What are tricyclic antidepressants?
Tricyclic antidepressants (TCAs) are a class of medications that help manage the symptoms of clinical depression (major depressive disorder). Healthcare providers prescribe them for other conditions as well.
TCAs are one of many classes of antidepressants. They were one of the first types of antidepressants invented and are considered “first-generation” antidepressants.
Today, providers more commonly prescribe TCAs for off-label use than for depression. This is because there are other classes of antidepressants for depression that are generally safer and have fewer adverse side effects.
Tricyclic antidepressants get their name from their chemical structure, which contains three rings with one side chain.
What are the types of tricyclic antidepressants?
The following are all the tricyclic antidepressants (and their brand names) that are approved by the Food and Drug Administration (FDA) to treat major depressive disorder:
- Amitriptyline (Elavil®, Vanatrip®).
- Amoxapine (Asendin®).
- Desipramine (Norpramin®).
- Doxepin (Silenor®, Sinequan®).
- Imipramine (Tofranil®, Tofranil-PM®).
- Nortriptyline (Aventyl®, Pamelor®).
- Protriptyline (Vivactil®).
- Trimipramine (Surmontil®).
Clomipramine (Anafranil®) is another TCA that’s FDA-approved for obsessive-compulsive disorder (OCD) in people aged 10 and older.
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What conditions do tricyclic antidepressants help treat?
Tricyclic antidepressants are FDA-approved to treat major depressive disorder and other depressive disorders. However, healthcare providers rarely choose TCAs as the first option for treating depression symptoms. This is because there are safer antidepressant options, such as SSRIs. Providers may only prescribe TCAs for depression if other antidepressants aren’t working, since TCAs may be more effective for some people. One potential exception is OCD, as providers consider the TCA clomipramine to be the gold standard treatment.
Providers more commonly prescribe TCAs for off-label use today. This means that the medication isn’t FDA-approved to treat the condition, but research has shown the medication may be effective in treating it.
The off-label (non-FDA) uses of TCAs include:
- Migraine prevention (prophylaxis).
- Insomnia.
- Anxiety disorders.
- Chronic pain, especially neuropathic pain conditions such as myofascial pain, diabetes-related neuropathy and postherpetic neuralgia.
- Fibromyalgia.
- Bedwetting (nocturnal enuresis).
What’s the difference between SSRIs and tricyclic antidepressants?
Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are both classes of antidepressants. TCAs are considered “first-generation” antidepressants, and SSRIs are considered “second-generation” antidepressants.
They’re both effective in improving the symptoms of major depressive disorder. But healthcare providers more commonly prescribe SSRIs than TCAs because TCAs cause more significant adverse side effects. In addition, overuse of TCAs can more easily result in toxicity and overdose.
