Different mental health problems often cause great suffering to those who suffer from them and/or limit their day-to-day life. And one of the most common worldwide, and probably throughout history, is depression.

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

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

What is amoxapine?

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

It is one of the best known components of the group of tricyclic antidepressants , which receive this name because its chemical composition is formed by three rings of atoms and have an important effect on noradrenaline and serotonin.

Amoxapine usually comes in a tablet presentation, to be taken orally and accompanied by 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, being visible between two and six weeks after the first intake.

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in the treatment of depression and were in fact the predominant antidepressants for a long period, they have now been superseded by the specific serotonin reuptake inhibitors , which have similar efficacy but act in a more targeted manner and tend to generate fewer side effects.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

Mechanisms of action

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

This means that noradrenaline and serotonin are released into the synaptic space, blocking the process that would cause some of these neurotransmitters to be returned to the sending neuron. As a result of this we have higher levels of noradrenaline and serotonin in the brain , so we can take advantage of and use a greater amount of these substances.

Likewise, it has been observed that amoxapine presents an antagonistic activity to dopamine, that is, it hinders the activity and transmission of this neurotransmitter. Although this may appear to be a negative point and may in fact give rise 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 indicated above, both this drug and the other tricyclics have been superseded by specific serotonin reuptake inhibitors or SSRIs or other types of drugs of higher 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 anxiety-depressive disorders. It is also sometimes used in reactive depressions.

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

Possible side effects

While it is true that amoxapine is a useful drug, it is also necessary to bear in mind that it can have some toxicity and can generate various types of side effects.

The most relevant and common side effects include drowsiness and fatigue, as well as nausea and vomiting and dry mouth . Headaches, difficulties in urinating or excessive desire to urinate, alterations in appetite and weight (increase), anxiety reactions, hypotension, hyperhidrosis, fever, photophobia or tachycardia or motor rigidity may also appear.

It is also possible to develop tardive dyskinesia. More serious reactions may include seizures, confusion or altered consciousness, breathing problems, and suicidal ideation. It should be noted that if treatment is discontinued, should be done in a gradual and orderly manner or withdrawal symptoms may arise .

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

Contraindications

Because of 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 is contraindicated for certain types of population.

Obviously one of the first groups to avoid its consumption is all those people who are allergic to amoxapine or to any of the components with which it is made. Those people who have recently suffered a heart attack or some cardiovascular problem should also avoid taking it , as it can have an effect on blood pressure and heart rate (it can cause tachycardia). It is also not recommended for people with Parkinson’s disease, as it can make their motor problems worse.

People who have suffered seizures, have epilepsy or glaucoma, kidney problems or genitourinary diseases should avoid it or should assess with their doctor the possible suitability of using this drug. Pregnant women and nursing mothers should also avoid it , as it has been shown 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 have very strict medical control. Finally, it should be borne in mind that this drug should never be used in combination with an MAOI, as there is a great risk of dangerous health disorders due to their interaction.

A professional should be consulted about the suitability of its use if other drugs are used. It should also not be taken with alcohol or other psychoactive substances (especially if they are depressants, as the effects are enhanced).

Bibliographic references:

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