Tricyclic Antidepressants

Tricyclic antidepressants (TCAs) are a class of drugs that have approval from the U.S. Food and Drug Administration (FDA) to treat depression.e60dc2a1-f33c-4a05-9b50-8e3e8e59762993abc95b-6787-4ea6-aff4-1cf6c454694e They work by increasing the levels of brain chemicals called neurotransmitters — specifically, serotonin and norepinephrine, which affect mood, attention, and pain. In addition to depression, TCAs may be prescribed for obsessive-compulsive disorder (OCD), anxiety, insomnia, chronic pain, or migraine.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d7e052cb-1df3-49c3-b3d8-b5153460aa2e
What Are Tricyclic Antidepressants? Overview TCAs are a class of antidepressants that alter the communication between nerve cells in the brain. They do this by increasing the amount of certain chemical messengers, or neurotransmitters .e60dc2a1-f33c-4a05-9b50-8e3e8e5976296416a435-9fed-4450-9813-92690378a1c4 Neurotransmitters regulate a range of bodily processes, such as mood, energy, and focus. It’s important to have an appropriate balance of neurotransmitters to sustain daily function.e60dc2a1-f33c-4a05-9b50-8e3e8e59762912d31b43-9806-4c6b-9689-e81ac6e91162 If you have too much or too little of a certain neurotransmitter, such as serotonin, depression symptoms may develop.e60dc2a1-f33c-4a05-9b50-8e3e8e59762912d31b43-9806-4c6b-9689-e81ac6e91162 This is why boosting the levels of some neurotransmitters may help reduce mood disturbances in some individuals.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e34da932-353a-4ba7-91e1-a706df8aa739
What Conditions Do Tricyclic Antidepressants Treat? Conditions Although TCAs were the first class of antidepressants to be invented, most TCAs are no longer a first-line choice in treating depression. Nonetheless, they may still be used if other medications or treatments have not improved depression symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f64fbdf-9e5b-43a3-bb55-a5585345e634 TCAs can also be used “off-label” to treat other conditions. This means it lacks FDA approval, but providers may still prescribe them based on research showing its effectiveness.e60dc2a1-f33c-4a05-9b50-8e3e8e597629767a5f5d-d06f-4b28-b0d0-7482897e3ec0 Depression Depression is a mental health condition characterized by low mood and a loss of pleasure or interest in activities. Depression can also affect sleep, appetite, energy, and concentration. Most TCAs have FDA approval to treat depression.e60dc2a1-f33c-4a05-9b50-8e3e8e597629729fb267-a5cb-4465-a44c-2fe9f14b3ab8 OCD OCD is a mental illness involving intrusive thoughts (obsessions) and repetitive behaviors (compulsions) intended to reduce obsessions. OCD can disrupt healthy thinking patterns and interfere with daily functioning. Clomipramine (Anafranil) has FDA approval for OCD treatment in people 10 years and older.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f64fbdf-9e5b-43a3-bb55-a5585345e634 Anxiety Disorders Anxiety refers to persistent and excessive worry, fear, or dread that’s disproportionate to a situation. TCAs may be used off-label to treat anxiety disorders.e60dc2a1-f33c-4a05-9b50-8e3e8e597629767a5f5d-d06f-4b28-b0d0-7482897e3ec0 Migraine Migraine is a complex and disabling neurological disease. Symptoms may vary, but a typical migraine attack may involve severe unilateral pain, sensory sensitivities, nausea, and vomiting. Research has shown that some TCAs can prevent migraine attacks, despite its lack of FDA approval for migraine.e60dc2a1-f33c-4a05-9b50-8e3e8e597629767a5f5d-d06f-4b28-b0d0-7482897e3ec0 Amitriptyline (Elavil), doxepin (Sinequan), and nortriptyline (Aventyl, Pamelor) are the most common TCAs used in migraine prevention.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f64fbdf-9e5b-43a3-bb55-a5585345e634 Chronic Pain TCAs may also be used to treat chronic pain due to nerve-related (neuropathic) pain conditions . These may include diabetic neuropathy , postherpetic neuralgia, and myofascial pain.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f64fbdf-9e5b-43a3-bb55-a5585345e634 Amitriptyline (Elavil) may be used to treat chronic pain.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296b31aea5-55e3-4cdd-98c6-805572622e82 Fibromyalgia Fibromyalgia is a chronic widespread pain condition that can cause fatigue, memory issues, mood disturbances, and sleep difficulties. TCAs may be used to treat fibromyalgia if first-line treatments don’t improve symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f64fbdf-9e5b-43a3-bb55-a5585345e634 Insomnia Insomnia refers to difficulty falling or staying asleep. Although TCAs don’t have FDA approval in treating insomnia, they may still be helpful.e60dc2a1-f33c-4a05-9b50-8e3e8e597629767a5f5d-d06f-4b28-b0d0-7482897e3ec0 Amitriptyline (Elavil)e60dc2a1-f33c-4a05-9b50-8e3e8e597629ef294a54-9bce-4dce-8e3e-8403d7d4361a and doxepin (Sinequan) may be used to treat insomnia.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290ef4474b-32dc-4081-98cf-504b4b100762 Bedwetting TCAs may be prescribed to treat bedwetting in children 10 years and older if first-line therapies are ineffective.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f64fbdf-9e5b-43a3-bb55-a5585345e634
