Amitriptilina: por que eu não prescrevo!

Summary

In this informative video, Dr. Marco Antônio Abud, a clinical psychiatrist, discusses Amitriptyline, a widely prescribed medication in 2020. He explains its use as an antidepressant and in pain management, detailing its mechanism of action on serotonin and norepinephrine. Dr. Abud highlights the benefits and risks, including potential side effects like sedation, weight gain, and cognitive impacts. He emphasizes the importance of proper dosage and medical supervision, especially for elderly patients or those with cardiovascular issues, advocating for informed decision-making in treatment choices.

Takeaways

• 😀 Amitriptyline was the most sold and prescribed medication worldwide in 2020, despite its complex use profile.
• 🤔 The speaker, Dr. Marco Antônio Abud, a psychiatrist, has not used amitriptyline in his practice for a long time due to its side effects and risks.
• 💊 Amitriptyline is an antidepressant with a complex history, initially synthesized in the 1950s as an antipsychotic but found to reduce depressive symptoms.
• 🔬 It works by inhibiting the reuptake of serotonin and norepinephrine, increasing their availability in the brain to improve mood and reduce pain signals.
• 🧠 The drug's effects on mood are related to its action in the amygdala and pre-frontal cortex, reducing anxiety and enhancing the ability to focus and concentrate.
• 🛑 High doses of amitriptyline are required for antidepressant effects, which can lead to significant side effects such as sedation, weight gain, and cognitive impairment.
• ⚠️ There are considerable risks associated with its use, especially in older adults or those with heart conditions, due to potential cardiovascular side effects.
• 💤 Amitriptyline can cause sedation and increase appetite, which may not be suitable for all patients, particularly those concerned about weight gain.
• 💔 It may also lead to sexual dysfunction and postural hypotension, especially in elderly patients taking other medications for blood pressure.
• 💊 The drug has a complex interaction profile, requiring careful monitoring and consideration of other medications a patient may be taking.
• 🌐 Non-pharmacological treatments, such as cognitive-behavioral therapy (CBT), are emphasized as potentially more effective for long-term management of anxiety and depression.

Q & A

What is the main topic of the video?

The main topic of the video is Amitriptyline, discussing its history, how it works, its side effects, benefits, risks, and why the speaker, a psychiatrist, does not use it in his practice.

What year was Amitriptyline first synthesized?

Amitriptyline was first synthesized in the 1950s.

Why was Amitriptyline initially synthesized?

Amitriptyline was initially synthesized as an attempt to replicate the success of another drug, chlorpromazine, which was found to calm patients post-operatively and was later used to treat symptoms of schizophrenia and bipolar disorder.

What is the therapeutic action of Amitriptyline related to serotonin?

The therapeutic action of Amitriptyline is related to its inhibition of serotonin reuptake, allowing serotonin to have a prolonged effect by remaining in the synaptic cleft longer, which can help reduce anxiety and stabilize mood.

How does Amitriptyline affect noradrenaline?

Amitriptyline also inhibits the reuptake of noradrenaline, increasing its availability to transmit signals to other neurons, which can help improve energy, concentration, and potentially reduce chronic pain.

What are some side effects associated with Amitriptyline?

Some side effects of Amitriptyline include sedation, weight gain, dry mouth, constipation, and potential cognitive effects such as reduced memory and learning capabilities.

Why is Amitriptyline not the first line of treatment for psychiatric conditions according to the speaker?

Amitriptyline is not the first line of treatment for psychiatric conditions because it has many side effects and risks, and it requires high doses that can be intolerable for treating anxiety and depression.

What is the therapeutic dose range for Amitriptyline when used for anxiety and depression?

The therapeutic dose range for Amitriptyline when used for anxiety and depression is typically between 75 mg to 300 mg.

What is the risk associated with using Amitriptyline in elderly patients or those with certain health conditions?

The risk associated with using Amitriptyline in elderly patients or those with certain health conditions includes the possibility of postural hypotension, increased risk of arrhythmias, and potential interactions with other medications that could exacerbate these issues.

What is the speaker's recommendation for treating chronic pain with Amitriptyline?

The speaker suggests that Amitriptyline may be used for chronic pain at lower doses, starting from 10 mg, which can help with sleep and potentially reduce pain, but it should be used with caution and under medical supervision.

What non-pharmacological treatments does the speaker mention for anxiety and depression?

The speaker mentions cognitive-behavioral therapy (CBT) and other forms of training that involve neuroplasticity and behavioral changes as non-pharmacological treatments for anxiety and depression.