G., Cremon, C., Bellini, M., Corsetti, M., Di Nardo, G., Falangone, F., Fuccio, L., Galeazzi, F., Iovino, P., Sarnelli, G., Savarino, E. V., Stanghellini, V., Staiano, A., Stasi, C., Tosetti, C., Turco, R., Ubaldi, E., Zagari, R. M., Zenzeri, L., & Marasco, G. (2023). Italian guidelines for the management of irritable bowel syndrome: Joint Consensus from the Italian Societies of: Gastroenterology and Endoscopy (SIGE), Neurogastroenterology and Motility (SINGEM), Hospital Gastroenterologists and Endoscopists (AIGO), Digestive Endoscopy (SIED), General Medicine (SIMG), Gastroenterology, Hepatology and Pediatric Nutrition (SIGENP) and Pediatrics (SIP). Dig Liver Dis, 55 (2), 187-207. https://doi.org/10.1016/j.dld.2022.11.015

Bezerra, T. P. T., Fabrício, A. I. C. R., Minervino, A. J., & Santos, R. M. d. (2023). Psychoactive drugs and metabolic disorders. Debates em Psiquiatria, 13, 1-20. https://doi.org/10.25118/2763-9037.2023.v13.439

Brasil. (2024). Listas de preços de medicamentos. Ministério da Saúde - ANVISA. https://www.gov.br/anvisa/pt-br/assuntos/medicamentos/cmed/precos

Caldwell, P. H., Sureshkumar, P., & Wong, W. C. (2016). Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database Syst Rev, 2016 (1), CD002117. https://doi.org/10.1002/14651858.CD002117.pub2

Calvi, A., Fischetti, I., Verzicco, I., Belvederi Murri, M., Zanetidou, S., Volpi, R., Coghi, P., Tedeschi, S., Amore, M., & Cabassi, A. (2021). Antidepressant Drugs Effects on Blood Pressure. Frontiers in Cardiovascular Medicine, 8. https://doi.org/10.3389/fcvm.2021.704281

Chan, H. N., Fam, J., & Ng, B. Y. (2009). Use of antidepressants in the treatment of chronic pain. Ann Acad Med Singap, 38 (11), 974-979. https://www.ncbi.nlm.nih.gov/pubmed/19956820

Chang, L., Sultan, S., Lembo, A., Verne, G. N., Smalley, W., & Heidelbaugh, J. J. (2022). AGA Clinical Practice Guideline on the Pharmacological Management of Irritable Bowel Syndrome With Constipation. Gastroenterology, 163 (1), 118-136. https://doi.org/10.1053/j.gastro.2022.04.016

Chinn, S., Caldwell, W., & Gritsenko, K. (2016). Fibromyalgia Pathogenesis and Treatment Options Update. Curr Pain Headache Rep, 20 (4), 25. https://doi.org/10.1007/s11916-016-0556-x

Everitt, H., Baldwin, D. S., Stuart, B., Lipinska, G., Mayers, A., Malizia, A. L., Manson, C. C., & Wilson, S. (2018). Antidepressants for insomnia in adults. Cochrane Database Syst Rev, 5 (5), CD010753. https://doi.org/10.1002/14651858.CD010753.pub2

Gillman, P. K. (2007). Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacol, 151 (6), 737-748. https://doi.org/10.1038/sj.bjp.0707253

Guaiana, G., Meader, N., Barbui, C., Davies, S. J., Furukawa, T. A., Imai, H., Dias, S., Caldwell, D. M., Koesters, M., Tajika, A., Bighelli, I., Pompoli, A., Cipriani, A., Dawson, S., & Robertson, L. (2023). Pharmacological treatments in panic disorder in adults: a network meta-analysis. Cochrane Database Syst Rev, 11 (11), CD012729. https://doi.org/10.1002/14651858.CD012729.pub3

Kerr, G. W. (2001). Tricyclic antidepressant overdose: a review. Emergency Medicine Journal, 18 (4), 236-241. https://doi.org/10.1136/emj.18.4.236

Lenze, E. J., Mulsant, B. H., Roose, S. P., Lavretsky, H., Reynolds, C. F., Blumberger, D. M., Brown, P. J., Cristancho, P., Flint, A. J., Gebara, M. A., Gettinger, T. R., Lenard, E., Miller, J. P., Nicol, G. E., Oughli, H. A., Pham, V. T., Rollman, B. L., Yang, L., & Karp, J. F. (2023). Antidepressant Augmentation versus Switch in Treatment-Resistant Geriatric Depression. New England Journal of Medicine, 388 (12), 1067-1079. https://doi.org/10.1056/NEJMoa2204462

Marazziti, D., Albert, U., Dell'Osso, B., Tundo, A., Cuniberti, F., Maina, G., Moroni, I., Benatti, B., Mucci, F., Massimetti, G., Piccinni, A., & Brakoulias, V. (2017). Italian prescribing patterns in obsessive-compulsive disorder. Hum Psychopharmacol, 32 (6). https://doi.org/10.1002/hup.2641

Moraczewski, J., Awosika, A. O., & Aedma, K. K. (2024). Tricyclic Antidepressants. StatPearls.

