• Korean Journal of Biological Psychiatry
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• v.8 no.2
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• pp.266-270
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• 2001

Objective : The purpose of this study was to compare the plasma amitriptyline and nortriptyline level between before and after fluoxetine addition with patients who were currently taking amitriptyline. Method : From the inpatient and outpatient unit of Soon Chun Hyang University Hospital, Chunan, fourteen subjects who were taking amitriptyline 25mg more than 1 week at least were given fluoxetine 20mg. Before and 2 weeks after fluoxetine addition, the plasma level of amitriptyline and nortriptyline are analyzed simultaneously by High Performance Liquid Chromatography(HPLC). At the same times, HAM-D(Hamilton Rating Scale for Depression) score and the UKU(Uldvalg for Klinske Unders${\Phi}$ gelser) side effect scale were checked. Results : After fluoxetine addition to the patients who were taking amitriptyline, the plasma level of amitriptyline, nortriptyline and sum of amitriptyline and nortriptyline had risen. The mean plasma amitriptyline level increased from $168.9{\pm}89.4ng/ml$ to $183.0{\pm}102.0ng/ml$ after fluoxetine addition(p=0.011), but the change was not statistically significant. The mean plasma nortriptyline level increased significantly from $114.3{\pm}70.2ng/ml$ to $168.0{\pm}86.2ng/ml$ after fluoxetine addition(p=0.011). In addition, the mean plasma level of total amitriptyline and nortriptyline increased significantly from $283.1{\pm}125.3ng/ml$ to $350.9{\pm}78.4ng/ml$ after fluoxetine addition(p=0.016). After fluoxetine addition, no significant change was noted in the UKU side effect scale score. Conclusion : As consequence of comparison of plasma amitriptyline and nortriptyline level before and after fluoxetine addition, mean amitriptyline, nortriptyline and total plasma level was increased after fluoxetine addition. This suggests that coadministration of amitriptyline and fluoxetine may induce improvement of depressive symptom in depressive patients by way of increased plasma level of amitriptyline.

• The Korean Journal of Physiology and Pharmacology
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• v.22 no.5
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• pp.585-595
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• 2018

Amitriptyline, a tricyclic antidepressant, is commonly used to treat depression and neuropathic pain, but its mechanism is still unclear. We tested the effect of amitriptyline on 5-hydroxytryptamine 3 ($5-HT_3$) receptor currents and studied its blocking mechanism because the clinical applications of amitriptyline overlapped with $5-HT_3$ receptor therapeutic potentials. Using a whole-cell voltage clamp method, we recorded the currents of the $5-HT_3$ receptor when 5-HT was applied alone or co-applied with amitriptyline in cultured NCB-20 neuroblastoma cells known to express $5-HT_3$ receptors. To elucidate the mechanism of amitriptyline, we simulated the $5-HT_3$ receptor currents using Berkeley $Madonna^{(R)}$ software and calculated the rate constants of the agonist binding and receptor transition steps. The $5-HT_3$ receptor currents were inhibited by amitriptyline in a concentration-dependent, voltage-independent manner, and a competitive mode. Amitriptyline accelerated the desensitization of the $5-HT_3$ receptor. When amitriptyline was applied before 5-HT treatment, the currents rose slowly until the end of 5-HT treatment. When amitriptyline was co-applied with 5-HT, currents rose and decayed rapidly. Peak current amplitudes were decreased in both applications. All macroscopic currents recorded in whole cell voltage clamping experiments were reproduced by simulation and the changes of rate constants by amitriptyline were correlated with macroscopic current recording data. These results suggest that amitriptyline blocks the $5-HT_3$ receptor by close and open state blocking mechanisms, in a competitive manner. We could expand an understanding of pharmacological mechanisms of amitriptyline related to the modulation of a $5-HT_3$ receptor, a potential target of neurologic and psychiatric diseases through this study.

• The Korean Journal of Pharmacology
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• v.31 no.1 s.57
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• pp.123-133
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• 1995

