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Medicine for Depression: Tricyclic and Tetracyclic Antidepressants

These antidepressants are used to treat depression. They are called older or first generation medicines. They generally have more side effects than newer or second generation antidepressants. These include medicines such as serotonin reuptake inhibitors (SSRIs) and other second generation antidepressants such as bupropion (Wellbutrin, Wellbutrin SR) and duloxetine (Cymbalta).

Examples

Tricyclic antidepressants (TCAs)

Generic name

Brand name

amitriptyline

Elavil®

desipramine

Norpramin®

doxepin

Zonalon®

imipramine

Tofranil®

nortriptyline

Aventyl®, Pamelor®

protriptyline

Vivactil®

trimipramine

Surmontil®

amoxapine

Asendin®

Tetracyclic antidepressants

Generic name

maprotiline

How they work

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

Why they are 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 they work

Cyclic antidepressants relieve depression in many 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 healthcare provider. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your healthcare provider tells you to.

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

  • Trouble breathing

  • Hives

  • Swelling of your face, lips, tongue, or throat

Call your healthcare provider right away if you have:

  • Thoughts of suicide

  • Agitation and restlessness

  • Seizures

  • Fast heartbeat

  • Nausea and vomiting

Common side effects of these medicines include:

  • Dry mouth

  • Dizziness

  • Drowsiness

  • Headache

  • Weight gain

  • Constipation

FDA advisory: The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA doesn't recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the dose is changed.

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 healthcare provider. 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 with your healthcare provider.

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 healthcare provider about all the medicines you are currently taking. TCAs can interact poorly with certain heart medicines—digoxin (Lanoxin); and/or with other medicines, such as those used to treat seizures—phenytoin (Dilantin).

Taking medicine

Medicine is one of the many tools your healthcare provider has to treat a health problem. Taking medicine as your healthcare provider 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.

Advice for women

If you are pregnant, breastfeeding, or planning to get pregnant, do not use any medicines unless your healthcare provider 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 healthcare providers know that you are pregnant, breastfeeding, or planning to get pregnant.

Specifically for depression, taking medicines for depression during pregnancy may increase the risk of birth defects. Untreated depression can also have a negative impact on your baby's health, so medicines may need to be continued if your depression is severe. Talk with your healthcare provider. He or she can help weigh the risks of treatment against the risk of untreated or undertreated depression.

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 healthcare provider 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. 

Do you have thoughts about suicide?

If you or a loved one has thoughts about death or suicide, call 911 or the Veterans Crisis Line at 800-273-TALK (800-273-8255) and press 1, or use other emergency services. Or you can chat with a trained counselor online at www.VeteransCrisisLine.net.

Author: StayWell Custom Communications
Last Annual Review Date: 7/1/2018
Copyright © The StayWell Company, LLC. except where otherwise noted.
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