Antidepressants, Tricyclic antidepressant, TCA for depression, side effects of tricyclic antidepressant, drug interactions of TCA, who should use tricyclic antidepressant, depression, who should avoid tricyclics

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:

Drowsiness

Anxiety

Restlessness

Dry mouth

Constipation

Urinary retention

Difficulty urinating

Cognitive and memory difficulties

Weight gain

Increased sweating

Dizziness

Decrease in sexual ability and desire

Muscle twitches

Fatigue

Weakness

Nausea

Increased heart beats

Irregular heart rhythms (very rare)

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.
Also avoid TCAs if you are taking any of the following as there can be a dangerous drug interaction:

Alcohol

Antihistamines

Antihypertensive medications

Antipsychotic drugs (such as Thorazine and Haldol, used to treat psychosis, including psychotic depression and severe mania)

Aspirin

Bicarbonate of soda

Diuretics

Oral contraceptives

Some blood coagulants

Some sleeping medications

Thyroid supplements

Tobacco

Vitamin

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.