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Tricyclic and Tetracyclic Antidepressants for Depression

Examples

Tricyclic antidepressants (TCAs)

Generic Name Brand Name
amitriptyline  
desipramine Norpramin
doxepin Zonalon
imipramine Tofranil
nortriptyline Aventyl, Pamelor
protriptyline Vivactil
trimipramine maleate Surmontil

Heterocyclic antidepressants

Generic Name
amoxapine
maprotiline

These are older (first-generation) antidepressants. They generally have more side effects than newer (second-generation) antidepressants such as serotonin reuptake inhibitors (SSRIs) and other second-generation antidepressants such as bupropion (Wellbutrin, Wellbutrin SR) and duloxetine (Cymbalta).

How It Works

Symptoms of depression result when certain brain chemicals (neurotransmitters) get out of balance. These medicines balance the brain chemicals, which may help the symptoms of depression.

Why It Is Used

These medicines are used to help the symptoms of major depression. They may be used when other types of antidepressants do not work.

When these medicines are not used

  • Some of these medicines are not given to older adults, because they can cause severe side effects.
  • They usually are not given to people who have low blood pressure or certain heart problems, such as irregular heartbeats.

How Well It Works

Cyclic antidepressants relieve depression in most people who have depression.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor right away if you have:

  • Hives.
  • Thoughts of suicide.
  • Agitation and restlessness.
  • Seizures.
  • Fast heartbeat.
  • Nausea and vomiting.

Common side effects of this medicine include:

  • Dry mouth.
  • Dizziness.
  • Drowsiness.
  • Headache.
  • Weight gain.
  • Constipation.

The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. Talk with your doctor about these possible side effects and the warning signs of suicide.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Never suddenly stop taking TCAs. The use of any antidepressant should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medicines can cause negative side effects or a relapse of your condition.

TCAs are started at low doses, and the dose is increased gradually to reduce the severity of side effects. You may need regular blood tests to check the amount of the medicine in your blood. Too much of this type of medicine in the bloodstream can be dangerous.

You may start to feel better in 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines or if you do not notice any improvement by 3 weeks, talk to your doctor.

People who have seizures (epilepsy), difficulty urinating (urinary retention), glaucoma (an eye disease), or heart conditions may notice that tricyclic antidepressants make these symptoms worse.

Be sure to tell your doctor about all the medicines you are currently taking. TCAs can interact poorly with certain heart medicines—digoxin (for example, Lanoxin)—and/or with other medicines, such as those used to treat seizures. One example is phenytoin (Dilantin).

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Lisa S. Weinstock, MD - Psychiatry
Last Revised January 11, 2013

Last Revised: January 11, 2013

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