Vivactil (protriptyline) is a drug that belongs to a class of antidepressants known as tricyclic antidepressants (TCAs). It is primarily prescribed to treat issues with mood and depression. Vivactil is a norepinephrine reuptake inhibitor, but it also acts on serotonin receptors. In some cases it is used to treat disordered eating such as bulimia nervosa, and has also been used to treat panic, obsessive compulsion, attention-deficit hyperactivity (ADHD), and enuresis (inability to control urination).

History of Vivactil

Tricyclic antidepressants were developed in the 1950s. Their name comes from their three-ringed chemical structure. TCAs helped revolutionize the treatment of depression, but today they are often used as a last resort due to their serious side effects and increased incidence of suicide. Selective serotonin reuptake inhibitors (SSRIs) have largely replaced tricyclic antidepressants and work by increasing the amount of serotonin available at the neuronal synapses. In many cases, their side effects are less severe than most TCAs.

How Does Vivactil Work?

This drug acts by decreasing the reuptake of norepinephrine and serotonin in the brain. It regulates nerve impulse transmission by regulating the balance of these chemicals in the brain. Vivactil also acts on acetylcholine, but to a lesser extent.

The therapeutic effect of this drug usually becomes evident after about one to two weeks of therapy. The changes occur in receptor sensitivity in the cerebral cortex and hippocampus in the limbic system. This system is responsible for the regulation of emotions. In addition to affecting serotonin and norepinephrine, Vivactil also affects alpha-1 and alpha-2 receptors, causing an increase in concentration of norepinephrine.

Vivactil can also decrease pain, especially neuropathic or neuralgic pain, by blocking sodium channels.

Dosage FAQs

Possible Side Effects

This medication, in addition to many other TCAs, has several severe potential side effects of which to be aware. If you are prescribed this drug, ensure your doctor and/or pharmacist discusses the following potential side effects with you.

Central nervous system effects
Due to the changes in concentration of norepinephrine, Vivactil may cause the following adverse effects:

Cardiovascular effects
Like other tricyclic antidepressants, Vivactil may lead to an increased risk of:

Gastrointestinal effects
For some, this medication may cause discomfort and/or:

Psychiatric effects
The use of this drug may lead to several mental health conditions including:

Hypersensitive reactions
Those sensitive to this medication may experience:

Other adverse effects

Other adverse effects include obstructive jaundice and bone marrow suppression. Liver function tests for those in treatment with this medication will also altered. This drug may cause swelling of parotid glands, alopecia, flushing, changes in weight, and altered urinary frequency.

Drug Interactions of Vivactil

This medication can have some potentially severe drug interactions with the following substances:

Precautions Associated with Vivactil

The use of Vivactil should be avoided by children as it can affect their social behavior, increase suicidal ideation, and cause drastic changes in mood. The use of this drug by the elderly can cause excessive sedation. 

People experiencing the following conditions should discuss all possible treatment options with their doctor before taking this medication:

Safe Withdrawal from Vivactil

Do not stop taking this medication abruptly, even if you feel like you no longer need it. If you need to stop taking this medication, work out a safe plan with your doctor to taper down your dosage. This will help you reduce the severity and occurrence of withdrawal symptoms. Stopping your treatment suddenly may cause severe flu-like symptoms, nausea, fatigue, and a return of depression symptoms.

References:

  1. de Beaurepaire, R. (2002). Questions raised by the cytokine hypothesis of depression. Brain, Behavior, and Immunity, 16(5), 610.
  2. Delgado, P.L. (2004). How antidepressants help depression: Mechanisms of action and clinical response. Journal of Clinical Psychiatry, 65(Suppl 4), 25.
  3. Dhillon, S., Scott, L.J., and Plosker, G.L. (2006). Escitalopram: A review of its use in the management of anxiety disorders. CNS Drugs, 20(9), 763.
  4. Dhillon, S., Yang, L.P., and Curran, M.P. (2008). Bupropion: A review of its use in the management of major depressive disorder. Drugs, 68(5), 653.

Page content reviewed by James Pendleton, ND.