RevisePsych

Tricyclic Antidepressants (TCAs)

• Examples: amitryptiline, clomipramine, dothiepin, imipramine, lofepramine

 

• The nerve cells normally recycle serotonin and norepinephrine by soaking it back up again. The majority of TCAs work by stopping (inhibiting) this re-uptake of serotonin and norepinephrine. As serotonin and norepinephrine is not soaked up again, more will be present to pass on messages to nerve cells nearby.

 

• Common side effects, as associated with the receptor profiles:

- Anticholinergic: dry mouth, blurred vision, urinary retention, constipation, drowsiness, confusion.

- Adrenergic antagonism: drowsiness, postural hypotension, tachycardia, sexual dysfunction.

- Antihistaminergic: drowsiness, weight gain.

- 5HT2 antagonism: anxiolytic, reduced sexual dysfunction, sedation.

 

• Advantages

- Well-established efficacy

- Possibly more effective in severe depression

 

• Disadvantages

- Toxicity in overdose

- Less well-tolerated than SSRIs

- Lower seizure threshold

- Slow cardiac conduction