Tricyclic Antidepressants

There are three groups of antidepressants, and though each work similarly, they do have differences in their actions and side effects. The tricyclics are older drugs, and though thought to be as effective as the newer SSRIs, they are reported to have more side effects. Used to treat depressive disorders, tricyclics have also been prescribed for panic disorder, social phobia, agoraphobia without panic disorder, and to ease the nightmares of posttraumatic stress disorder.

Tricyclic was first used extensively in the 1950s, and the first drug, Tofranil (imipramine) is still one of the most prescribed tricyclics. Your doctor will start you off with a small dose, to see if any side effects occur and to allow your body to adjust slowly to the drug. Tricyclics work by impeding the deactivation of two neurotransmitters, norepinephrine and serotonin, in the central nervous system. These neurotransmitters are involved in feelings of well-being and activity, and tricyclics allow them to remain active longer in the body.

Tricyclics do not “cure” you of depression or anxiety, or give you a “high,” but when they do kick in, usually within a few weeks, you'll find that the severity of your anxiety and depression will lift, and you may feel that you are able to function in areas of your life that you couldn't before beginning the medication. People who do well on a course of treatment with tricyclics report being able to sleep better and experience a decrease in dreaming, feel more energetic, and have an increased ability to concentrate.

Side Effects of Tricyclics

The usual course of treatment on tricyclics is six to eight months. At the beginning of treatment, however, when your body is adjusting to the medication, increases in anxiety, sweating, or night sweats may occur. The main complaint is feeling sedated. Restlessness, problems with falling asleep, or disturbed sleep, and decrease in concentration are common. These symptoms will pass, but many people find them so uncomfortable, they are unable to continue the medication. However, if they do stop abruptly, depression and anxiety may return. Other side effects that cause discomfort and distress include: dry mouth or eyes, having a “funny” taste in your mouth, sensitivity to light, blurry vision, constipation and difficulty urinating, weight gain, and erectile dysfunction.

Alert

Tricyclics can cause rapid heartbeat, palpitations, or dizziness upon rising. If you have cardiovascular disease, tricyclics can have serious effects on you. They may cause arrhythmias, or worsening of or even causing angina, heart failure, or a heart attack. If you have heart problems, or there is a history of heart problems in your family, before you begin tricyclics, make sure you are checked out by a cardiologist first.

Withdrawal from Tricyclics

Unlike benzodiazepines, tricyclics are not addictive, so you will not develop a dependency, and feel the need to increase your dose to stop symptoms of withdrawal. But problems can ensue if you stop the medication suddenly. If you want to stop taking a tricyclic it is best to do it gradually with the help of your physician. The withdrawal can be uncomfortable, with symptoms that include: feeling anxious and depressed, stomach problems, feeling dizzy, and headaches.

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