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Older Antidepressant Medications:
Tricyclic Antidepressants (TCAs)
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Tricyclic antidepressants, or TCAs, were one of the first classes of antidepressants developed.
Though they do generally have more side effects than SSRIs, some people find them more effective in treating the
symptoms of clinical depression. TCAs include:
- Adapin (doxepin)
- Anafranil (clomipramine)
- Asendin (amoxapine)
- Elavil (amitriptyline)
- Endep (amitriptyline)
- Ludiomil (maprotiline)
- Norpramin (desipramine)
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- Pamelor (nortryptyline)
- Pertofrane (desipramine)
- Sinequan (doxepin)
- Surmontil (trimipramine)
- Tofranil (impramine)
- Vivactil (protriptyline)
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In addition to treating depression, TCAs (particularly Anafranil) are sometimes used to control the symptoms of
obsessive-compulsive disorder.
Along with the positive effects of TCAs, you may also experience some side effects. Side effects are unintended
or undesirable reactions to medications. Most of the side effects you experience can be lessened with additional
medications, dosage changes, or changes in your daily habits. Or, they may simply fade as your body adjusts to
the medication. If you experience any side effects, contact your doctor or clinician right away and continue taking
your medication.
It is also important to be aware of the risks of antidepressant medication. The risks occur very rarely, but it is important to know what to look for, just in case. If you think
you are experiencing one of the risks, contact your doctor or clinician or go to the emergency room right away!
| Most common side effects |
constipation, dizziness, drowsiness, dry mouth, weight gain |
| Occasional side effects |
anxiety/nervousness, blurry vision, diarrhea, headache, insomnia, nausea, sexual difficulties, tremors |
| Least common side effects |
urinary retention |
| Risks |
heart arrhythmia, hypomania, liver irritation, seizures |
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Most common side effects
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Constipation
TCAs can sometimes cause constipation. This side effect usually does not go away, but you can learn
how to control it by increasing the amount of high fiber foods in your diet, such as breads, fruits, and vegetables,
and bran. It also helps to exercise regularly and drink plenty of fluids. If constipation is still a problem, your
doctor may recommend a laxative or fiber product, or may prescribe an additional medication to reduce the side
effect. |
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Dizziness
If you feel dizzy when you sit or stand up quickly, there are some precautions that you can take
to avoid injury. Get up very slowly from a laying or sitting position and make sure you have something to hold
onto as you get up. Then, wait a moment or two before you start walking. |
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Drowsiness
When you first begin taking your medication, you may feel drowsy all of the time, even if you 've
had a good night 's sleep. You might move around more slowly, be less coordinated, and nod off more. This side
effect should wear off after a few weeks. In the meantime, be sure not to drive a car or operate other heavy machinery
while you are feeling drowsy. |
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Dry mouth
Some people taking antidepressant medications experience dry mouth. Although dry mouth may not go
away completely, it usually gets better with time. Dry mouth may be relieved by sucking on hard candy or crushed
ice, drinking plenty of fluids, or eating frozen grapes. |
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Weight gain
Some TCAs may cause you to gain weight. Your doctor or clinician can help you monitor your weight
and suggest a healthy diet and exercise program for you if weight gain is a concern. |
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Occasional side effects
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Anxiety/nervousness
You may experience heightened anxiety or nervousness as a result of your antidepressant,
but it should wear off in a few weeks. If anxiety continues to be a problem, talk to your doctor about it. |
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Blurry vision
Blurred vision is another side effect of antidepressant medication. If you think that you are experiencing
blurred vision, don 't drive until you talk to your doctor or clinician about it. |
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Diarrhea
If you experience diarrhea, drink plenty of fluids to prevent dehydration. Your doctor can tell
you which anti-diarrhea products are safe to take with your medication. |
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Headache
TCAs can cause headaches, which often fade as your body adjusts to the medication. If you experience
headaches, and they 're disruptive, talk to your doctor before you take any pain medications. S/he can let you
know which medications are safe to take with your antidepressant. |
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Insomnia
If you experience insomnia as a result of your medication, your doctor may change your dose, prescribe
a medicine to help you sleep, advise you to take the medication in the morning, or change your antidepressant altogether.
To combat insomnia, avoid eating heavy meals, exercising, or drinking caffeinated beverages before bed. |
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Nausea
Most people who experience this side effect notice that it usually disappears in a few weeks. To
reduce or eliminate nausea, eat several small meals per day instead of three big ones, or try snacking on dry toast
or crackers. |
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Sexual difficulties
Changes in sexual function may include difficulty achieving orgasm, difficulty maintaining an erection,
delayed ejaculation, or decreased physical sensation. These problems are sometimes the most difficult for people
to discuss. They might feel embarrassed and instead of mentioning it to their physicians, they suffer with it or
worse yet, stop their medication on their own. Doctors are accustomed to talking about these problems and they
are trying to help you recover. Please do not hesitate to talk to your doctor if you experience this or any other
side effect or risk. |
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Tremors
Some people taking TCAs experience slight shaking or trembling, often in the hands. If you experience
tremors, your doctor might try to adjust your dose or add another medication to control the side effect.. |
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Least common side effects
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Urinary retention
If you are unable to urinate but your bladder feels full, you may be experiencing urinary retention.
If you think that you are experiencing urinary retention, contact your doctor immediately. |
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Risks
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Heart arrhythmia
Since TCAs can affect the rhythm of your heart, your doctor will probably order a test to check
your heart 's rhythm before starting this type of medication and continue to monitor it throughout treatment. If
you notice your heart beating in an unusual manner, contact your doctor immediately. |
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Hypomania
TCAs may cause an increase in mood called hypomania. Symptoms of hypomania include euphoria, racing
thoughts, pressured speech, and excessive energy. If you notice any of these changes, contact your doctor right
away. S/he can help you determine if your change in mood seems unusual. |
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Liver irritation
The symptoms of liver irritation include extreme tiredness, severe nausea, and yellowing of the
whites of the eyes and skin. If you experience these symptoms, contact your doctor immediately! |
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Seizures
A seizure is the result of abnormal electrical activity in the brain. A patient suffering from a
seizure may experience involuntary body movements and/or a loss of consciousness. Less than 1% of people taking
TCAs experience seizures as a result of their medication. You will probably not be aware if you are having a seizure;
someone will tell you when you regain consciousness. If you have had a seizure, have someone take you to the emergency
room immediately. |
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