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Tricyclic Antidepressants Tricyclic antidepressants were the most commonly prescribed antidepressants until selective serotonin reuptake inhibitors (SSRIs) came along. Doctors still prescribe tricyclic antidepressants, particularly to people who have not been helped by SSRIs. Tricyclics are very effective, and may be more effective than SSRIs for certain types of severe depression.
Tricyclic antidepressants are generally taken once per day. Because they can be sedating, they are taken in the evening, when they may promote a better night’s sleep. Doses vary widely. It is sometimes helpful to have your blood levels checked. In any case, your doctor will adjust your dose gradually depending on whether you are improving and what side effects you may experience. It is very important to take enough tricyclic antidepressant. One of the most common reasons that depression does not get better is because people do not take a large enough dose. However, because tricyclic antidepressants can be dangerous if given in too high a dose, you and your doctor need to work out the correct dose for you. | Generic Name | Brand Name | Dose* | | Imipramine | Tofranil | An average of 150-300 milligrams per day | | Amitriptyline | Elavil, Endep | An average of 150-300 milligrams per day | | Clomipramine | Anafranil | An average of 75-250 milligrams per day | | Doxepin | Sinequan, Adapin | An average of 150-300 milligrams per day | | Desipramine | Norpramin | An average of 150-300 milligrams per day | | Nortriptyline | Pamelor | An average of 50-150 milligrams per day | | Protriptyline | Vivactil | An average of 20-60 milligrams per day | | Trimipramine | Surmontil | An average of 75-200 milligrams per day | |
*These ranges are averages for otherwise healthy adults. Older people metabolize tricyclic antidepressants more slowly than younger people do, so they generally need lower doses. And the elderly are more susceptible to side effects. Back to top When taken in normal, therapeutic doses, tricyclic antidepressants are safe. Common side effects include the following: - Dry mouth
- Blurred vision when reading
- Constipation
- A slower urine stream
- Light-headedness when rising to stand (Called orthostatic hypotension, this refers to a drop in blood pressure that accompanies a posture change.)
- Sedation, restlessness or poor sleep
- Sweating
- Skin rash or other allergic reaction
- Weight gain
- Nausea, vomiting or poor appetite
- Tremor
- Confusion (especially in the elderly)
- Increased risk of seizure for people predisposed to seizures
- Rapid heartbeat
Back to top Because tricyclic antidepressants can cause dangerous heart rhythms, an overdose can be fatal. Anyone who overdoses should be rushed to an emergency room. Because of this overdose risk, tricyclic antidepressants are used less frequently today than other types of antidepressants (such as selective serotonin reuptake inhibitors). However, tricyclic antidepressants can and should be used if someone's symptoms may be helped, particularly if other treatments have failed. Suicide Risk. All antidepressants (not just tricyclic antidepressants) carry warnings about suicide risk. In October 2004, the Food and Drug Administration began requiring that manufacturers include a warning on package inserts for all antidepressants. The warning mentions the risk of suicidal thoughts, hostility and agitation in both children and adults. After you start taking any antidepressant, there is a risk that you may feel worse rather than better. The danger is greatest in the first few weeks of treatment, so make sure you follow-up with your doctor. There is also a small risk for an increase in suicidal thinking and behavior. Fortunately, research shows that the overall suicide rate lowers in people taking antidepressants. However, a small number of people using antidepressants encounter a lower mood, and feel more anxious, irritable, self-destructive or impulsive. This overdose risk is what causes tricyclic antidepressants to be used less frequently than other types of antidepressants (such as SSRIs). There is concern about giving these drugs to a patient who is depressed, because the risk of suicide is greater for people who are depressed. Discontinuation of tricyclic antidepressants. Abruptly stopping your use of these drugs can cause the following: - Loss of appetite, nausea, vomiting, diarrhea
- Runny nose, sweating, muscle aches, fever
- Tingling, restlessness, insomnia, increased dreaming, dizziness, lightheadedness, anxiety, agitation
The tricyclic antidepressant clomipramine (Anafranil) has a strong effect on serotonin. When you stop using clomipramine, you may experience symptoms similar to those that occur when people stop using selective serotonin reuptake inhibitors. Examples include dizziness, trouble with coordination, headache, nausea, lethargy, tingling, electric-shock-like sensations, vivid dreams, irritability and lowered mood. Symptoms usually peak within the first week and then fade away. Back to top
Last updated July 01, 2005
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