Tricyclic antidepressants, (commonly called TCAs) have been prescribed since the 1950s for depression. They are the oldest antidepressants we use today. Until recently TCAs were the clear first choice of physicians for the vast majority of people with major depressive disorder.
Examples of TCAs are: imipramine (Tofranil), amitriptyline (Elavil) and nortriptyline (Pamelor).
TCAs work by raising the levels of serotonin and norepinephrine in the brain by slowing the rate of reuptake, or reabsorption, by nerve cells. It may take several weeks for you to see the desired result.
Side Effects of TCAs
TCAs tend to have more unpleasant side effects than the newer antidepressants such as SSRIs. The side effects of TCAs vary with the specific medication taken and the individual. Here are some typical side effects:
These side effects often disappear quickly or can be reduced by lowering the dosage or changing to another tricyclic.
Drug Interactions For Tricyclic Antidepressants
TCAs can be dangerous when combined with other drugs. Here is a partial list.
Safety Warnings on the Use of TCAs
Because of the possibility of causing serious cardiac complications, TCAs can be lethal if misused at high doses. TCAs are the leading cause of death by drug overdose in the United States. Because people with major depressive disorder may be contemplating suicide, the danger of overdosing is quite real and should be considered in prescribing TCAs.
Who Shouldn't Take TCAs?
Do not take TCAs if you have a history of heart disease as TCAs may create cardiovascular problems.
Heart arrhythmias have been seen in children and adolescents taking desipramine, a tricyclic antidepressant. Caution is advised when using this drug for this population.
People who wear soft contact lenses may find TCAs uncomfortable. TCAs may lead to decreased tearing that may lead to excessive deposits of thick mucoid secretions on the lenses, causing the eyes to itch.
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