Tricyclic antidepressants (TCAs) are medications developed to treat depression. They are now less frequently used, but were in heavy use during the 1950s and later. The advent of medications called selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors (SSRIs and SNRIs), decreased use of the tricyclic antidepressants because many acted in similar manner, especially the SNRIs, and have fewer side effects. There are still some reasons why TCAs might be used, and these do not always relate to the treatment of depression.
Some of the generic names of the tricyclic antidepressant types include the following:
- Amitriptyline
- Desipramine
- Imipramine
- Nortryptiline
- Amoxapine
- Doxepin
- Protriptyline
- Trimipramine
People may know some tricyclic antidepressant types better by their brand names, which include Sinequan®, Pamelor®, Elavil®, Surmontil® and Vivactil® among the many names these medications have had. Their principal action is to raise available levels of norepinephrine and dopamine. Some of these drugs also affect and raise available serotonin levels, though not all do so. However, appropriate dosing may result in many side effects, and the following is a partial list:
- Drowsiness
- Dizziness
- Dry mouth
- Sleepiness
- Fatigue
- Decrease in Libido or Ability to Achieve Orgasm
- Rapid Heart Rate
- Changes in Blood Pressure
- Weight Gain
- Appetite Changes
- Constipation
- Urinary Changes
- Nausea
Not all people experience all of these symptoms. Generally most complain of sleepiness if taking these drugs, which can make functioning during the day difficult. Sometimes, a tricyclic antidepressant is prescribed primarily to assist in sleep instead of as a main antidepressant. These drugs might also be used for some people who suffer from chronic pain, to treat some symptoms of attention deficit disorder, or to treat the symptoms of irritable bowel disorder. Again, side effects of these medications may make them less preferred when alternatives with fewer side effects exist.
Another reason why many physicians hesitate to prescribe a tricyclic antidepressant is because these drugs are extremely dangerous in overdose amounts. Overdosing can be lethal quickly, and patients that are depressed may also be suicidal. There is some evidence that TCAs, like many other antidepressants, may actually increase suicidality in a percentage of patients. The last thing a doctor wants is to put a potentially lethal substance in the hands of a person who is profoundly suicidal or could become so. SSRIs and SNRIs have the advantage here because even in overdose amounts, they tend not to cause as much damage.
On the other hand, there are patients who may not respond to treatment with SSRIs and SNRIs, and a tricyclic antidepressant may be considered as a possible alterative treatment, which patients may respond to better. Yet certain classes of patients should probably not use these medications including those men with enlarged prostates and anyone with thyroid disorder. People who have diabetes will likely require more blood sugar monitoring too, as TCAs can affect blood sugar levels.
