Handouts · Medications
Tricyclic Antidepressants (TCAs)
Includes amitriptyline, nortriptyline, imipramine, and doxepin. Older antidepressants also used for pain, migraine, and sleep.
What This Group Is
TCAs are effective older antidepressants that raise serotonin and norepinephrine.
Today they are often used at lower doses for nerve pain, migraine prevention, and sleep as well as depression.
How to Take It
Often taken at bedtime because they cause drowsiness. Take with or without food.
Start low and increase slowly. Do not stop abruptly — taper with your prescriber.
Black Box Warning & Overdose Danger
Antidepressants carry a small risk of increased suicidal thoughts in people under 25.
Very important: TCAs are dangerous, even fatal, in overdose — they affect the heart’s rhythm. Keep only a safe supply on hand and store securely.
Common (Usually Mild) Side Effects
- Dry mouth, constipation, blurred vision.
- Drowsiness and weight gain.
- Dizziness on standing (a head rush).
- Trouble urinating.
Serious — Call Us or Seek Care
- Heart rhythm changes: fainting, palpitations, very fast or irregular heartbeat.
- Confusion or hallucinations (more likely in older adults).
- Serotonin syndrome with other serotonin drugs.
- Any overdose — call 911 or Poison Control (1-800-222-1222) immediately.
Alcohol & Interactions
Avoid alcohol — it adds to sedation and heart risk.
Many drug interactions — share your full medication list, including antihistamines and other antidepressants.
Monitoring
We usually get a baseline EKG (and repeat it at higher doses), especially if you are over 40 or have heart disease. We also check heart rate and blood pressure.
Blood levels can be measured for some (nortriptyline, imipramine) to guide dosing.