Mayo Clinic Health Manager

Get free personalized health guidance for you and your family.

Get Started

Free

E-Newsletter

Subscribe to receive the latest updates on health topics. About our newsletters

  • Housecall
  • Alzheimer's caregiving
  • Living with cancer

Tricyclic antidepressants (TCAs)

Tricyclic antidepressants work on three brain neurotransmitters in relieving depression symptoms, such as irritability and anger. Explore their side effects and whether TCAs are your right choice for improving mood.

By Mayo Clinic staff

Certain brain chemicals called neurotransmitters are associated with depression, including the neurotransmitters serotonin (ser-oh-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and dopamine (DOE-puh-mene). Research suggests that abnormalities in neurotransmitter activity can affect mood and behavior.

How TCAs work

Tricyclic antidepressants (TCAs) inhibit the reabsorption (reuptake) of serotonin and norepinephrine by brain cells. To a lesser extent, TCAs also inhibit reabsorption of dopamine. These antidepressants also block other cell receptors, which accounts for many of their side effects. TCAs are called tricyclic because of their chemical structure. They were among the earliest antidepressants developed and remained the first line of treatment for depression before newer antidepressants arrived.

Antidepressants, in general, may also work by playing a neuroprotective role in how they relieve anxiety and depression. It's thought that antidepressants may increase the effects of brain receptors that help nerve cells keep sensitivity to glutamate — an organic compound of a nonessential amino acid — in check. This increased support of nerve cells lowers glutamate sensitivity, providing protection against the glutamate overwhelming and exciting key brain areas related to anxiety and depression.

Therapeutic effects of antidepressants may vary in people, due in part to each person's genetic makeup. It's thought that people's sensitivity to antidepressant effects, especially selective serotonin reuptake inhibitor effects, can vary depending on:

  • How each person's serotonin reuptake receptor function works
  • His or her alleles — the parts of chromosomes that determine inherited characteristics, such as height and hair color, which combine to make each person unique

Antidepressant medications are often the first treatment choice for adults with moderate or severe depression, sometimes along with psychotherapy. Although antidepressants may not cure depression, they can help you achieve remission — the disappearance or nearly complete reduction of depression symptoms.

TCAs approved to treat depression

Here are the TCAs approved by the Food and Drug Administration specifically to treat depression, with their generic, or chemical, names followed by available brand names in parentheses:

  • Amitriptyline
  • Amoxapine
  • Desipramine (Norpramin)
  • Doxepin (Sinequan)
  • Imipramine (Tofranil, Tofranil-PM)
  • Nortriptyline (Pamelor)
  • Protriptyline (Vivactil)
  • Trimipramine (Surmontil)

Some of these medications come in forms that must be injected or as oral solutions that must be mixed with liquids, such as water or juice.

Some of these medications may also be used to treat conditions other than depression.

Side effects of TCAs

Because TCAs are less selective about which cells they affect, they typically have more side effects than other antidepressants do.

Side effects of TCAs include:

  • Drowsiness
  • Dry mouth
  • Blurred vision
  • Constipation
  • Urinary retention
  • Dizziness
  • Impaired sexual functioning
  • Increased heart rate
  • Disorientation or confusion
  • Headache
  • Low blood pressure
  • Sensitivity to sunlight
  • Increased appetite
  • Weight gain
  • Nausea
  • Weakness
Next page
(1 of 2)
References
  1. FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. U.S. Food and Drug Administration. http://www.fda.gov/bbs/topics/NEWS/2007/NEW01624.html. Accessed Sept. 12, 2008.
  2. Questions and answers on antidepressant use in children, adolescents, and adults. U.S. Food and Drug Administration. http://www.fda.gov/cder/drug/antidepressants/QA20070502.htm. Accessed Sept. 29, 2008.
  3. Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 1, 2008.
  4. Antidepressants: Selecting one that's right for you. MayoClinic.com. http://www.mayoclinic.com/health/antidepressants/HQ01069. Accessed Oct. 16, 2008.
  5. Buss LK (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 21, 2008.

MH00071

Dec. 10, 2008

© 1998-2009 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "EmbodyHealth," "Reliable tools for healthier lives," "Enhance your life," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.

Print Share Reprints

Text Size: smaller largerlarger