A number of tricyclic antidepressants appear to have inhibitory action on calmodulin. Although amitriptyline, imipramine and doxepine have been shown to inhibit calcium uptake, oxidative phosphorylation and ATPase activities, effects of amitriptyline, imipramine and doxepine on functional responses of human neutrophils have not been elucidated. In this study, effects amitriptyline, imipramine and doxepine on superoxide and hydrogen peroxide generation, myeloperoxidase release, leukocriene B4 formation and intracellular calcium level were investigated. Superoxide and hydrogen peroxide production in heat aggregated IgG-activated neutrophils were inhibited by amitriptyline, imipramine and doxepine. EDTA, EGTA, verapamil and bepredil inhibited heat aggregated IgG-induced superoxide production. Chlorpromazine, trifluoperazine, staurosporine and H-7 also inhibited it. PMA-induced superoxide production was inhibited by amitriptyline, imipramine, doxepine, chlorpromazine and H-7. Amitriptyline, imipramine, chlorpromazine and trifluoperazine inhibited the myeloperoxidase release by heat aggregated IgG. Productions of $LTB_4$, and 5-HETE in heat aggregated IgG-activated neutrophils were inhibited by amitriptyline, imipramine and doxepine. In neutrophils, elevation of intracellular calcium induced by heat aggregated IgG was inhibited by amitriptyline, imipramine, doxepine, chlorpromazine and EGTA, while verapamil slightly inhibited increase of intracellular calcium and H-7 did not inhibit it. These results suggest that the inhibitory effect of amitriptyline, imipramine and doxepine on respiratory burst, myeloperoxidase release and LTB4 production in heat aggregated IgG-activated neutrophils appears to be ascribed to the inhibition of calcium mobilization, calmodulin and protein kinase C.

• Korean Journal of Psychosomatic Medicine
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• v.3 no.1
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• pp.11-18
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• 1995

The efficacy of fluoxetine was evaluated in 32 patients with major depression in double-blind amitriptyline-controlled clinical trials. Patients were randomly assigned to 6 weeks of treatment with 20mg/day of fluoxetine and 25-100mg/day of amitriptyline. We used the Hamilton rating scale for depression(HAM-D) and the Clinical Global Improvement(CGI) to evaluate the improvement of depression. In addition, we also used the Covi Anxiety Scale and the Anxiety/Somatization subscale of HAM-D to investigate the relieving effect of anxiety. The improvement by fluoxetine in mean total score of HAM-D and CGI was comparable to amitriptyline. Fluoxetine also reduced anxiety significantly, but there was no difference between fluoxetine and amitriptyline in relieving anxiety symptoms. Fluoxetine showed considerably less adverse effects, especially anticholinergic effect and weight gain than amitriptyline. In conclusion, 20mg/day of fluoxetine was sufficiently effective in the treatment of depressive patients and was better tolerated than amitriptyline.

• The Korean Journal of Physiology
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• v.26 no.2
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• pp.137-141
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• 1992

The present study was aimed at elucidating the mode of inhibitory action of tricyclic antidepressants on the smooth muscle. Effects of amitriptyline on the isolated detrusor muscle strips of the urinary bladder of the rabbit were examined. The spontaneous rhythmic movement of the muscle preparation was frequently observed, which was decreased or abolished by addition of amitriptyline $(10^{-5}{\sim}10^{-3}\;M)$. The muscle preparation responded with contraction dose dependently to carbachol, of which dose response curve shifted to the right in the presence of either amitriptyline or atropine. However, amitriptyline produced a nonparallel shift, whereas atropine caused a parallel one. In calcium free medium, the contraction response to carbachol was markedly decreased, which was resumed by the addition of $CaCl_2$ (2.5mM), but not in the presence of either amitriptyline or nifedipine. KCI (60 mM) produced a potent contraction, which was abolished in the presence of amitriptyline or nifedipine. These results suggest that amitriptyline, unlike atropine, not only acts as a noncompetitive antagonist at cholinergic muscarine receptors but also inhibits Ca-influx through the muscle cell membrane.

• Molecules and Cells
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• v.38 no.8
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• pp.734-740
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• 2015

Recent studies report that a history of antidepressant use is strongly correlated with the occurrence of Parkinson' disease (PD). However, it remains unclear whether antidepressant use can be a causative factor for PD. In the present study, we examined whether tricyclic antidepressants amitriptyline and desipramine can induce dopaminergic cell damage, both in vitro and in vivo. We found that amitriptyline and desipramine induced mitochondria-mediated neurotoxicity and oxidative stress in SH-SY5Y cells. When injected into mice on a subchronic schedule, amitriptyline induced movement deficits in the pole test, which is known to detect nigrostriatal dysfunction. In addition, the number of tyrosine hydroxylase-positive neurons in the substantia nigra pars compacta was reduced in amitriptyline-injected mice. Our results suggest that amitriptyline and desipramine may induce PD-associated neurotoxicity.

