Tricyclic (TCAs) and Heterocyclics for depression

Tricyclics (TCAs) and Heterocyclics are used to relieve symptoms of major depression. They balance certain brain chemicals (neurotransmitters). When these brain chemicals are in proper balance, the symptoms of depression are relieved. They are effective in 52% to 56% of people with depression.

Tricyclic antidepressants (TCAs):

  • amitriptyline hydrochloride (Amitril, Elavil)
  • desipramine hydrochloride (Norpramin, Pertofrane)
  • doxepin hydrochloride (Sinequan)
  • imipramine hydrochloride (Janimine, Tofranil)
  • nortriptyline hydrochloride (Aventyl HC1, Pamelor)
  • protriptyline hydrochloride (Vivactil)
  • trimipramine maleate (Surmontil)

Heterocyclic antidepressants:

  • amoxapine (Asendin)
  • trazodone hydrochloride (Desyrel)
  • maprotiline hydrochloride (Ludiomil)

Side effects associated with these medications.

Side effects vary among these medications, and most lessen as the person continues to take the medication.

  • Stomach upset and other problems, such as constipation.
  • Dry mouth, blurred vision, and drowsiness.
  • Lowered blood pressure.
  • Weight gain.
  • Tremors and sweating.
  • Inability to urinate (urinary retention).
  • Loss of sexual desire or ability.
  • Confusion or delirium in older adults.

Tricyclic (TCAs) and heterocyclics should not be used with:

  • Certain heart medications, such as digoxin (Lanoxin).
  • Certain medications used to treat seizures, such as phenytoin (Dilantin).

Facts about Tricyclic (TCAs) and Heterocyclics:

  • These medications need to be started at low doses, and the dose should be increased gradually to reduce the severity of side effects.
  • They may take 4 to 6 weeks to start working.
  • People taking these medications need to have blood tests taken to check the amount of the medication in their blood. Too much of this type of medication in the bloodstream can be dangerous.
  • Older adults need less of this medication but must take it for a longer period of time for it to be effective. However, these medications may not be the preferred choice for treatment of depression in older adults because they cause too many negative side effects.
  • Some of these medications are not given to older adults TCAs/heterocyclic medications usually are not given to people with certain heart problems, such as irregular heartbeats and low blood pressure.
  • Some people may need to be in the hospital until these medications are working. These people may need to be protected from their thoughts of wanting to harm or kill themselves.
  • Desipramine, nortriptyline, and trazodone have the least side effects. They are usually given to older adults for this reason.

These medications can cause death if a person takes an overdose. For this reason your doctor may:

  • Give only one week's supply at a time.
  • Have the person come in to the office every week.
  • Be available to the person by telephone.