Psycho-Babble Medication Thread 323277

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Can I take tricyclics with liver problems?

Posted by zor on March 11, 2004, at 14:28:09

I am 26 and had Hep-B and although have serum immunity from this and no sign of the virus active (this was 5 years ago) I continue to become jaundice, bruise and extreme lethargy. And yes, the virus is not active (per tests).

I have always been very depressed; severe adult ADD, anxiety, et al. The typical run-of-the-mill psychological problems.

Anyway, I dont respond to any meds, save possible low dose nortriptyline (25-40 mgs). I know this med to be particularly hepatoxic in contrast to some of the newer meds. However, it does somewhat help. And any help is better than none at this point! (SSRI's, Effexor, Stimulants, benzos dont help).

Is there any member of the tricyclic family that has less effect on the liver in contrast to the others. Such as desipramine being a metabolite of imipramine--thus it takes less for the liver to break down. Is this true, or is my hypothesis moot?

Any ideas. My typical clinical depression is become severely worse--most likely from my LFTs getting progressively worse. I'd rather be happy and dying while taking a med that may be toxic to me, than be dying and depressed doing nothing about it.

I really appreciate any input or personal experience. BTW Ultram (tramdol) used to help me. I continue to take it but its basically lost effect.

Re: Can I take tricyclics with liver problems?

Posted by King Vultan on March 11, 2004, at 15:21:09

In reply to Can I take tricyclics with liver problems?, posted by zor on March 11, 2004, at 14:28:09

> I am 26 and had Hep-B and although have serum immunity from this and no sign of the virus active (this was 5 years ago) I continue to become jaundice, bruise and extreme lethargy. And yes, the virus is not active (per tests).
>
> I have always been very depressed; severe adult ADD, anxiety, et al. The typical run-of-the-mill psychological problems.
>
> Anyway, I dont respond to any meds, save possible low dose nortriptyline (25-40 mgs). I know this med to be particularly hepatoxic in contrast to some of the newer meds. However, it does somewhat help. And any help is better than none at this point! (SSRI's, Effexor, Stimulants, benzos dont help).
>
> Is there any member of the tricyclic family that has less effect on the liver in contrast to the others. Such as desipramine being a metabolite of imipramine--thus it takes less for the liver to break down. Is this true, or is my hypothesis moot?
>
> Any ideas. My typical clinical depression is become severely worse--most likely from my LFTs getting progressively worse. I'd rather be happy and dying while taking a med that may be toxic to me, than be dying and depressed doing nothing about it.
>
> I really appreciate any input or personal experience. BTW Ultram (tramdol) used to help me. I continue to take it but its basically lost effect.

Desipramine is a metabolite of imipramine, as is nortriptyline of amitriptyline; they are both the secondary amine versions of their tertiary amine parents. Both tricyclics and SSRIs are metabolized by the CYP-450 enzyme system, with the 2D6 enzyme being a particularly important one in the metabolism of these drugs. I do not have specific data on the hepatotoxicity of tricyclics, but my understanding is that it is not necessarily any higher than other antidepressants. The psychotropic drugs I'm aware of that do have a higher incidence of hepatotoxicity are Serzone, Nardil, and pemoline. Even if you do have a liver issue, you may still be able to take these drugs as long as liver function is monitored during therapy, but I am not an MD.

Stattera is a non-tricyclic that has psychopharmacologic effects very similar to that of desipramine. Both of these drugs are norepinephrine selective reuptake inhibitors, as is nortriptyline, for that matter. However, nortriptyline is dirtier than either desipramine or Strattera, a relatively strong histamine blockade probably being its most notable non-therapeutic effect.

Todd

Re: Can I take tricyclics with liver problems?

Posted by DepNYer on March 11, 2004, at 17:04:35

In reply to Re: Can I take tricyclics with liver problems?, posted by King Vultan on March 11, 2004, at 15:21:09

Using tricyclics in the setting of liver disease, especially if severe, can potentially be done, adjusting the dose accordingly, and with monitoring for any potentially toxic level of the TCA. The issue of the risk versus benefit needs to be worked out betweeen your liver specialist and a pdoc knowledgable in psychopharm. One other important issue is that there are waste products that accumulate with liver disease, and your liver doc should make sure there is nothing metabolic that is causing or contributing to your feelings of depression that could be treated.

All of this info needs to be given to you directly by your doc, as your situation is not something that can be solved by you alone, or by advice here. I hope you feel better.

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