Types of Tricyclic Antidepressants Types Different TCAs may be used to treat different conditions. Examples of TCAs include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629a6743a0b-3a0e-4d5c-9cce-3685d235a9b5 Amitriptyline (Elavil) Amoxapine (Asendin) Clomipramine (Anafranil) Desipramine (Norpramin) Doxepin (Sinequan) Imipramine (Tofranil) Nortriptyline (Aventyl, Pamelor) Protriptyline (Vivactil) Trimipramine (Surmontil)
How Do Tricyclic Antidepressants Work? Function TCAs work by increasing the amount of two mood-altering neurotransmitters: norepinephrine and serotonin .e60dc2a1-f33c-4a05-9b50-8e3e8e597629cfdd767d-af19-43d6-bba9-a985498985ae Usually, neurotransmitters are absorbed back into the nerve cells that released them in a process called reuptake. This is how the body stops neurotransmitters from exerting their effects.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cfdd767d-af19-43d6-bba9-a985498985ae TCAs can block reuptake. This means neurotransmitters like serotonin and norepinephrine aren’t reabsorbed, and they can remain available for the brain to use.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cfdd767d-af19-43d6-bba9-a985498985ae As a result, serotonin and norepinephrine’s effects on mood, attention, and pain may continue. By blocking reuptake, TCAs may help improve mood and reduce pain signals.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cfdd767d-af19-43d6-bba9-a985498985ae
What Are the Possible Side Effects of Tricyclic Antidepressants? Side Effects TCAs have a high risk of side effects, so physicians often start with a low dosage and gradually increase it based on a patient’s response.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c99b6d88-f820-43b8-88e3-f92f5e614c99 Common side effects of TCAs may include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976297062c492-71e7-4ad7-8ee5-e3d4929aaa1b Drowsiness Blurry vision Constipation Dry mouth Low blood pressure when standing up from your seat, also known as orthostatic hypotension Urine retention (inability to completely empty the bladder) Less common side effects may include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976297062c492-71e7-4ad7-8ee5-e3d4929aaa1b Unexpected or unintended weight loss Unexpected or unintended weight gain due to an increased appetite Increased sweating Shaking and tremors Low libido (sex drive) Erectile dysfunction Delayed orgasm Certain TCAs may be more likely to cause specific side effects, such as drowsiness or weight gain, than others. Whether a patient experiences a particular side effect depends on their symptoms and any underlying health problems they may have.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297062c492-71e7-4ad7-8ee5-e3d4929aaa1b TCAs aren’t addictive, but you may experience withdrawal symptoms if you suddenly stop or miss several doses. Withdrawal symptoms may include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976297062c492-71e7-4ad7-8ee5-e3d4929aaa1b Anxiety Agitation Chills, muscle aches, and other flu-like symptoms Drowsiness Headaches Irritability Nausea Sweating It’s important to talk to your doctor about the best way to gradually and safely reduce your dosage.
Are There Any Risks Related to Tricyclic Antidepressants? Risks People taking TCAs, especially teenagers and young adults under 25, may be at increased risk for suicidal thoughts and behaviors. This risk is indicated in a black-box warning, which the FDA requires all antidepressants to have.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290f6c7b04-0939-4ce1-9278-cc8f0921098b Some TCAs may also cause confusion in people 65 years and older, especially at higher dosages.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291f732862-d507-42db-8c45-964596525357 Certain medications can interact with TCAs. These include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629a3fe8514-dbb8-4f8b-ae1c-4b29c86f8638 Serotonin-norepinephrine reuptake inhibitors (SNRIs) SSRIs Anticholinergic drugs, including antihistamines or antipsychotics Anticoagulants ( blood-thinning medications ) Lithium (Eskalith) Clonidine (Catapres) Medications to treat blood pressure Cimetidine (Tagamet) Doctors may avoid prescribing TCAs to people with certain health conditions to reduce the risk of complications. Let your doctor know if you have:e60dc2a1-f33c-4a05-9b50-8e3e8e5976291f732862-d507-42db-8c45-964596525357 Diabetes Heart problems A thyroid disorder An enlarged prostate Glaucoma Liver disease A history of seizures A family history of sudden death from heart problems or a heart condition called QTc interval prolongatione60dc2a1-f33c-4a05-9b50-8e3e8e597629a3fe8514-dbb8-4f8b-ae1c-4b29c86f8638 A history of allergic reactions to TCA drugse60dc2a1-f33c-4a05-9b50-8e3e8e597629a3fe8514-dbb8-4f8b-ae1c-4b29c86f8638 Used monoamine oxidase inhibitors (MAOIs) within the past 14 dayse60dc2a1-f33c-4a05-9b50-8e3e8e597629a3fe8514-dbb8-4f8b-ae1c-4b29c86f8638 TCAs also carry a higher risk of overdose than other antidepressants, so it’s important to take any TCA as directed by your doctor.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a3fe8514-dbb8-4f8b-ae1c-4b29c86f8638
The Takeaway Tricyclic antidepressants are a class of drugs that affect neurotransmitters, or chemical messengers, in the brain. They may be used to treat depression, migraine, chronic pain conditions, insomnia, and bedwetting in children. TCAs have an increased risk of suicidal thoughts, so be sure to talk to your doctor about the benefits and side effects before starting one.

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