Posted by vanvog on April 18, 2013, at 13:58:00
In reply to Re: nardil tolerance and ensuing cognitive - rose4, posted by Tyrannosaur on April 18, 2013, at 11:55:51
"The older TCAs (and some other antidepressants, e.g. mianserin, trazodone) have been shown to cause more impairment than the newer antidepressants (including lofepramine) in laboratory tests of cognitive and psychomotor function (Hindmarch et al, 1992).
The older tricyclics have also been shown to cause impairment in driving tests, whereas SSRIs, reversible inhibitors of monoamine oxidase A (RIMAs) and nefazodone cause little or no impair ment (Louwerens et al, 1986; Raemaekers et al, 1994; Robbe & O'Hanlon, 1995; Van Laar et al, 1995). Although these findings support the use of the newer drugs for long-term treatment, the predictive validity of psychomotor tests has been questioned (Parrott, 1987;Freeman &O'Hanlon, 1995).Many skilled tasks can be performed without undue effort and with spare processing capacity left available, and it has been suggested that information-processing tasks are measures of competence (potential) rather than actual performance (Parrott, 1991).
Furthermore, most of the investigations were carried out after short-term administration of drugs (sometimes in single doses), rather than during longer-term treatment, when adaptation may occur. Adaptation to the effects of TCAs on driving has, in fact, been demonstrated (Ramaekers et al, 1994; Robbe & O'Hanlon, 1995; van Laar et al, 1995). Perhaps these considerations explain why TCAs were found in the body fluids of only 0.2% of people who died in traffic accidents, compared with alcohol in 35% and other drugs liable to affect the CNS in 7.4% (Everest et al, 1989).
Consistent with the observations that older TCAs cause psychomotor impairment, is the finding that elderly drivers treated with these drugs have an increased risk of vehicle crashes in which injuries are sustained, and that there is a relationship between the risk and dose of drug (Ray et al, 1992; Leveille et al, 1994). This suggests that the drugs contribute to the accidents, although inability to control for all potentially confounding variables does not allow for definite conclusions to be reached. The extent to which antidepressants cause or contribute to road traffic and other accidents is not known. Nevertheless, the aforementioned concerns should be taken into account in the choice of drug for long-term treatment. Although the risk may be greater when treatment is first introduced, it should also be considered when the dose is increased or when antidepressants are taken with other substances that affect cognition and psychomotor performance. For patients thought to be at high risk of accidents, including those who experience persistent sedation when taking TCAs or drug combinations, it is sensible to err on the side of safety and prescribe non-sedative antidepressants.
http://apt.rcpsych.org/content/3/1/52.full.pdf
Also:
Edwards, J. G. (2004) Unwanted effects of psychotropic drugs. 1. Effects on human physiological systems, mechanisms and methods of assessment. In Seminars in Clinical Psychopharmacology (2nd edn) (ed. D. J. King), pp. 573600.
poster:vanvog
thread:1042294
URL: http://www.dr-bob.org/babble/20130408/msgs/1042325.html