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Understanding Antidepressant Medications (cont.)

Tricyclic Antidepressants

Tricyclic antidepressants (TCAs) are often prescribed in severe cases of depression or when SSRI medications do not work.

Tricyclic antidepressants include:

How do TCAs work?

TCAs block the uptake of serotonin and norepinephrine, thereby providing higher levels of these neurotransmitters at the brain receptor site. Besides increasing norepinephrine and serotonin, amoxapine also increases the neurotransmitter dopamine.

Who should not use these medications?

  • Individuals who have allergic reactions to TCAs
  • Individuals in the acute recovery phase following a heart attack
  • Individuals with glaucoma
  • Individuals with urine retention
  • Individuals who are currently taking or have taken MAOIs within the past 2 weeks (Phenelzine [Nardil], and tranylcypromine [Parnate], are examples of MAOIs.) (Do not start taking MAOIs for at least two weeks after stopping TCAs. This is a general warning; see drug and food interactions for low-dose use together.)
  • Individuals taking some medications that alter heart rhythm such as thioridazine (Mellaril) or cisapride (Propulsid)


  • Tricyclic antidepressants are taken orally by tablet, capsule, or oral solution.
  • Elderly individuals and adolescents often require lower doses.

Elderly: Elderly individuals require lower doses. Elderly individuals are more susceptible to sedative effects and may feel faint when standing up, therefore increasing the risk of falls and injuries.

Children: The following TCAs are approved in the United States for treating adolescents with depression who are older than 12 years:

  • amitriptyline (Elavil, Endep)
  • desipramine (Norpramin)
  • doxepin (Sinequan, Adapin)
  • nortriptyline (Pamelor, Aventyl)
  • protriptyline
  • trimipramine (Surmontil)
  • amoxapine (approved for persons older than 16 years)
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Tricyclic antidepressants (TCAs) were one of the most important causes of mortality resulting from poisoning until 1993 and continue to be responsible for more deaths per prescription than all the other antidepressants put together.

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