Tricyclic Antidepressants


Overview: Tricyclic Antidepressants are a class of antidepressants that are sometimes used to help treat several mental health conditions. SSRIs and SNRIs have largely replaced Tricyclic antidepressants, though they are still occasionally used to this day. They are used mainly for Depression, though can also be used for Anxiety, Obsessive-Compulsive DisorderPersonality Disorders and Post-traumatic stress disorder among various eating disorders.





How do they work?: It isn’t entirely known how any of the antidepressants work. Tricyclic antidepressants raise the levels of norepinephrine and serotonin in the brain. In doing so, it is believed that mood and emotion increase. TCA’s work in the same way as SNRI antidepressants, but as will be discussed, lead to more side effects. Tricyclic antidepressants are useful in treating the symptoms of several mental health conditions, yet should be used in conjunction with therapy, as this can help provide further support.


How effective are they?: Research on the efficacy of antidepressants is mixed. Tricyclic antidepressants were used for many years before the creation of the SSRI class. Both Tricyclic antidepressants and SSRIs have similar efficacy rates. Tricyclic antidepressants are more dangerous in overdose.


Treatment Course: Tricyclic antidepressants generally come in tablet form, though some can be injected or taken as a liquid if required. Once prescribed, a low dose will initially be prescribed. A typical treatment course lasts six months., though it can often rise to around 18 months, or even indefinite use. Unfortunately, it takes at least two weeks for benefits to be felt. At first, your mood may start to increase again. The full benefits of antidepressants normally take up to six weeks to be felt. If after this point you haven’t witnessed an improvement, it is worth talking to your GP or mental health specialist. They may suggest switching antidepressants. Many people succeed on their second antidepressant. It is highly likely you will experience some mild side effects early in the treatment. It is crucial however to not stop taking the tablets, as these side effects will disappear quickly. All Tricyclic antidepressants can be prescribed by a GP.


Types of Tricyclic Antidepressants: There are several types of antidepressants. Each class has its own dedicated page. There are many Tricyclic antidepressants, though it is rare for any to be used these days. However, they are often used if SSRIs and SNRIs haven’t worked. If they are prescribed, generally they will be one of the four below.



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Side Effects

We recommend consulting the individual page for each antidepressant for information on side effects – as they differ from tablet to tablet. Furthermore, the leaflet that comes with each pack of tablets contains enhanced information on side effects. Side effects generally are only present in the first few days of treatment, with the body needing time to get used to treatment. You will often see a GP during the first month of treatment to see how you are reacting.


Tricyclic antidepressants have been known to cause a dry mouth, constipation, difficulties in urinating, drowsiness, weight gain, excessive sweating and even hearth rhythm problems – sexual problems are again prevalent. An overdose can be lethal, due to cardiac effects, and risk of a serious seizure. Research in 2018 also suggested that long-term use of Tricyclic antidepressants can lead to an increase in developing dementia.




As with any medication, you must be careful when taking antidepressants. Your GP or mental health professional should make you aware of any types of medicine or foods that you should avoid. Some frequently used medications, even over-the-counter ones shouldn’t be used with antidepressants. It is worth looking at the individual page of each antidepressant to see cautions, but an overview is provided here.


Other Medicines: Each information leaflet will provide the types of medicines not to be used. It is important NOT to combine medicines from different classes of antidepressants, or take two from one class at the same time. You should also avoid the herbal remedy St John’s Wort. Antipsychotics must be avoided.


Alcohol: Alcohol acts as a depressant, therefore it is recommended that anyone taking an antidepressant stays away from drinking alcohol.


Pregnancy and Breastfeeding: Antidepressants generally aren’t recommended for pregnant women. Taking antidepressants while breastfeeding also isn’t recommended.


Young People: People under the age of 18 are rarely prescribed antidepressants, instead being offered therapy. The exception to this is the SSRI Fluoxetine (Prozac). If therapy hasn’t worked, antidepressants can be prescribed. People under the age of 25 taking antidepressants have been shown to be vulnerable to suicidal thoughts – a serious side effect.


Illicit Drugs: The use of illegal or recreational drugs isn’t recommended, as they can react unpredictably with antidepressants. Cannabis, cocaine, heroin and ketamine have been known to particularly worsen symptoms.


As always, ensure you read the information leaflet.