Tricyclic Antidepressants

Tricyclics are an antidepressant class used to treat symptoms of diagnosed depression such as sadness and anxiety. They are termed tricyclic due to their chemical structure. They are, in fact, one of the oldest antidepressant classes and are commonly prescribed to treat depression. Some of the TCAs you may be prescribed include:

• Doxepin
• Amoxapine
• Amitriptyline
• Lofepramine
• Trimipramine
• Dosulepin
• Nortriptyline

How Do They Work?

It is thought that when depression is present, there is a reduction in serotonin and noradrenaline in the brain. These chemicals are important in the control and regulation of an individual's mood and their release from cells acts to enhance mood. Once reuptake into cells occurs, however, the mood enhancing effect is no longer present. TCAs function to block the reabsorption of noradrenaline and serotonin into cells, which then extends their mood boosting potential. TCAs also inhibit reuptake of dopamine albeit to a lesser extent than serotonin and noradrenaline.

There are various different TCAs that your doctor may prescribe. If you are pregnant, breastfeeding or have certain liver disorders, TCAs will probably not be recommended for your depression. Your particular health status, which includes other conditions present, will be used to determine which TCA is best for your needs.

Keep in mind that although TCAs are effective in a great many people, not everyone will respond favourably and there are other antidepressant options should this occur. It can be frustrating to get high hopes for a depression treatment, only to find you are not feeling better. Don't despair and do communicate with your doctor.

Will I Feel Better Right Away?

The maximum benefits of TCAs tend to occur from two to four weeks but you may begin to feel better shortly after you begin treatment. You may feel better immediately simply from the hope and increased motivation and belief that they will get better. Some people are able to take TCAs for shorter periods of time, such as six months, while others find that they need to remain on them for many years. Your doctor will periodically assess your unique health and together you can decide if long-term continuation of treatment is appropriate.

Side Effects and Risks

TCAs are not as specific in their mechanism of action as other antidepressant classes, so they do have many side effects. Although considered effective in comparison with other antidepressants, TCAs do tend to have more side effects and you can speak to your doctor about these should they become particularly bothersome. Some of the side effects you may experience are:

• Headache
• Bowel problems such as constipation
• Dizziness or confusion
• Visual abnormalities
• Dry mouth
• Sexual dysfunction
• Appetite and weight changes
• Gastrointestinal upset
• Heart palpitations

You can ease some of the side effects yourself-try drinking more fluids if you experience a severely dry mouth. You can help any constipation or other similar symptoms by eating a healthy, high fibre diet and including sufficient fluids. You should also avoid alcohol if possible, as the effects of alcohol tend to be more intense when combined with TCAs. You may find that you experience greater drowsiness as well as a lack of coordination should you drink, so avoid driving.

Although TCAs are not believed to be addictive, you should not stop treatment without speaking to your doctor first. Withdrawal symptoms can occur and if both you and your doctor decide that it's appropriate for you to discontinue TCA use, you may need to gradually decrease the dosage. Even so, you may still experience some withdrawal symptoms. These may include:

• Headaches
• Exhaustion and fatigue
• Tingling and dizziness
• Nausea

For the most part, if side effects are mild and you have just begun TCA treatment, you may find that they abate as you continue the medication. If side effects feel too intense to handle, speak to your doctor before abruptly stopping the medication. You may be able to find a lower dosage that reduces side effects or your doctor may suggest trying another antidepressant. There are many antidepressant options available for treating depression; TCAs will hopefully be one class of medications that provide success in treating your symptoms.