BCA - ByCyclic Antidepressant (Wiki)

Please note: Dosage equivalents are provided for certain drugs below and are denoted as unit equivalents, i.e. one unit of drug x is roughly the equivalent as one unit of drug y, where the dosage equal to one unit varies.

Bicyclic drugs specifically refer to the chemical structure of the compounds in question, which all structurally possess two rings. It is a classification that is seldom used in favour of more descriptive categories such as SSRI and RIMA; this is in stark contrast with the status of tricyclic antidepressants and to a lesser extent tetracyclic antidepressants.

These drugs should not typically be taken in conjunction with RIMA or MAOI antidepressants and a "cooling out" period is suggested in order to minimise the chance of a potentially serious condition known as serotonin syndrome; however, combinations are not totally out of the question.


Fluoxetine (Wiki)

Brand names: Adofen®, Alzac 20®, Andep®, Ansilan®, Auroken®, Deprexin®, Deproxin®, Fluctin®, Fluctine®, Fludac®, Flufran®, Flunil®, Fluox®, Fluoxac®, Fluoxeren®, Fluoxil®, Fluox-Puren®, Fluronin®, Flusac®, Flutin®, Flutine®, Fluxen®, Fluxetil®, Fluxetin®, Fluxil®, Fontex®, Foxetin®, Lanclic®, Lorien®, Lovan®, Magrilan®, Margrilan®, Modipran®, Neupax®, Nopres®, Nuza®, Oxactin®, Oxedep®, Pragmaten®, Prizma®, Proctin®, Prodep®, Prozac®, Prozac 20®, Rowexetina®, Salipax®, Sanzur®, Symbyax® (when compounded with Olanzapine), U-Zet®, ZAC®, Zactin®, Zepax®, Флуоксетин®
Formula: C17H18F3NOHCl
Half life: ~ 4 to 6 days
Single unit dose: Unknown
Recommended outpatient dose: 20mg per day [Verified]
Maximum outpatient dose: 80mg per day [Verified]

Fluoxetine is also known and classified as an SSRI antidepressant, meaning that it only inhibits the reuptake of the monoamine neurotransmitter serotonin to any statistically significant extent.

This drug started out life as an antihistamine, diphenhydramine, which was found to inhibit the reuptake of the monoamine neurotransmitter serotonin. Fluoxetine is fairly stimulating, yet is an approved treatment for anxiety related conditions; even more converse is the fact that anxiety is one of the most (if not the most) frequent side effect of fluoxetine therapy. The drug also possesses a remarkably long half life which has proven useful in the treatment of more reluctant patients; should they suddenly stop taking the drug, the antidepressant effect will remain for a fair amount of time, hopefully long enough for the cessation to be noticed and rectified. Currently fluoxetine is available for use in children as young as eight, should psychotherapies fail.

Fluoxetine fast became an infamous drug under the brand name of Prozac; millions were prescribed the drug, largely due to an extremely effective and extensive advertising campaign. Unfortunately, the medication became controversial towards the end of the century due to an increased risk of suicidal behaviour amongst patients treated with the drug. Based on past resale sells, Fluoxetine is the third most prescribed antidepressant on the market.

The most common side effects are anxiety, headaches, nervousness, insomnia, fatigue, tremor, dizziness, dry mouth, weight loss (possibly leading to anorexia), excessive sweating, nausea and diarrhea. Maximum therapeutic effect usually manifests after a period of a month to a month and a half.

Venlafaxine (Wiki)

Brand names: Depot®, Efectin®, Efectin ER®, Efexor®, Efexor XR®, Effexor®, Effexor XR®
Formula: C17H27NO2
Half life: ~ 4 to 6 hours
Single unit dose: Unknown
Recommended outpatient dose: 150mg per day [Verified]
Maximum outpatient dose: 375mg per day [Verified]

Venlafaxine is also known and classified as an SSNaDRI antidepressant, meaning that it inhibits the reuptake of the monoamine neurotransmitters noradrenaline, serotonin and (at high doses) dopamine to statistically significant extents. In terms of efficacy, Venlafaxine is similar to the Tri-Cyclic Antidepressant (TCA) Amitriptyline.

