Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e
Chapter 171. Cyclic Antidepressants
Sections: Epidemiology, Pathophysiology, Pharmacokinetics, Toxicity, Clinical Features, Diagnosis, Treatment, Disposition and Follow-Up, References.
Topics Discussed: antidepressive agents; antidepressive agents, tricyclic.
Cyclic antidepressants are considered first-generation antidepressants, along
with monamine oxidase inhibitors (see Chapter 173,
Monamine Oxidase Inhibitors). Although they have different
mechanisms of action, both classes have in common a nonspecific
pharmacologic approach to treating depression, low therapeutic index,
troublesome side effects, and the potential to produce severe toxicity
in overdose. Second-generation antidepressants (see Chapter 172, Atypical Antidepressants, Serotonin Reuptake Inhibitors, and Serotonin Syndrome) have been developed over the past 30 years
with more specific mechanisms of action, higher therapeutic index,
fewer side effects, and considerably greater safety in overdose
compared with the first-generation antidepressants. Although cyclic
antidepressants are currently considered second-line therapy for treating
major depression, they are frequently used in treating other psychiatric
and medical conditions such as obsessive-compulsive disorder, attention-deficit
disorder, panic and phobia disorders, anxiety disorders, eating
disorders, insomnia, chronic pain syndromes, fibromyalgia, irritable
bowel syndrome, peripheral neuropathies, and nocturnal enuresis, as
well as for migraine headache prophylaxis and drug-withdrawal..."
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