Tricyclic antidepressants

1. amitriptyline and imipramine o the first generation tricyclics o the most sedating: valuable if marked anxiety and insomnia o strongest anticholinergic side effects, e.g. constipation, blurred vision, prostatism

2. clomipramine, desipramine, dothiepin, doxepin, nortriptyline o less sedating and anticholinergic activity o nortriptyline is the least hypotensive of the tricyclics

Dosage: 50-75 mg (o) nocte, increasing every 2 to 3 days to 150 mg (o) nocte by day 7.

If no response after 2 to 3 weeks, increase by 25-50 mg daily at 2 to 3 week intervals (depending on adverse effects) to 200-250 mg (o) nocte. Trial for 6 weeks.

General adverse effects

• dry mouth, weight gain, constipation, sedation

glaucoma, urinary retention, tremor

• confusion and delirium in the elderly (caution in the elderly)

• sexual dysfunction

• postural hypotension

• cardiac conduction impairment (caution in heart disease)

• lowered seizure threshold

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