102 Section 2/ Drugs Acting on CNSpotension, palpitation, dry mouth, urinary
retention, blurred vision, confusion and low-
ering of seizure threshold.
It is indicated in depression, illness accom-
panied by anxiety, agitation, restlessness and
disturbances of sleep; masked depression;
dysphoria and depression in alcoholics;
childhood bed wetting. It is also useful for
prophylaxis of migraine.
NORTRIPTYLINE
It is same as amitriptyline and its anti-
depressant effect may persist up to six
weeks.
Adverse effects include dry mouth, con-
stipation, nausea, epigastric discomfort, seda-
tion, confusion, arrhythmias, altered vision,
skin rash, jaundice and impaired alertness.
It is indicated in neurotic, reactive,
masked endogenous, recurrent depression;
depression with insomnia, depression, en-
uresis, panic disorder, neurogenic pain, ur-
ticaria and nausea and vomiting during che-
motherapy; maniac depressive psychosis in
depressive phase.
TRIMIPRAMINE
It has more sedative effect than other tri-
cyclic antidepressants and is suitable for
patients showing depression with agitation
and anxiety.
DOTHIEPIN
The mechanism of action is same as of
tricyclic antidepressant and used in depres-
sion and anxiety associated with depression.
Adverse effects include dry mouth, ta-
chycardia, palpitation, impotence, constipa-
tion, difficulty in accommodation, rarely
hyperpyrexia and paralytic ileus. Lethargy,
headache, drowsiness, tremors, ataxia,
sweating, convulsion, urticaria, skin rash,
pruritus, cholestatic jaundice, cardiac
arrhythmias, orthostatic hypotension,
agranulocytosis, gynecomastia, galactor-
rhoea and dependence are also seen.TETRACYCLIC ANTIDEPRESSANTSMIANSERIN
It exerts potent presynaptic central a 2 , adr-
energic blocking activity which may cause
increased noradrenaline release. It does not
effect noradrenaline or 5-HT uptake in
CNS.
Adverse effects include hypersensitiv-
ity reaction, nausea, drowsiness, jaundice,
may precipitate seizures, blood dyscrasias,
lethargy and tremors.
It is used in psychotic and neurotic
depression and obsessive compulsive neu-
rosis.MIRTAZAPINE
It acts as an antagonist at central presyn-
aptic a 2 inhibitory adrenergic auto-receptors
and hetero-receptors. This results in an in-
crease in central noradrenergic and seroton-
ergic activity. Mirtazapine is a potent an-
tagonist of 5-HT 2 and 5-HT 3 receptors.
Adverse effects include asthenia, flu like
syndrome, back pain, dry mouth, increased
appetite, constipation, weight gain, periph-
eral edema, myalgia, somnolence, dizziness,
abnormal dreams, abnormal thinking,
tremor, confusion, dyspnea and urinary
frequency.