Amitriptyline: Tricyclic Antidepressant (T

Individuals taking tricyclic antidepressants (TCA) for major depression sometimes use these same drugs to attempt suicide. Unresolved depression can lead to individuals taking further drastic measures to deal with their emotional dissatisfaction. While TCA’s may not always be the most lethal drugs, an overdose can still have life threatening consequences. Following overdose of TCA’s, early identification of predictive symptoms for life endangering seizures and ventricular arrhythmias could allow healthcare providers the opportunity to take preventative measures and thus save lives.

My primary concern is Jane’s immediate and complete discontinuation of her antidepressant, Paxil. In doing so, Jane is at risk for developing side effects, more specifically serotonin discontinuation syndrome. Common symptoms of discontinuation syndrome include general somatic symptoms (dizziness, lethargy, headaches), sleep disturbance, gastrointestinal symptoms (nausea, vomiting, diarrhea) and affective symptoms (anxiety/agitation, irritability, low mood). Rare, but more severe symptoms include extrapyramidal symptoms and movement disorders including akathisia and parkinsonism and visual and auditory hallucinations (Haddad, 2001; Ferguson, 2001; Furukori and Kaneko, 2011). Notably, abrupt discontinuation of psychotropic medication in depressed patients can be associated with worsening depressive symptoms and increased suicidal ideation (Tint et.al, 2008).

Since Bipolar Disorder involves the cycling between two different states of mania and major depression, there are many different etiological factors in play. The neurotransmitters that are involved in this disease are serotonin, norepinehrine and dopamine. There has been some preliminary research involved with glutamate as well. In patients with the depressive portion of Bipolar Disorder, Serotonin levels were found to be lower than healthy, non-depressed patients (Young, Warsh, Kish, Shannak & Hornykeiwicz, 1994). Young et. al. (1994) found reduced amounts serotonin’s metabolite, 5-HIAA, in frontal and parietal lobes of deceased bipolar disorder patients. Norepinehphrine was also found to be lower as well. During the depressed state of bipolar disorder, the concentration of norepinehphrine ‘s synthesis enzyme, tyrosine hydroxylase, was lower in the locus coeruleus than patients who only had depression and not Bipolar Disorder (Wiste, Arango, Ellis, Mann, & Underwood, 2008). Although in the mania cycle of Bipolar Disorder, Norepinephrine is found to be elevated in the brain (Manji & Lenox,2000). Furthermore, Dopamine was also found to be lower in the brain as well during the depressed state of Bipolar disorder. According to a study by Vawter, Freed, Kleinman (2000), the concentration of the metabolite of dopamine, homovanillic acid, was found to be significantly lower in the parietal lobe of the brain. Dopamine Agonists, while they can treat the depression cycle of the disorder, can also bring about the mania in the disorder; therefore, the pharmacological treatment of the Bipolar disorder must be regulated heavily so that the treatment itself doesn’t exacerbate the disorder instead of treat the disorder (Manji et. al. 2003). ...

Patients taking this drug might encounter side effects such as loss of appetite, cough, diarrhea, headache, constipation, change in body fat distribution, fatigue, nausea, skin rashes, and vomiting. Some of the life threatening symptoms include liver problems, severe anemia, muscle disease, pneumonia, tuberculosis, and decreased white blood cells.

The gastric emptying might have taken place because of the simultaneous ingestion of amitriptyline and olanzapine. There were no symptoms of any main antidepressant or antipsychotic poisoining however, this might be an aloof possibility for causing this. The hepatotoxicity can also be produced by Valporate. But, the serum valproate levels were examined for 2 days after the ...

Calcium channel blockers, also called calcium antagonists, are drugs that lower blood pressure by preventing calcium ions from entering cells of the heart and blood vessel walls. They relax and widen these vessels by working on the cells in the muscles of the arterial walls by serving as antagonists to the channels that accept calcium in the cardiovascular system. They work because calcium serves as a crucial second messenger physiologically and is commonly used in channels, exchangers, and pumps. Calcium is also involved in the depolarization of the cardiac muscle cells, which govern the contraction and relaxation cycles of the heartbeat. In general, calcium channel blockers can be effective in treating high blood pressure, angina, arrhythmia, and some more serious complications, but they are not always as effective as other drugs (diuretics, beta-blockers, ACE inhibitors, or angiotensin II receptors) because they work by interacting directly with very sensitive receptors. Additionally, there is evidence that some calcium channel blockers reduce the ability of the body to remove the drug from the body and therefore allow it to build up in the body. Because this can cause serious side effects, calcium channel blockers are less commonly used than most of the other types of drugs [6].

Pharmacotherapy is the first-line treatment for bipolar disorder and lithium is the oldest effective mood stabilizer for bipolar disorder. However, elderly patients have poor tolerance to lithium than younger patients. First, age-related pharmacokinetic changes, including absorption, distribution, plasma protein binding, hepatic metabolism and renal clearance, predispose older patients to a higher risk of lithium toxicity.[5] Second, lithium neurotoxicity (e.g., sedation, confusion, delirium, memory impairment) can occur even within therapeutic range in older persons because of age-dependent changes in tissue sensitivity to the action of the drug (pharmacodynamics).[6] Third, serum lithium levels can significantly increase due to drug-drug interaction between lithium and medications frequently prescribed for elderly, such as, thiazide diuretics and ACE inhibitors for hypertension, and nonsteroidal anti-inflammatory drugs for arthritis.[7] Other medication options for bipolar disorder also have unfavorable side effects and significant drug-drug interaction, for example, carbamazepine is a potent CYP450 inducer and valproic acid is a potent CYP450 inhibitor.

Reserpine reduces the noradrenaline supplies in peripheral organs. It also reduces the cardiovascular response to sympathomimetic amines. When reserpine is taken the postganglionic sympathetic nerves are not able to transfer impulses through the neuroeffector junctions.

Escitalopram, the pure S-enantiomer of its racemic derivative, i.e. citalopram belongs to the selective serotonin reuptake inhibitors (SSRI) class of anti-depressants. Ever since its introduction, it has now rapidly become one of the therapeutic mainstays for major depressive disorders and a spectrum of anxiety disorders. Despite escitalopram being a relatively safe SSRI, there have been a few reports implicating it as the offending agent in causing life-threatening Hyponatraemia[1-4].

Amiodarone (Cordarone) is a complex antiarrhythmic agent with multiple electrophysiological effects, unusual pharmacokinetics, and numerous