Bicyclic Antidepressants

Bicyclic Antidepressants

Antidepressants, despite their name, are often used to treat other conditions, on- or off-label, for conditions such as anxiety disorders, obsessive compulsive disorder, eating disorders, chronic pain, and some hormone-mediated disorders such as dysmenorrhea, and for snoring, migraines, attention-deficit hyperactivity disorder (ADHD) and substance abuse. Antidepressants are used either alone or combination with other medications. Most antidepressants have a delayed onset of action (2–6 weeks) but for responders, efficacy is often seen after one week.

For depression, a systematic review of anti-depressant efficacy, published in 2012, failed to demonstrate superior effectiveness of anti-depressants compared to psychotherapy, alternative therapy such as exercise, acupuncture and relaxation, or active intervention controls such as sham acupuncture or therapies not specific to depression.

Many off-label drugs can produce an antidepressant effect, but their use is controversial. Opioids were used to treat major depression until the late 1950s.Amphetamines were used until the mid-1960s. Scant research on the use of opioids limit their use for the treatment of depression, whereas amphetamines have found a thriving market for conditions as widely arrayed as attention deficit disorder, narcolepsy, and obesity, and continue to be studied for myriad applications. Both opioids and amphetamines induce a therapeutic response very quickly, showing results within twenty-four to forty-eight hours; the therapeutic ratios for both opioids and amphetamines are greater than those of the tricyclic anti-depressants. In a small study published in 1995, the opioid buprenorphine was shown to have potential for treating severe, treatment-resistant depression. The nutritional supplement tryptophan is also used in treating some forms of seasonal depression or in combination with use of bright light exposure.

Low dose antipsychotics are also used, as are benzodiazepines, and St John's wort. The use of benzodiazepines can cause a physical dependence. Abrupt benzodiazepine discontinuation can induce life threatening seizures, and intense withdrawal symptoms. Antipsychotics can have severe long term negative effects, such as tardive dyskinesia, brain atrophy, and metabolic syndrome Inert placebos can also have significant antidepressant effects.

Non pharmaceutical approaches to the treatment of depression include psychotherapy, cognitive-behavioural therapy, electro-convulsive therapy, acupuncture, exercise, sleep deprivation, or bright light exposure.

Read more about Bicyclic Antidepressants:  History, Therapeutic Efficacy, Controversy, Publication Bias, Adverse Effects