Introduced in 1993, venlafaxine has become a popular antidepressant and is known as one of the most stimulating antidepressants available, often making it a poor choice for sufferors of anxiety; interestingly, the medication is indicated for the treatment of generalised anxiety disorders, a quirk similar to that found in the SSRI antidepressant fluoxetine. Based on past resale sells, Venlafaxine is the sixth most prescribed antidepressant on the market.

Venlafaxine has proven useful as a therapy for treatment resistant patients who have failed to react favourably to other antidepressants. On top of this, the drug typically has a relatively strong antidepressant effect, another reason for the popularity it enjoys.

Unlike most antidepressants, venlafaxine often causes weight loss which is often substantial; as a result it is being assessed as a treatment for obesity, but this use is not endorsed or recommended by the current patent holder, Wyeth.

The mode of action is in this case rather novel. At low doses, only serotonin is affected (whose reuptake is blocked, increasing the amount of said monoamine neurotransmitter available to neurons at any given time). At doses of approximately 225mg per day, the drug also affects the monoamine neurotransmitter noradrenaline in the same fashion. Finally, at high doses of approximately 300mg per day and above, the monoamine neurotransmitter dopamine is also affected, again in the same fashion. As the maximum outpatient dose is 225mg a day, full therapeutic effect requires an inpatient status; moderately or lightly depressed individuals tend not to respond to dosage increases over 225mg per day.

After three days of treatment, the medication reaches a steady chemical concentration level in the bloodstream; however, full therapeutic effect is typically not experienced sooner than three weeks into therapy; a month is a sensible timeframe.

Since venlafaxine has a relatively short half life, it is advisable to take the drug in divided doses throughout the day in order to prevent peaks and troughs in mood. Extended release variants pretty much eliminate this concern.

Unfortunately, venlafaxine does have its share of downsides. Typically speaking, the medication suppresses sexual desire and increases blood pressure, the latter especially at higher doses, making extensive therapy with this drug unsuitable for patients with heart conditions or high blood pressure. As mentioned above, venlafaxine is a strong stimulant, so sufferers of anxiety may want to pass on this drug; those who are treated with it would be well advised not to take this medication late on in the day as it may very well turn you into a bit of an insomniac. Those who react badly to the stimulation may inevitably become more agitated and/or depressed, which unfortunately raises the chances of self harm or even suicide; this is noted in a black box warning attributed to the drug. Further to this, patients with poor impulse control (such as is featured in a borderline personality disorder) or a history of substance abuse should not be treated with venlafaxine.

The most common side effects include nausea (37% chance), headaches (25% chance), somnolence (23% chance), a dry mouth (22% chance), dizziness (19% chance), insomnia (18% chance), constipation (15% chance) and nervousness (13% chance).

Perhaps the biggest problem with this drug is the withdrawal process. Compared with most antidepressants, withdrawal symptoms for this drug are marked; close care must be applied during discontinuation, a process that can often take several months given the typical weekly reduction of just 37.5mg per week. Symptoms typically include agitation, headaches, nausea, fatigue, dysphoria and odd sensations often described as "brain shivers". Patients with extreme difficulties in withdrawing from the drug should be very slowly transferred to the SSRI antidepressant fluoxetine, which can in turn be discontinued at a later date with far greater ease.

Viloxazine (Wiki)

Brand names: Emovit®, Vivalan®, Vivarint®, Vicilan®
Formula: C13H19NO3
Half life: ~ 3.4 hours
Single unit dose: Unknown
Recommended outpatient dose: 100mg per day [Not Verified]
Maximum outpatient dose: 300mg per day [Not Verified]

Viloxazine is also known and classified as an NARI antidepressant, meaning that it only inhibits the reuptake of the monoamine neurotransmitter noradrenaline to any statistically significant extent. It has been studied for use as a treatment for enuresis (bed-wetting), narcolepsy and alcoholism fairly successfully (suggesting that it exerts a urinary hesitance and/or retention quality as well as a stimulant effect). Conversely, the drug has been shown to be comparatively ineffective in the treatment of dysthymia.

Side effects include the two obvious symptoms of insomnia and urinary hesitance and/or retention, nausea and/or vomiting, changes in appetite (usually a loss of appetite), epigastric pain, diarrhoea, confusion and psychomotor agitation.

Due to the stimulant effect, this drug should not be taken any later than 6pm. Typically, viloxazine takes approximately two weeks to start delivering any antidepressant effect, but as with all medications, this is subjective.

This medication has been discontinued within the United Kingdom.