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Tricyclic Antidepressants and Suicide

Is there a link between tricyclic antidepressants and suicide? In clinical studies, there appeared to be an increased risk of suicidal thoughts and behavior in children and teenagers who took antidepressants (including tricyclic antidepressants). Although tricyclic antidepressants have not been approved for use in children and teenagers with depression, they can be prescribed off-label to treat other conditions for these age groups.

An Overview of Tricyclic Antidepressants and Suicide

Tricyclic antidepressants (TCAs) are prescription medications used for the treatment of depression and a few other conditions. As with all antidepressants, there may be an increased risk of suicidal behavior when taking tricyclic antidepressants.
 

Tricyclic Antidepressants and Suicide: FDA Warning

The U.
 S. Food and Drug Administration (FDA) has issued a special warning about the risk of suicidal thoughts and behavior with antidepressant use in children and teenagers. The warning was issued due to concerns that antidepressants seemed to increase the risk of suicidal behavior in children and teenagers in clinical studies.
 
None of the tricyclic antidepressants are approved for treating depression in children or teens. However, clomipramine (Anafranil®) is approved for obsessive-compulsive disorder (OCD) in children as young as 10 years old, and imipramine hydrochloride (Tofranil®) is approved for bedwetting in children as young as six years old. While the other tricyclic antidepressants may be used "off-label" in children or teens, they are generally not recommended for children under 12 years old.
 
Although tricyclic antidepressants are not approved for treating depression in children and teenagers, they may be used "off-label" for these age groups.
 
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Written by/reviewed by: Kristi Monson, PharmD; Arthur Schoenstadt, MD
Last reviewed by: Kristi Monson, PharmD
 
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