Depression and HIV
October 2003 View PDF En
español
Reprinted from www.aidsmeds.com,
US
Cyclic antidepressants side effects
Sedation
These cyclic antidepressant medications vary primarily by side effects.
Some are more sedative than others—that is, they make you
feel sleepy or fall asleep. This can be useful if you are suffering
from insomnia or troubling if it interferes with your daily activities.
Anticholinergic side effects
These drugs have what are referred to as anticholinergic side effects,
some drugs more than others. These side effects include dry mouth,
constipation, blurred near vision, and difficulty in urinating.
Dry mouth is the most frequent symptom. Sucking on hard candies,
especially citrus-flavored ones (preferably sugar-free ones for
the sake of your teeth) can alleviate it.
Orthostatic Hypotension
Sometimes cyclic antidepressants cause a drop in blood pressure
associated with change in posture that can lead to fainting or dizziness.
This is referred to as orthostatic hypotension. Standing up slowly
after being in a prone or squatting position can help prevent this.
Other side effects
- Norpramin (desipramine) and Tofranil (imipramine) are two of the
most widely prescribed cyclic antidepressants. Norpramin is one
of the least sedating of the cyclic antidepressants and causes fewer
anticholinergic side effects (dry mouth, etc.) than most other cyclic
medications. It can be monitored in the blood with blood tests to
determine if a therapeutic level is being reached. Norpramin causes
fewer anticholinergic symptoms than Tofranil but some psychiatrists
believe that it is less effective than Tofranil.
- Elavil (amitriptyline) is a very sedating and causes severe anticholinergic
side effects (such as dry mouth).
- Vivactil (protriptyline) has the advantage of possibly being energizing
and not causing weight gain. However, it has severe anticholinergic
side effects and can cause anxiety and insomnia.
- Ludiomil (maprotiline), Sinequan or Zonalon (doxepin), Surmontil
(trimipramine), and Asendin (amoxapine) are antidepressants that
are currently not widely used. They have no major advantages and
they have problems that make them generally less desirable than
other drugs. Ludiomil can increase the possibility of developing
seizures. Sinequan is believed by many psychiatrists to be less
effective than other cyclic antidepressants but is often used as
an effective and non-addicting sleeping pill. Asendin can cause
a serious and sometimes irreversible side effect known as tardive
dyskinesia, an involuntary movement of muscles.
- All of the cyclic antidepressants except Vivactil may cause weight gain.
- People with narrow angle glaucoma or certain heart rhythm irregularities
may not be able to take certain cyclic antidepressants.
Monoamine oxidase inhibitors (MAOIs) are antidepressants generally
used for patients who have not responded to other antidepressant
drugs. They are not usually the first choice but can be very effective
and seem to work well in certain patients who are considered to
have atypical depressions. They are particularly useful for people
who have depression combined with panic disorder, although other
antidepressants work for this purpose also. The following MAOIs
have comparable effectiveness and similar side effects:
BRAND
NAME |
GENERIC
NAME |
Monoamine
oxidase inhibitors (MAOIs):
Note: these pills can come in different shapes & colors,
based on dose and/or manufacturer. |
| Parnate |
tranylcypromine |
| Nardil |
phenelzine |
| Marplan |
isocarboxazid |
MAOIs have significant side effects. They provoke dangerously high
blood pressure when combined with a substance known as tyramine,
which is contained in some food, beverages, and drugs. If you take
MAOIs, you must avoid liver, cheese pizza, Chianti wine, certain
beers and cheeses, herring, bologna and some other sausages, and
a number of other foods as well as many cough and cold medications.
Any meat you eat must be fresh. Coffee and chocolate should be consumed
only in small amounts. If you take MAOIs you must get a dietary
restriction list from your doctor. If you eat a “forbidden”
food with no problem, you may still develop a severe reaction if
you eat that food again.
Psychostimulants, like those listed below, are useful in patients
with severe medical illness and especially for people those who
are withdrawn and apathetic. They are occasionally used for physically
healthy depressed people who do not respond to other medication.
They are energizing and work more rapidly than cyclic depressants
or MAOIs.
BRAND
NAME |
GENERIC
NAME |
Psychostimulants:
Note: these pills can come in different shapes & colors,
based on dose and/or manufacturer. |
| Dexedrine |
amphetamine |
| Ritalin |
methylphenidate |
| Cylert |
pemoline |
Dexedrine appears to be more effective than Ritalin. Cylert occasionally
causes serious liver damage and may be particularly risky for people
taking multiple drugs for HIV infection.
Side effects are jitters, insomnia, and loss of appetite and these
medications can be addictive. When used for recreational purposes,
these drugs have a high potential for abuse and addiction, which
is why they are not widely prescribed. This problem may be outweighed
by their utility in seriously ill patients (those with major symptomatic
medical problems). An overdose may lead to paranoid episodes with
loss of ability to judge reality.
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