Neuropathic pain is a common problem in clinical practice, affecting patients physically, emotionally, financially, and socially. Current treatment includes antidepressants, antiepileptics, and opioid analgesics. Bupropion is a specific inhibitor of neuronal noradrenaline reuptake and a weak inhibitor of dopamine reuptake, which shows some promise in the treatment of neuropathic pain.

Tricyclic antidepressants have been shown to alter thyroid function in man and laboratory animals, but have not been evaluated in the dog. The effect of administration of clomipramine on canine thyroid function was studied in a prospective protocol in which 14 mature, healthy dogs were administered clomipramine (3 mg/kg PO q12h) for 112 days. Thyroid-stimulating hormone (TSH), total thyroxine (T4), total 3,5,3' triiodothyronine (T3), free thyroxine (fT4), and 3,3',5' triiodothyronine (reverse T3; rT3) concentrations were measured on selected days. Thyrotropin-releasing hormone (TRH) response tests were performed concurrently. Repeated measures analysis of variance was applied to test for effects of day of treatment; when significance (p < 0.05) was noted, it was further investigated using orthogonal polynomial trends. Significant decreases were found in serum T4 (26 ± 1.2 to 17 ± 0.5 nmol/L, p < 0.001), fT4, (29 ± 2.4 to 19 ± 1.3 pmol/L, p < 0.0002), and rT3 (1.2 ± 0.1 to 0.83 ± 0.08 nmol/L, p < 0.0001) concentrations. The effect of time on serum T3 concentration was also significant (p < 0.0001), but no consistent trend could be identified. No significant effect of time was noted in either pre- or post-TRH TSH concentrations. The results of this study indicate that significant and substantial decreases in T4 (35%), fT4 (38%), and rT3 can occur during clomipramine administration. Long-term administration of clomipramine may result in a misdiagnosis of hypothyroidism if a dog is tested while taking this medication and, since decreased serum fT4 occurs, hypothyroidism may result. / Master of Science

To assess the long-term effects of antidepressant medication on balance, equilibrium, and postural reflexes, we studied 30 patients, ages 20-76 years, who had a diagnosis of depressive disorder (as defined by DSM-III-R criteria) and had been treated with tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) for ≤1 year. They were assessed by a Balance Master System. The assessment included three tasks: static balance, rhythmic weight shift, and limits of stability. When compared with 30 nonhospitalized healthy controls (of comparable age and the same sex), patients who took TCAs showed impaired balance function in all main indices. The results suggest that the impairment of balance function includes motor coordination, fine-motor control, postural reflexes,maintaining equilibrium, and reaction time. No obvious impairment of balance function was observed in patients who took SSRIs.