classesTricyclic Antidepressants

    Tricyclic Antidepressants: Uses, most common brand names, and safety information

    Jamie Winn, PharmD
    ✅ Medically reviewed by  Jamie Winn, PharmD

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    Tricyclic antidepressants (TCAs) were discovered almost 70 years ago. They are named after their 3 ring chemical structure. TCAs and tetracyclic antidepressants such as Ludiomil (maprotiline) were some of the first medications used to treat depression.

    TCAs development began after the synthesis of the first widely used psychiatry medication Thorazine (chlorpromazine) in 1950. The first TCA derived from chlorpromazine that was used in the treatment of depression was Tofranil (imipramine) in the late 1950s. It was followed by the approval of Elavil (amitriptyline) in 1961.

    The use of TCAs has declined significantly since newer antidepressant treatment options came on the market. Today they are typically used in severe cases that have failed other therapies such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

    The list below includes the best tricyclic antidepressants approved by the U.S. Food and Drug Administration (FDA) and their pricing:

    List of tricyclic antidepressants

    Drug nameDescription
    Anafranil (clomipramine)Anafranil is indicated to treat OCD.
    Norpramin (desipramine)Norpramin is indicated to treat depression.
    Tofranil (imipramine)Tofranil is indicated to treat depression.
    Elavil (amitriptyline)Elavil is indicated to treat depression.
    Sinequan (doxepin)Silenor is indicated to treat depression and anxiety.
    Surmontil (trimipramine)Surmontil is indicated to treat depression.
    Asendin (amoxapine)Asendin is indicated to treat depression.
    Pamelor (nortriptyline)Pamelor is indicated to treat depression, chronic urticaria (rash), and postherpetic neuralgia.
    Vivactil (protriptyline)Vivactil is indicated to treat depression.
    Limbitrol (chlordiazepoxide/amitriptyline)Limbitrol is indicated to treat depression with anxiety.

    What are tricyclic antidepressants?

    Tricyclic antidepressants, also called cyclic antidepressants, are a class of medicines that were originally used to treat symptoms of depression. They now have a variety of indications, including neuropathic pain, anxiety disorders, and the prevention of migraines.

    TCAs were found to be as effective as SSRIs and SNRIs in mild to moderate depression but have a significantly higher incidence of adverse effects and toxicity. Because of this, they are not often used as a first-line treatment. They are typically used if other antidepressant medications did not work.

    Treatment with TCAs takes time to work. Response to these medications happens gradually and can take up to 3 weeks or longer to see the full effects.

    How do tricyclic antidepressants work?

    Tricyclic antidepressants work by inhibiting the reabsorption of certain neurotransmitters such as serotonin and norepinephrine. This causes an accumulation of these neurotransmitters in your brain which helps improve your mood. TCAs also block histamine, cholinergic, and muscarinic receptors which can be the cause of side effects such as blurred vision, constipation, and drowsiness. Research suggests TCAs relieve pain by inhibiting the transmission of pain signals in the spinal cord.

    TCAs differ in the effects they have on these neurotransmitters which are reflected in their therapeutic use and incidence of side effects.

    What conditions are tricyclic antidepressants used to treat?

    Tricyclic antidepressants are a class of medications used in the treatment of depression and other conditions such as:

    • Major depressive disorder
    • Obsessive-compulsive disorder (OCD)
    • Generalized anxiety disorder (GAD)
    • Panic disorder
    • Social anxiety disorder (SAD)
    • Post-traumatic stress disorder (PTSD)
    • Neuropathic pain
    • Chronic pain
    • Migraine headache prevention
    • Eating disorders such as bulimia
    • Insomnia
    • Fibromyalgia
    • Bedwetting (nocturnal enuresis)

    Are tricyclic antidepressants safe?

    When taken as prescribed, tricyclic antidepressants are relatively safe and effective. Your prescribing physician should be aware of your medical conditions, including:

    • Cardiovascular disease
    • Coronary artery disease
    • Seizures
    • Glaucoma
    • Diabetes
    • History of QTc prolongation
    • Are pregnant or plan on becoming pregnant as they may cause fetal harm and/or death
    • Diabetes
    • Liver impairment
    • Thyroid disease

    You should also make sure they are aware of all the medications you take, including prescription drugs, over-the-counter medications, and supplements, as they may cause drug interactions:

    • SSRIs such as Prozac (fluoxetine), Zoloft (sertraline), and Lexapro (escitalopram)
    • SNRIs such as Cymbalta (duloxetine) and Pristiq (desvenlafaxine
    • Monoamine oxidase inhibitors (MAOI) such as Emsam (selegiline)
    • St. John’s wort and other antidepressant drugs that increase serotonin
    • Anticholinergic medications such as Ditropan XL (oxybutynin) and Spiriva (tiotropium)
    • Epi-Pen (epinephrine)
    • Tagamet (cimetidine)

    Can you take tricyclic antidepressants while you are pregnant or breastfeeding?

    TCA use during pregnancy has been associated with congenital birth defects. Because of this, TCAs are not generally recommended for use while pregnant.

    Most TCAs are excreted in breast milk. Because this puts the infant at risk of exposure and serious side effects such as sedation and respiratory distress, breastfeeding is not recommended while taking a TCA.

    You should always discuss the risks and benefits of any medication you need with your doctor or mental health professional if you are pregnant, plan on becoming pregnant, or are breastfeeding.

    What are the common side effects of tricyclic antidepressants?

    Some common adverse effects of tricyclic antidepressants include:

    • Constipation
    • Dizziness
    • Dry mouth
    • Blurred vision
    • Confusion
    • Urinary retention
    • Nausea
    • Weight gain
    • Drowsiness
    • Sexual dysfunction
    • Elevated liver enzymes
    • Headache

    Tricyclic antidepressants can sometimes cause rare, severe adverse effects, including:

    • Serotonin syndrome
    • Orthostatic hypotension (low blood pressure upon standing)
    • Arrhythmias
    • Increased risk of suicidal thoughts or behavior
    • Ventricular fibrillation
    • Tachycardia (increased heart rate)

    This is not a complete list of side effects and we encourage you to consult with your healthcare professional for medical advice about any possible side effects.

    How much do tricyclic antidepressants cost?

    Tricyclic antidepressants are very expensive with an average cost of around $500-1,000 per year.

    You can purchase tricyclic antidepressants for $49 per month from NiceRx if eligible for assistance. Prices at the pharmacy vary by location, strength, and quantity, as well as your insurance status.

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    The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.