Everything You Should Know About Tricyclic Antidepressants

Tricyclic Antidepressants are a class of Antidepressants that are used to treat numerous mental health conditions, such as Depression and Anxiety.

Tricyclic antidepressants are among the oldest antidepressants, with Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) having largely replaced TCAs in recent years.

TCAs are still used occasionally, with one medicine called Amitriptyline still particularly common. TCAs are most effective when used in conjunction with some form of talking therapy.

Information on Tricyclic Antidepressants

In general, it takes between four and six weeks for an antidepressant’s full effectiveness to be felt. However, some people will see some signs of improvement after around a week.

It is important to take an antidepressant how and when a Doctor has advised. This involves taking the correct dose at the right time, and taking the medication on a consistent basis. Never take more than one dose at a time to make up for a forgotten dose.

A low dose will initially be prescribed. Once remission has been achieved, it is important to continue to take an antidepressant, as this will improve the chances of symptoms not coming back. Sometimes, antidepressant use can last for lifetime.

What conditions are Tricyclic Antidepressants used for?

TCAs were initially used for a range of mental health conditions. But in the modern age, due to more modern medicines like SSRIs and SNRIs existing, TCAs are used for only a few conditions.

• Depression
• Anxiety
• Obsessive-Compulsive Disorder
• Somatic Disorders
• Chronic Pain

What are the different types of Tricyclic Antidepressants?

There are a few different TRCAs that are licensed for use in the United Kingdom for mental health conditions. In reality, barely in any of the below are actually used.

• Amitriptyline (Elavil)
• Clomipramine (Anafranil)
• Imipramine (Tofranil)
• Lofepramine (Gamanil)
• Dosulepin (Prothiaden)
• Doxepin (Sinequan)
• Nortriptyline (Pamelor)
• Trimipramine (Surmontil)

How do Tricyclic Antidepressants work?

It isn’t entirely known how Tricyclic antidepressants work. It is believed that antidepressants work by increasing levels of a group of chemicals in the brain called neurotransmitters.

TCAs work on the neurotransmitters serotonin and at high doses – norepinephrine. These are chemicals that appear to be linked to mood.

TCAs also block the action of acetylcholine – another neurotransmitter. The exact process of TCAs isn’t entirely known.

Side Effects of Tricyclic Antidepressants

Side effects are common with Tricyclic antidepressants. The main reason why TCAs have largely been replaced is due to the negative side effects compared to more modern antidepressants.

It is important to note that the side effects for each medicine within this class differs slightly. With any antidepressant, a Patient Information Leaflet will be included in the box. This leaflet provides an exhaustive list of side effects.

Side effects from TCAs can potentially be difficult to live with. Sometimes, side effects will last just a few days as the body adjusts to the medication. However, some side effects may be persistent.  

Common side effects of TCAs include dry mouth, constipation, difficulties in urinating, drowsiness, weight gain, excessive sweating, low sex drive and sexual dysfunction.

Serious side effects include suicidal thoughts, seizures, chest pain, psychosis or any abnormal behaviour. An overdose should be avoided, as it can cause the potentially fatal Serotonin Syndrome. TCAs can be lethal in overdose.

In the event of severe side effects occurring, it is important to contact a Doctor or emergency department immediately. 

Cautions of Tricyclic Antidepressants

It is important to thoroughly read the Patient Information Leaflet that comes with your medication. The leaflet will include specific cautions that should be taken into consideration when taking a medicine.

General considerations when taking antidepressants include:

• Tell a Doctor about any medicine or substance that is currently being used – such as Herbal Remedies like St. John’s Wort
• Avoiding alcohol in the first few days of treatment, to allow the body to get used to the medication. After adjustment is complete, it is advised to not consume alcohol – given its properties as a depressant. If consumed, drinking alcohol in moderation is important.
• Any antidepressant can react unpredictably with illegal drugs; therefore it is advisable to not use recreational drugs when undergoing antidepressant therapy.
• Studies show that people under the age of 25 taking antidepressants are at heightened risk of suicidal ideation [1]. Therefore, it is important to exert caution during treatment.
• Antidepressants shouldn’t routinely be taken during pregnancy or breastfeeding. It is important to discuss this with a Doctor.
• To remember that antidepressants are most effective when combined with a form of talking therapy. Antidepressants can help relieve symptoms, but not cure a mental health condition.

Summary

TCAs are an effective type of antidepressant. However, their use has lowered since the advent of SSRIs and SNRIs.

But if a patient has not had any positive responses to other antidepressants, they may feasibly be prescribed a TCA. Normally, this will be Amitriptyline, but any could be used.

See Also

• Antidepressants Homepage
• Everything You Need To Know About Antidepressants
• About SSRI Antidepressants
• About SNRI Antidepressants
• About Tricyclic Antidepressants
• About MAOI Antidepressants
• About Atypical Antidepressants

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