• Clinical and Experimental Pediatrics
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• v.52 no.5
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• pp.538-543
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• 2009

Purpose : To report the clinical experience with amitriptyline for managing children with cyclic vomiting syndrome (CVS). Methods : Totally, eleven children (eight males) were diagnosed with CVS. Of these, medical records were reviewed for eight children treated with amitriptyline; three children were not treated because one was not followed up and two were kept under observation to study the natural course without medication, because the frequency of vomiting had recently decreased to less than one episode per year. The eight amitriptyline-treated children were divided into three groups by the therapeutic response: (1) complete remission (CR), with no recurrence of symptoms after treatment; 2) partial remission (PR), in which the frequency of symptoms decreased by almost 50% after treatment; and (3) no response. Results : For the eight amitriptyline-treated children, the mean age of symptom onset was 4.7 (0.3-7) yr and mean age at diagnosis was 8.9 (6.0-11.3) yr. The mean number of vomiting episodes was 8.8 (2-25) per year, and the duration of vomiting in each episode ranged from 3 hours to 5 days. CR was achieved in five (62.5%) of the eight amitriptyline-treated children (0.2-0.8 mg/kg/day orally, at night) and PR was achieved in three children (37.5%). Two children relapsed on discontinuation of amitriptyline by their parents decision but showed improvement on remedication. No adverse effects were noted throughout the study period. Conclusion : Amitriptyline can be used in long-term prophylaxis for the management of children with CVS aged over 6 yr. However, a large-scale study is needed to ascertain its effects.

• Journal of The Korean Society of Clinical Toxicology
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• v.4 no.2
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• pp.155-157
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• 2006

Myoclonus is manifested in a variety of situations including metabolic derangements, brain lesions, epilepsy, and drugs toxicity. We reported a rare case of amitriptyline-induced myoclonus. A 64-year-old man with a tension-type headache was administered amitriptyline at 15 mg/day. Eight days after initiation of amitriptyline, multifocal myoclonus developed, involving the face and upper extremities. Two hours after the administration of clonazepam at 1 mg, myoclonus resolved completely.

• Bulletin of the Korean Chemical Society
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• v.33 no.7
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• pp.2163-2167
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• 2012

A rapid, specific, and reliable LC-MS/MS-based bioanalytical method was developed and validated in rat plasma for the simultaneous quantitation of amitriptyline and its metabolite nortriptyline. Chromatographic separation of these analytes was achieved on a Gemini C18 column ($50{\times}4.60mm$, $5{\mu}m$) using reversed-phase chromatography. The mobile phase was an isocratic solvent system consisting of 1% formic acid in water and methanol (10:90, v/v), at a flow rate of 0.2 mL/min. The analytical range was set as 0.1-500 ng/mL for amitriptyline and 0.08-500 ng/mL for nortriptyline using a $200{\mu}L$ plasma sample. The accuracy and precision of the assay were in accordance with FDA regulations for the validation of bioanalytical methods. The validated method was successfully applied to a pharmacokinetic study in six rats after oral administration of amitriptyline (15 mg/kg). This method allows laboratory scientists to rapidly determine amitriptyline and nortriptyline concentrations in plasma.

• Korean Journal of Biological Psychiatry
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• v.6 no.1
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• pp.96-101
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• 1999

Background : Since dysthymia begins in late childhood or adolescence and has a chronic course, long-term pharmacotherapy may be required. New generation antidepressant, moclobemide, with more acceptable side effect profiles, is effective in the treatment of dysthymia. The main objective of this study was to determine whether they exhibit comparable efficacy and tolerability in dysthymia to amitriptyline. Method and Materials : The efficacy and tolerability of the moclobemide and amitriptyline, were compared in a eight-week single-centre double-blind study in patients(n=37) with dysthymia using he HAMD-17, the Clinical Global Impression Scale(CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), Efficacy Index-Therapeutic Index(EITE), 4-point Index Side Effect Scale(4-PISES), and Efficacy Index- Side Effect Scale(EISE). Results : A total of 37 patients entered the study, 19 were randomly assigned to the moclobemide group and 18 to be amitriptyline group. Demo-graphic and illness characteristics were similar in both groups. There were no significant difference between two groups at the total 17-HDRS score, the HAMD-17% improvement, the total MADRS score, CGI response, and the EITE. In the comparison of EISE between two groups, the scores of the moclobemide group were relatively lower than the amitriptylinen group in full treatment. And the differences were significant(moclobemide group $1.39{\pm}0.61$ ; amitriptyline group $2.00{\pm}0.85$, p<.001). At the 4-PISE, There was no serious or treatment threatening side effects. And there was no specific difference in side effects between two groups. The moclobemide group reported higher EIR scores than the amitriptyline group at every follow up day, but the differences were not significant. And, there was no significant differences in the scores of five HRQOL subcategories which is compared between two groups at every follow up days. Conclusions : In terms of 17-HDRS and MADRS, moclobemide and amitriptyline are equally effective at least in allevating dysthymic symptoms. But moclobemide tended to be less troubling and better tolerated than amitriptyline. Therefore, moclobemide treatment can be used as a safe, and higher satisfactory treatment strategy for the dysthymia.