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Tricyclic antidepressants and tetracyclic antidepressants

Tricyclic and tetracyclic antidepressants affect brain chemicals to ease depression symptoms. Explore their side effects and whether one of these antidepressants may be a good choice for you.

By Mayo Clinic staff

Managing Depression

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Tricyclic and tetracyclic antidepressants were among the earliest antidepressants developed. They're effective, but have generally been replaced by antidepressants that cause fewer side effects. Other antidepressants are prescribed more often, but these antidepressants are still a good option for some people. In certain cases, they relieve depression when other treatments have failed.

How tricyclic and tetracyclic antidepressants work

Tricyclic and tetracyclic antidepressants, also called cyclic antidepressants, ease depression by affecting chemical messengers in the brain (neurotransmitters). These naturally occurring brain chemicals are used to communicate between brain cells. Most antidepressants work by changing the levels of one or more neurotransmitters.

Cyclic antidepressants block the absorption (reuptake) of the neurotransmitters serotonin (ser-oh-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin), making more of these chemicals available in the brain. This seems to help brain cells send and receive messages, which in turn boosts mood. These antidepressants also affect other chemical messengers, which can lead to a number of side effects.

Cyclic antidepressants approved to treat depression

Tricyclic and tetracyclic antidepressants approved by the Food and Drug Administration to treat depression, with their generic names followed by brand names in parentheses, include:

  • Amitriptyline
  • Amoxapine
  • Desipramine (Norpramin)
  • Doxepin
  • Imipramine (Tofranil, Tofranil-PM)
  • Maprotiline
  • Nortriptyline (Pamelor)
  • Protriptyline (Vivactil)
  • Trimipramine (Surmontil)

Some of these medications come in forms that must be injected or as liquids (oral solutions).

Sometimes, these antidepressants are used to treat conditions other than depression.

Side effects of tricyclic antidepressants

Side effects of cyclic antidepressants vary somewhat from medication to medication. They can include:

  • Drowsiness
  • Dry mouth
  • Blurred vision
  • Constipation
  • Urinary retention
  • Dizziness
  • Delayed orgasm and low sex drive, particularly in men
  • Increased heart rate
  • Disorientation or confusion
  • Low blood pressure, which can cause lightheadedness
  • Increased appetite
  • Weight gain
  • Fatigue
  • Headache
  • Sensitivity to sunlight
  • Nausea
  • Seizures (particularly with maprotiline)

Some cyclic antidepressants are more likely to cause particular side effects. For example, desipramine and protriptyline are more likely to make you sleepy than do other cyclic antidepressants. Amitriptyline and doxepin are more likely to cause weight gain than do other cyclic antidepressants. Choosing one particular cyclic antidepressant over another may help you avoid particular side effects.

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References
  1. Schatzberg AF, et al. Antidepressants: Introduction. In: Schatzberg AF, et al. Manual of Clinical Psychopharmacology. 7th ed. Arlington, Va.: American Psychiatric Publishing; 2010. http://www.psychiatryonline.com/content.aspx?aID=600624. Accessed Oct. 5, 2010.
  2. Fava M, et al. Antidepressants. In: Stern TA, et al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia, Pa.: Mosby. 2008. http://www.mdconsult.com/das/book/body/221513496-3/0/1657/421.html?tocnode=57543329&fromURL=421.html#4-u1.0-B978-0-323-04743-2..50045-7_1104. Accessed Oct. 5, 2010.
  3. Hirsch M, et al. Tricyclic and tetracyclic drugs for treating depressed adults http://www.uptodate.com/home/index.html. Accessed Oct. 7, 2010.
MH00071 Dec. 9, 2010

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