Tricyclic antidepressants (TCAs) were once heavily used to treat depression, but are now less common due to side effects and the availability of newer drugs. TCAs can also be used for chronic pain, attention deficit disorder, and irritable bowel disorder. However, they can cause drowsiness, dizziness, and other side effects, and are dangerous in overdose. TCAs may be considered as an alternative treatment for patients who do not respond to other drugs, but are not recommended for certain groups of people.
Tricyclic antidepressants (TCAs) are drugs developed to treat depression. They are used less frequently now, but were in heavy use during the 1950s and later. The advent of drugs called selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors (SSRIs and SNRIs), has reduced the use of tricyclic antidepressants because many worked similarly, especially SNRIs, and have less side effects. There are still a few reasons why TCAs might be used, and these don’t always pertain to treating depression.
Some of the generic names of types of tricyclic antidepressants include the following:
Amitriptyline
Desipramine
Imipramine
Nortriptilina
Amoxapine
Doxepin
protriptilina
Trimipramine
People may know some types of tricyclic antidepressants better through their brand names, which include Sinequan®, Pamelor®, Elavil®, Surmontil®, and Vivactil® among the many names these medications have gone by. Their main action is to increase the available levels of norepinephrine and dopamine. Some of these drugs also affect and increase the levels of available serotonin, although not all of them do. However, proper dosage can cause many side effects and the following is a partial list:
Drowsiness
Dizziness
Dry mouth
Drowsiness
tiredness
Decreased libido or ability to orgasm
Rapid heartbeat
Changes in blood pressure
Increase the weight
Appetite changes
Constipation
Urinary changes
Nausea
Not all people experience all of these symptoms. Generally most complain of drowsiness when taking these drugs, which can make it difficult to function during the day. Sometimes, a tricyclic antidepressant is prescribed primarily to aid sleep rather than as the primary antidepressant. These medications may also be used for some people who have chronic pain, to treat some symptoms of attention deficit disorder, or to treat symptoms of irritable bowel disorder. Again, the side effects of these drugs may make them less preferred when alternatives with fewer side effects exist.
Another reason many doctors hesitate to prescribe a tricyclic antidepressant is because these drugs are extremely dangerous in overdose amounts. Overdose can be rapidly fatal and depressed patients can even commit suicide. There is some evidence that TCAs, like many other antidepressants, may actually increase suicidal tendencies in a proportion of patients. The last thing a doctor wants is to put a life-threatening substance into the hands of a person who is deeply suicidal or may become suicidal. SSRIs and SNRIs have the edge here because even in overdose amounts, they tend not to cause as much harm.
On the other hand, there are patients who may not respond to SSRI and SNRI treatment and a tricyclic antidepressant can be considered as a possible alternative treatment, to which patients may respond better. However, some classes of patients probably shouldn’t use these drugs, including men with enlarged prostates and anyone with thyroid disorders. People who have diabetes will also likely require more blood sugar monitoring, as TCAs can affect blood sugar levels.
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