Tricyclic Antidepressants - Medication Family Profile

by Marcia Purse

The first tricyclic antidepressant, Imipramine (later named Tofranil), was discovered in the late 1950s. The medication family was named for the chemical structure of many of the drugs in the class - three rings, though not all have this structure. Besides Imipramine, the tricyclic family of antidepressants includes:

• Amitriptyline (Elavil, Endep)
• Nortriptyline (Pamelor, Aventyl)
• Desipramine (Norpramin, Pertofrane)
• Protriptyline (Vivactil)
• Clomipramine (Anafranil)
• Trimipramine (Surmontil)
• Doxepin (Adapin, Sinequan)
• Amoxapine (Asendin)

Most are thought to act by blocking reuptake of two critical brain hormones, the neurotransmitters serotonin and norepinephrine - some block one more, some the other, some are "dual action." (See Messengers of the Brain for more information on how neurotransmitters work.)

Allergies
If you have had a bad reaction to carbamazepine (e.g., Tegretol), trazodone (Desyrel) or maprotiline (Ludiomil), make sure you tell this to your doctor if he suggests you take a tricyclic antidepressant.

Pregnancy / Breast-Feeding
Studies have not been done in pregnant women, but there are reports of babies having problems when their mothers took tricyclic antidepressants at the end of the pregnancy. Tricyclics do pass into breast milk. If you are pregnant, nursing or plan to become pregnant, discuss use of tricyclics with your doctor.

Common Side Effects
Although each tricyclic antidepressant is slightly different from the others, they share some of the most common side effects, including:

• Dry mouth
• Sensitivity to sunlight
• Drowsiness - some may be prescribed for insomnia
• Increased appetite
• Weight gain - may be significant
• Dizziness

See our Side Effects Library for the side effects of individual tricyclic antidepressants.

Interaction Information
Some of the side effects of tricyclic antidepressants can be intensified by other drugs. Your doctor should know what other drugs you are taking, including prescription medications, over-the-counter drugs and street drugs. For example:

• Tricyclics can cause cardiac arrhythmia - a fast, pounding or irregular heartbeat. Drugs that can make this worse include amphetamines, diet pills, decongestants such as Sudafed, allergy medications, and asthma medications.
• Sleeping pills, antipsychotic medications, muscle relaxants, antihistamines, tranquilizers and alcoholic beverages can increase the sedating properties of tricyclics.

Other drugs that can cause problems when taken with tricyclics include but are not limited to:

• Blood-thinning drugs
• Medications for overactive thyroid
• Cimetidine (Tagamet)
• Certain blood pressure medications

Finally, serious, even fatal complications can occur when combining tricyclic antidepressants with MAO inhibitors or switching from one to the other. Taking them together or within two weeks of each other may cause sudden high body temperature, extremely high blood pressure, severe convulsions, and death. Your doctor may prescribe them together, but this situation should be under the doctor's close supervision.

Disclaimer: This is not intended to be all-inclusive or to replace information provided by your doctor or with prescriptions from drug manufacturers.

Resources:

• Susic, P. (2006, January 19). Antidepressants: The tricyclics. St.Louis Psychologist and Counseling Information and Referral. 9-28-06.
  
• MedlinePlus (2005). Antidepressants - Tricyclic (Systemic). 9/4/06. [No longer online]
  
• Trujillo, K.A., and Chinn, A.C. (1996). Antidepressants. 9/8/06.
  
• Ross-Flanagan, N. (2002). Antidepressants, Tricyclic. 9/27/06.