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Tricyclic Antidepressants

Tricyclic antidepressants are generally used to treat depression. However, a few of these medications are approved to also treat other conditions, such as bedwetting, anxiety, and obsessive-compulsive disorder. Although it is not entirely clear how they work, it is believed that they cause certain chemicals to stay in the brain longer. Some potential side effects of these medications include dizziness, drowsiness, and headaches.

What Are Tricyclic Antidepressants?

Tricyclic antidepressants (TCAs) are prescription medications typically used to treat depression. A few of the tricyclic antidepressants are approved to treat other conditions, such as bedwetting, anxiety, or obsessive-compulsive disorder (OCD).
 
(Click Uses of Tricyclic Antidepressants for more information on these uses, along with possible off-label uses for tricyclic antidepressants.)
 

How Do They Work?

It is not entirely clear how tricyclic antidepressants work.
 They affect several chemicals in the brain, including serotonin and norepinephrine. It is thought that maybe tricyclic antidepressants allow these chemicals to stay in the brain longer, which can help with symptoms of depression.
 
One tricyclic antidepressant, amoxapine (Asendin®), also affects dopamine. This makes this particular medication especially useful for treating psychotic depression (depression with hallucinations, delusions, or other psychotic features).
 

When and How Do I Take Them?

Some general considerations for when and how to take tricyclic antidepressant medications include:
 
  • They are taken by mouth. Some people take their tricyclic antidepressant several times a day, while others take it just once a day at bedtime.
     
  • If your tricyclic antidepressant makes you drowsy, ask your healthcare provider about taking it at night.
     
  • You can take them with or without food. If your tricyclic antidepressant bothers your stomach, try taking it with food.
     
  • They should be taken at the same time(s) each day to maintain an even level of the drug in your blood.
     
  • For tricyclic antidepressants to work properly, they must be taken as prescribed. Your medication will not work if you stop taking it.
     

Tricyclic Antidepressant Dosage

The dosage your healthcare provider recommends will vary depending on a number of factors, including:
 
  • The specific type of tricyclic antidepressant
  • The medical condition being treated
  • Other medical conditions you may have
  • Other medications you may currently be taking.
     
As is always the case, do not adjust your tricyclic antidepressant dose unless your healthcare provider specifically instructs you to do so.
 

Side Effects

(The tricyclic antidepressant side effects listed below are NOT a complete list of possible side effects. Your healthcare provider can discuss a more complete list of side effects with you. You can also read about specific side effects for each type of tricyclic antidepressant by going to the specific drug within the eMedTV Web site.)
 
As with any medicine, there are possible side effects with tricyclic antidepressants. However, not everyone who takes them will experience side effects. In fact, most people tolerate the medication well. When side effects do occur, in most cases they are minor and either require no treatment or can easily be treated by you or your healthcare provider. Serious side effects are less common.
 
The most common side effects of tricyclic antidepressants include:
 
(Click Side Effects of Tricyclic Antidepressants to learn about specific side effects, including some of the more serious side effects that you should report to your healthcare provider.)
 

What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking a tricyclic antidepressant if you have:
 
Also, let your healthcare provider know if you:
 
Be sure to tell your healthcare provider about all of the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
 
(Click Precautions and Warnings With Tricyclic Antidepressants for more information on this topic, including information on who should not take tricyclic antidepressants.)
 

Overdose

People who take too much of a tricyclic antidepressant may have overdose symptoms that could include, but are not limited to:
 
  • Changes in heart rhythm (arrhythmia)
  • Very low blood pressure (hypotension)
  • Seizures
  • Confusion
  • Trouble concentrating
  • Hallucinations
  • Dilated (wide open) pupils
  • Agitation
  • Overactive reflexes
  • Drowsiness
  • Muscle tension
  • Vomiting
  • Low body temperature (hypothermia) or high fever (hyperpyrexia)
  • Loss of life.
     
If you happen to overdose, seek medical attention immediately.
 

A List of Tricyclic Antidepressants

There are 11 tricyclic antidepressants currently available:
 
Technically, maprotiline and amoxapine are tetracyclic antidepressants, due to their chemical structures. However, many sources classify them as tricyclic antidepressants, as they are so similar to tricyclic antidepressants. Also, amitriptyline is available in the following combination medications:
 

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Written by/reviewed by: Kristi Monson, PharmD; Arthur Schoenstadt, MD
Last reviewed by: Kristi Monson, PharmD;
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