Tricyclic Antidepressants: What You Need to Know

If you're exploring treatment options for depression, you may have heard of tricyclic antidepressants (TCAs). While newer medications like SSRIs are now first-line treatments, TCAs remain effective options for certain patients. At Next Step Psychiatry in Lilburn, we help patients throughout Gwinnett County understand all their treatment options.

What Are Tricyclic Antidepressants?

TCAs were among the first antidepressants developed, with imipramine approved in 1959. They work by increasing levels of serotonin and norepinephrine in the brain—chemicals that help regulate mood. While SSRIs and SNRIs have largely replaced them as first-line treatments due to fewer side effects, TCAs may be prescribed when other medications haven't worked.

Common TCAs Include:

• Amitriptyline (Elavil) - also used for chronic pain and insomnia
• Nortriptyline (Pamelor) - sometimes used for ADHD
• Imipramine (Tofranil) - also prescribed for bedwetting in children
• Doxepin (Silenor) - commonly used for insomnia
• Clomipramine (Anafranil) - FDA-approved for OCD

When Are TCAs Prescribed?

Today, your psychiatrist may recommend TCAs when:

• SSRIs or SNRIs haven't adequately relieved symptoms
• You need treatment for chronic pain alongside depression
• Other medications have caused intolerable side effects
• Off-label uses like anxiety, insomnia, or fibromyalgia are indicated

Potential Side Effects

TCAs can cause more side effects than newer antidepressants:

• Dry mouth and constipation
• Drowsiness and dizziness
• Blurred vision
• Weight gain
• Heart rhythm issues

Our team carefully monitors patients taking TCAs and adjusts treatment as needed.

How Long Do TCAs Take to Work?

You may start seeing improvements in 2-4 weeks, though full effectiveness can take longer. Never adjust or stop your medication without consulting Dr. Ursani or Fathima Chowdhury, PA-C, as this can cause withdrawal symptoms.