Moraczewski, J., Awosika, A. O., & Aedma, K. K. (2024). Tricyclic Antidepressants. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/32491723

Nascimento, C. d. P., Couto, H. Z., Baldaçara, L., Silva, A. G. d., Mello, M. F. d., & Mello, A. F. d. (2023). Pharmacological treatment of post-traumatic stress disorder: a treatment guide based on a systematic literature review. Debates em Psiquiatria, 13, 1-72. https://doi.org/10.25118/2763-9037.2023.v13.1037

Ogawa, Y., Takeshima, N., Hayasaka, Y., Tajika, A., Watanabe, N., Streiner, D., & Furukawa, T. A. (2019). Antidepressants plus benzodiazepines for adults with major depression. Cochrane Database Syst Rev, 6 (6), CD001026. https://doi.org/10.1002/14651858.CD001026.pub2

Özkaya, E., Babuna Kobaner, G., Yılmaz, Z., & Kutlay, A. (2019). Doxepin in difficult‐to‐treat chronic urticaria: A retrospective, cross‐sectional study from Turkey. Dermatologic Therapy. https://doi.org/10.1111/dth.12993

Royal, A., New Zealand College of Psychiatrists Clinical Practice Guidelines Team for Panic, D., & Agoraphobia. (2003). Australian and New Zealand clinical practice guidelines for the treatment of panic disorder and agoraphobia. Aust N Z J Psychiatry, 37 (6), 641-656. https://doi.org/10.1080/j.1440-1614.2003.01254.x

Saarto, T., & Wiffen, P. J. (2007). Antidepressants for neuropathic pain. Cochrane Database Syst Rev, 2007 (4), CD005454. https://doi.org/10.1002/14651858.CD005454.pub2

Schneider, J., Patterson, M., & Jimenez, X. F. (2019). Beyond depression: Other uses for tricyclic antidepressants. Cleve Clin J Med, 86 (12), 807-814. https://doi.org/10.3949/ccjm.86a.19005

Shaha, D. (2023). Insomnia Management: A Review and Update. J Fam Pract, 72 (06 Supp). https://doi.org/10.12788/jfp.0620

Skaer, T. L. (2014). Fibromyalgia: disease synopsis, medication cost effectiveness and economic burden. Pharmacoeconomics, 32 (5), 457-466. https://doi.org/10.1007/s40273-014-0137-y

Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333-339. https://doi.org/10.1016/j.jbusres.2019.07.039

Thouaye, M., & Yalcin, I. (2023). Neuropathic pain: From actual pharmacological treatments to new therapeutic horizons. Pharmacol Ther, 251, 108546. https://doi.org/10.1016/j.pharmthera.2023.108546

Ulrich, S., Ricken, R., Buspavanich, P., Schlattmann, P., & Adli, M. (2020). Efficacy and Adverse Effects of Tranylcypromine and Tricyclic Antidepressants in the Treatment of Depression: A Systematic Review and Comprehensive Meta-analysis. J Clin Psychopharmacol, 40 (1), 63-74. https://doi.org/10.1097/JCP.0000000000001153

Undurraga, J., & Baldessarini, R. J. (2017). Direct comparison of tricyclic and serotonin-reuptake inhibitor antidepressants in randomized head-to-head trials in acute major depression: Systematic review and meta-analysis. J Psychopharmacol, 31 (9), 1184-1189. https://doi.org/10.1177/0269881117711709

Zohar, J., & Westenberg, H. G. (2000). Anxiety disorders: a review of tricyclic antidepressants and selective serotonin reuptake inhibitors. Acta Psychiatr Scand 403, 39-49. https://doi.org/10.1111/j.1600-0447.2000.tb10947.x

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Published

14/04/2024

How to Cite

BALDAÇARA, L.; FREITAS, R.; BALDAÇARA, R. P. de C. . Tricyclic antidepressants: An update. Research, Society and Development, [S. l.], v. 13, n. 4, p. e4413445539, 2024. DOI: 10.33448/rsd-v13i4.45539. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/45539. Acesso em: 16 nov. 2024.

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Health Sciences