Amoxapine: uses and side effects of this antidepressant

The different mental health problems usually generate great suffering for those who suffer from them and/or limit their day-to-day life. And one of the most common in the world, and probably throughout history, is depression.

This disorder is characterized by the presence of a sad mood and difficulty feeling pleasure, in addition to generating passivity, hopelessness, feelings of guilt, difficulties sleeping, eating, concentrating, thinking and relating, and even suicidal ideation. It is therefore a condition that has serious repercussions and affects all areas of life.

Because of this, throughout history attempts have been made to generate different strategies and methods to treat depression. One of the different ways to do this is through pharmacology, which can help control symptoms and can serve as support while working on their causes. And there are many drugs that have been created for this purpose. One of them is amoxapine, which we will talk about next.

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What is amoxapine?

Amoxapine is one of the so-called antidepressant drugs, substances with psychoactive properties that have been found to be effective in combating the symptoms of depression because they generate an alteration in brain chemistry that increases the levels of certain neurotransmitters.

Is about one of the best known components of the group of tricyclic antidepressants, which receive this name given that their chemical composition is made up of three rings of atoms and that they have an important effect at the level of norepinephrine and serotonin.

Amoxapine usually comes in a tablet presentation, to be taken orally with water, and it has been observed that it tends to present its first effects in a shorter period of time than other tricyclics such as imipramine, and may be visible between two and six weeks after the first take.

Although amoxapine and the rest of the tricyclics are effective drugs in the treatment of depression and in fact for a long period were the predominant antidepressants, currently have been superseded by specific serotonin reuptake inhibitors, which have similar efficacy but act more specifically and tend to have fewer side effects.

This is because amoxapine acts at a non-specific level, affecting both areas of the brain where its effects are beneficial and others where they are not. In fact, in excessive doses they can be toxic and even cause death by overdose.

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Action mechanisms

The action of amoxapine on the body and its effects on improving mood are due to to its mechanism of action, which is based on the inhibition of serotonin reuptake and norepinephrine.

This means that norepinephrine and serotonin are released into the synaptic space, the process that would cause part of these neurotransmitters to be returned to the emitting neuron is blocked. As a result of this we have increased levels of norepinephrine and serotonin in the brain, so that we can take advantage of and use a greater amount of these substances.

Likewise, it has been observed that amoxapine presents an antagonistic activity of dopamine, that is to say, it hinders the activity and transmission of this neurotransmitter. Although this may seem like a downside and may actually lead to side effects, it may also have clinical utility in some conditions.

Main indications

Amoxapine is, as we have said, an effective antidepressant, and as such one of its main indications is major depression.

Although, as we have previously indicated, both this drug and the rest of the tricyclics have been superseded by specific inhibitors of the reuptake of serotonin or SSRIs or other types of drugs with greater specificity, the truth is that they are still used when there is no response to treatment with other drugs.

Its use may also be indicated in dysthymia or persistent depressive disorder, as well as in anxious depressions or mixed anxious-depressive disorders. It is also sometimes used in reactive depressions.

In addition to this, it is especially indicated in patients whose depressions have psychotic characteristics and has been used in the treatment of bipolar disorder, since it helps to control these types of symptoms (something in which dopamine antagonism can benefit).

Possible side effects

Although it is true that amoxapine is a useful drug, it is also necessary to take into account that it can present some toxicity and that it can generate various types of side effects.

Among the most relevant and common side effects, it is worth mentioning drowsiness and fatigue, as well as nausea and vomiting and dry mouth. There may also be headaches, difficulties urinating or an excessive desire to do so, changes in appetite and weight (increase), anxiety reactions, hypotension, hyperhidrosis, fever, photophobia or tachycardia or motor rigidity In some cases, the presence of dyspareunia, or pain during intercourse.

It is also possible that tardive dyskinesia appears. Likewise, more serious reactions may include the appearance of convulsions, confusion or alterations of consciousness or respiratory problems, as well as suicidal ideation. It should be noted that if treatment is discontinued, It must be done in a regular and gradual manner or withdrawal syndrome may occur.

One of the most serious possible side effects is agranulocytosis. Another of them (although the least frequent) is the malignant neuroleptic syndrome, which, although it is usually produced by antipsychotics it has also been observed in some cases with other drugs (including amoxapine). Both can have serious health repercussions and even lead to death.

contraindications

Due to these and other possible side effects, amoxapine is not a drug that can be taken freely. by any type of person but must be regulated and that it is contraindicated for certain types of population.

Obviously, one of the first groups that should avoid its consumption is that of all those people who are allergic to amoxapine or to any of the components with which it is made. They should also avoid eating those people who have just recently suffered a heart attack or some cardiovascular problem, because it can have effects on blood pressure and heart rate (it can cause tachycardia). It is also not recommended for people with Parkinson's disease, as it can worsen their motor problems.

People who have suffered seizures, have epilepsy or glaucoma, kidney problems or diseases genitourinary disorders should avoid it or they should assess with the doctor the possible adequacy of using this drug. Pregnant women and lactating mothers should also avoid it., since it has been seen to be excreted in breast milk.

People with diabetes and thyroid problems, as well as those with kidney or liver problems, should also avoid it or carry out very rigorous medical control. Finally, it should be noted that this drug should never be used in combination with an MAOI, since there is a great risk of dangerous health changes due to their interaction.

The suitability of its use in case of consuming other drugs should be consulted with a professional. Nor should it be taken with alcohol or other psychoactive substances (especially if they are depressants, since the effects are enhanced).

Bibliographic references:

• Gabriel, M.; Sharma, V (29 May 2017). "Antidepressant discontinuation syndrome". Canadian Medical AssociationJournal. 189(21):E747.
• Koren G, Nordeng HM (2013). "Selective serotonin reuptake inhibitors and malformations: case closed?". Semin Fetal Neonatal Med. 18 (1): 19–22.