MayoClinic.com reprints
This single copy is for your personal, noncommercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, use the reprints link below.
· Order reprints of this article now.
Tricyclic antidepressants (TCAs)
By Mayo Clinic staffAlternative medicine (1)
- Treatment-resistant depression: Explore options when depression doesn't get better
Coping and support (4)
- Support groups: Find information, encouragement and camaraderie
- Depression: Supporting a family member or friend with depression
- Support groups: Share experiences about depression, mental health conditions
- see all in Coping and support
Definition (1)
- Mental health: What's normal, what's not
Lifestyle and home remedies (3)
- Seasonal affective disorder treatment: Choosing a light therapy box
- Meditation: Take a stress-reduction break wherever you are
- Depression and anxiety: Exercise eases symptoms
Risk factors (2)
- Depression in women: Understanding the gender gap
- Stress symptoms: Effects on your body, feelings and behavior
Tests and diagnosis (2)
- Mental health providers: Find one to suit your needs
- Cytochrome P450 (CYP450) genotyping test
Treatments and drugs (21)
- Antidepressants: Are they safe during pregnancy?
- Serotonin syndrome
- Family therapy
- see all in Treatments and drugs
Mayo Clinic Health Manager
Get free personalized health guidance for you and your family.
Get Started
About our e-newsletters
- Free e-newsletters
- Mayo Clinic expertise
- We do not share your e-mail address
Housecall, our weekly general-interest e-newsletter, keeps you up to date on a wide variety of health topics with timely, reliable, practical information, recipes, blogs, questions and answers with Mayo Clinic experts and more. Our biweekly topic-specific e-newsletters also include blogs, questions and answers with Mayo Clinic experts, and other useful information that will help you manage your health.
Housecall Archives
Mayo Clinic Housecall
Stay up to date on the latest health information.
What you get
- Free weekly e-newsletter
- Mayo Clinic expertise
- Recipes, tools and other helpful information
- We do not share your e-mail address
Tricyclic antidepressants (TCAs)
Tricyclic antidepressants work on three brain neurotransmitters in relieving depression symptoms, such as irritability and anger. Explore their side effects and whether TCAs are your right choice for improving mood.
By Mayo Clinic staffCertain brain chemicals called neurotransmitters are associated with depression, including the neurotransmitters serotonin (ser-oh-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and dopamine (DOE-puh-mene). Research suggests that abnormalities in neurotransmitter activity can affect mood and behavior.
How TCAs work
Tricyclic antidepressants (TCAs) inhibit the reabsorption (reuptake) of serotonin and norepinephrine by brain cells. To a lesser extent, TCAs also inhibit reabsorption of dopamine. These antidepressants also block other cell receptors, which accounts for many of their side effects. TCAs are called tricyclic because of their chemical structure. They were among the earliest antidepressants developed and remained the first line of treatment for depression before newer antidepressants arrived.
Antidepressants, in general, may also work by playing a neuroprotective role in how they relieve anxiety and depression. It's thought that antidepressants may increase the effects of brain receptors that help nerve cells keep sensitivity to glutamate — an organic compound of a nonessential amino acid — in check. This increased support of nerve cells lowers glutamate sensitivity, providing protection against the glutamate overwhelming and exciting key brain areas related to anxiety and depression.
Therapeutic effects of antidepressants may vary in people, due in part to each person's genetic makeup. It's thought that people's sensitivity to antidepressant effects, especially selective serotonin reuptake inhibitor effects, can vary depending on:
- How each person's serotonin reuptake receptor function works
- His or her alleles — the parts of chromosomes that determine inherited characteristics, such as height and hair color, which combine to make each person unique
Antidepressant medications are often the first treatment choice for adults with moderate or severe depression, sometimes along with psychotherapy. Although antidepressants may not cure depression, they can help you achieve remission — the disappearance or nearly complete reduction of depression symptoms.
TCAs approved to treat depression
Here are the TCAs approved by the Food and Drug Administration specifically to treat depression, with their generic, or chemical, names followed by available brand names in parentheses:
- Amitriptyline
- Amoxapine
- Desipramine (Norpramin)
- Doxepin (Sinequan)
- Imipramine (Tofranil, Tofranil-PM)
- Nortriptyline (Pamelor)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
Some of these medications come in forms that must be injected or as oral solutions that must be mixed with liquids, such as water or juice.
Some of these medications may also be used to treat conditions other than depression.
Side effects of TCAs
Because TCAs are less selective about which cells they affect, they typically have more side effects than other antidepressants do.
Side effects of TCAs include:
- Drowsiness
- Dry mouth
- Blurred vision
- Constipation
- Urinary retention
- Dizziness
- Impaired sexual functioning
- Increased heart rate
- Disorientation or confusion
- Headache
- Low blood pressure
- Sensitivity to sunlight
- Increased appetite
- Weight gain
- Nausea
- Weakness
Safety concerns with TCAs
In general, avoid tricyclic antidepressants if you have narrow-angle glaucoma, an enlarged prostate (benign prostatic hyperplasia) or certain types of heart disease. TCAs are associated with a higher risk of heart attack. If you have diabetes, you may need to check your blood sugar more often while taking TCAs, as they may affect blood sugar levels. TCAs should be used with caution if you have a history of seizures or thyroid problems.
Stopping treatment with TCAs
TCAs aren't considered addictive. However, stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, including:
- Nausea
- Headache
- Dizziness
- Lethargy
- Flu-like symptoms
This is sometimes called discontinuation syndrome. Talk to your doctor before stopping so that you can gradually taper off the medication.
Suicidal feelings and TCAs
In some cases, antidepressants may be associated with worsening symptoms of depression or suicidal thoughts or behavior in those ages 18 to 24. These symptoms likely occur in the first one to two months of treatment or when you change your dosage. Be sure to talk to your doctor about any changes in your symptoms. You may need more careful monitoring when beginning treatment or changing dosage, or you may need to stop the medication if your symptoms worsen. Adults age 65 and older taking antidepressants have a decreased risk of suicidal thoughts.
Work with your doctor or a mental health provider to nix your irritability, sadness or guilt and boost your mood with tricyclics. Feel good again.
- FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. U.S. Food and Drug Administration. http://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html. Accessed Sept. 12, 2008.
- Questions and answers on antidepressant use in children, adolescents, and adults. U.S. Food and Drug Administration. http://www.fda.gov/cder/drug/antidepressants/QA20070502.htm. Accessed Sept. 29, 2008.
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 1, 2008.
- Antidepressants: Selecting one that's right for you. MayoClinic.com. http://www.mayoclinic.com/health/antidepressants/HQ01069. Accessed Oct. 16, 2008.
- Buss LK (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 21, 2008.
