Experiences of antidepressants

Using an antidepressant – tricyclics (TCAs)

Tricyclic antidepressants (TCAs) are an older type of antidepressant. They are no longer regarded as a first-line treatment for depression because an overdose can be dangerous. They may be prescribed for people with severe depression that fails to respond to other treatments. A tricyclic may also be recommended for other mental health conditions such as obsessive-compulsive disorder and bipolar disorder.
Examples of Tricyclic antidepressants include:
  • amitriptyline (Tryptizol)
  • clomipramine (Anafranil)
  • imipramine (Tofranil)
  • lofepramine (Gamanil)
  • nortriptyline (Allegron)
A few people we interviewed had been prescribed a tricyclic antidepressant at some time. Some took them years ago before SSRIs were developed. Others had been prescribed them because their symptoms had not improved after trying one or several other antidepressants. Some of the people we interviewed were also taking other medicines such as antipsychotics or medicines for anxiety. It could be difficult to tease out the effects of each separately (see ‘Taking other medicines with antidepressants). People who had taken this class of antidepressant usually had a history of severe or persistent depression. Not everyone was certain why a particular antidepressant had been prescribed. People who had taken several or many different antidepressants over time could find it hard to recall details about each one.
As with all antidepressants, people reacted differently to tricyclics. Many had mixed feelings about them. Caroline was prescribed amitriptyline when she was first diagnosed with depression some years ago and felt it worked, but she had felt ‘high’ on it and ‘not like me’. Her GP only prescribed it for a short period. Sonia felt lofepramine was effective the first time she took it, but not on a later occasion. She wanted to take it because it reduced her appetite and helped her lose weight. She explained she had an eating disorder, and taking it may not have helped her. Other side effects people mentioned were ‘restless leg syndrome’, a metallic taste, and constipation. Janet was prescribed a laxative to prevent the constipation from lofepramine.
(See ‘Coping with antidepressant side effects’, ‘Taking other medicines with antidepressants’ and ‘Managing antidepressants’). 
Sharon had recurrent episodes of depression for most of her adult life and at one point her doctor suggested she try a tricyclic when ‘he didn’t think the SSRIs were working effectively’. She tried both lofepramine and dosulepin at different times they relieved her symptoms to an extent but looking back she said she felt ‘doped up’ and says at the time she was ‘just going through the motions’. She described feeling as though she had ‘been hit by a ton of bricks’. Similarly, Thomas had felt ‘completely flattened’ when taking amitriptyline. A doctor may prescribe this type of antidepressant for someone because the sedative effects can help. Gerry was prescribed trimipramine for about a month in addition to an SSRI to help him sleep better. 
Many people found it hard to remember how they had felt when they were taking this type of antidepressant, because their symptoms had been bad at the time. It could also be difficult to be sure whether the effects they described were due to the antidepressant, or were symptoms of the illness itself (see also 'Telling the difference between depression symptoms and antidepressant side effects'). Both Michael and Janet, now in their 70’s, took amitriptyline when first diagnosed with depression, before the newer antidepressant medicines came in. Michael has a long history of depression and has never felt that the antidepressants he has taken have done much to relieve his symptoms. On amitriptyline he felt tired for most of the time, slept a lot and lacked energy but he also said he felt ‘quite good’ on it and that maybe it had helped to an extent. ‘I just kept taking the pills and doing what people told me’. Janet said she felt ‘dopey and tired’ on amitriptyline and still depressed. 
Tricyclic antidepressants can be dangerous in overdose. Thomas and Sharon both said that doctors should be careful prescribing these medicines to severely depressed people who may be at risk of harming themselves. 
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Last reviewed June 2016.


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