Tricyclics Antidepressants Side Effects in Social Phobia/Anxiety Disorder|
Social Anxiety Shyness Info
In this series of consecutive
articles, we examine several aspects related to the side effects
of medications used in the treatment of Social Phobia / Anxiety
Disorder and excessive Shyness. However, such topics will not be
wholly exhausted in this series and we may come back to them in
future articles. We will use concepts and information from other
articles. If anything in this article is not clear to you, in
all likelihood it may become clear if previous articles from the
series and others in this website are read or reread. Such
articles from this website are, among others:
Social Phobia/Anxiety Disorder:
and Social Anxiety Disorder: Neurophysiological Approach,
Social Anxiety Disorder: Medication Action
Tricyclics antidepressants are, in Social Phobia/Social Anxiety
Disorder, as in depressions, third-line medications,
especially due to the frequency, intensity and inconvenience
of the side effects they cause. Prior to mentioning
the most common side effects, I will go into other issues,
in addition to those already dealt with in a
previous article, to help understand this theme.
-- What are tricyclics antidepressants?
-- How do tricyclics antidepressants act?
-- Why do the tricyclics antidepressants produce similar effects?
What tricyclics antidepressants are - They
are a set of substances whose common basic chemical structure
comprises three rings of carbon and hydrogen (see images below). The rings are interlinked and
a side chain of carbon, nitrogen and hydrogen atoms
comes out of the middle ring. The differences among the various
tricyclics are due to minor changes in this side chain and
to the presence or absence of nitrogen in the middle ring.
The three-cycle or three-ring concept comes from the
molecule's planar image. Planar image is the molecule's representation in
one sole plane, as in the images above, and is used in teaching chemistry
in high schools and universities. Upon examining the images, one can
observe how the differences between them are small.
How tricyclics antidepressants act - They act
in several biological substances and, thus, are able
to alter the function of many organs. For instance, in all likelihood
they inhibit serotonin and noradrenalin re-uptake in the neurons
and partly block the action of another neurotransmitter, acetylcholine.
Why they produce similar side effects - The
side effects are similar because the molecules display many
structural similarities and, probably, because the part which
least undergoes changes - the three-ring set and the side
sequence of three carbon atoms - plays a paramount role in
its action on other biologic substances.
Tricyclics' Undesirable Side Effects
The more common side effects are
due to the partial blocking of acetylcholine. They
are dry mouth, intestinal constipation, urinary hesitation,
and orgasm delay. These effects occur in most people.
Other effects, of average frequency, are pupil
dilation, interference with the libido, nausea, appetite increase
or decrease, convulsions (mainly when associated with alcohol
and/or when the person is epileptic, even when taking anticonvulsive),
tremor (especially shaky hands), headache, and cardiac arrhythmia.
Other side effects are less common but make
up a long list.
The intensity of side effects varies from person to
person and tends to reduce in the range from
3 to 15 days. In most people, these effects are found at a bearable
level and do not disturb their daily activities. However,
in some persons the intensity remains high and, in some
cases, it is best that the medication be withdrawn.
It seems that the long use of these
medications may bring about some irreversible alterations whose onset is imperceptible. A case in point is hypothyroidism.
Hence, the convenience of regular control with a physician and
overall bodily evaluation.
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