Tricyclic Antidepressants

Tricyclic antidepressants are not just for depression

Tricyclic antidepressants are used to treat depression. They are also used to treat some other conditions such as migraine, panic disorder, obsessive compulsive disorder, recurrent headaches, and some forms of pain. The word 'tricyclic' refers to the chemical structure of the drug.

How do antidepressants work?

Antidepressants alter the balance of some of the chemicals in the brain (neurotransmitters). These are thought to play some part in causing depression and other conditions.

Sometimes a life problem such as bereavement, redundancy, illness, etc, may trigger a depression. Sometimes there is no apparent cause for a depression. However, antidepressants treat the symptoms of depression, whatever the cause.

Symptoms of depression include: low mood, feelings of sadness, sleep problems, poor appetite, irritability, poor concentration, decreased sex drive, loss of energy, guilt feelings, headaches, aches, pains, and palpitations. If symptoms are eased, you not only feel better, but you may also be able to cope better with any problems or difficult circumstances.

About 5-7 in 10 people with depression improve within a few weeks of starting treatment with antidepressants. However, up to 3 in 10 people improve with dummy tablets (placebo) as some people would have improved in this time naturally. So, you are roughly twice as likely to improve with antidepressants compared to taking no treatment. But, they do not work in everybody.

Note: antidepressants do not necessarily make sad people happy. The word depressed is often used when people really mean 'sad', 'fed-up', or 'unhappy'. True depression is different to unhappiness and has persistent symptoms (which often includes persistent sadness).

The success rate of tricyclic antidepressants in treating the other conditions listed above (migraine, etc) varies.

How quickly do tricyclic antidepressants work?

An antidepressant takes 2-4 weeks to build up its effect and work fully. Some people stop treatment after a week or so thinking it is not helping. It is best to wait for 3-4 weeks before deciding if an antidepressant is helping or not. If poor sleep is a symptom of the depression, it is often helped first, within a week or so.

With some types of tricyclic antidepressant, the initial dose that is started is often small and is increased gradually to a full dose. (One mistake that sometimes occurs is that some people remain on the initial dose which is often too low to work fully.)

If you find that the treatment is helpful after 3-4 weeks, it is usual to continue. A normal course of antidepressants lasts up to six months or more after symptoms have eased. If you stop the drug too soon, your symptoms may rapidly return. Some people with recurrent depression need longer courses of treatment.

When you are taking tricyclic antidepressants

It is important to take the medication each day at the dose prescribed. Do not stop taking them abruptly. The dose is usually gradually reduced before stopping completely at the end of a course of treatment. But don't do this yourself - your doctor will advise on dosage reduction when the time comes. It is best not to stop treatment or change the dose without consulting a doctor.

Are there different types of tricyclic antidepressants?

There are several different types. They include: imipramine, amitriptyline, doxepin, mianserin, trazodone, lofepramine, and amoxapine. Each of these comes in different brand names.

There is no 'best buy' that suits everyone. A doctor makes a judgement as to which one would best suit. Things such as your age, other drugs that you may take, other medical problems, possible side-effects, and previous use of antidepressants are taken into account. If the one chosen does not suit, it is sometimes necessary to change the dose, or change the preparation. Also, if tricyclic antidepressants do not help then another type of antidepressant may be advised.

What about side-effects?

The most common side-effects are: a dry mouth, constipation, sweating, slight hesitancy in passing urine, slight blurring of vision, and drowsiness. These often ease after a week or so as the body becomes used to the drug. It is worth keeping on with treatment if side-effects are mild at first. Frequent drinks will help a dry mouth.

The leaflet that comes in the drug packet gives a full list of possible side-effects. Tell your doctor if a side-effect persists or is troublesome. A switch to a different drug may then suit you better.

Do not drive or operate machinery if you become drowsy whilst taking an antidepressant.

Are antidepressants addictive?

Tricyclic antidepressants are not tranquillisers, and are not thought to be addictive. Most people can stop antidepressants without any problem. At the end of a course of treatment it is usual to reduce the dose gradually over about four weeks before finally stopping. This is because some people develop 'withdrawal' symptoms if an antidepressant is stopped abruptly.

Withdrawal symptoms that may occur include: dizziness, anxiety and agitation, sleep disturbance, 'flu-like symptoms, diarrhoea, abdominal cramps, pins and needles, mood swings, feeling sick, and low mood. These symptoms are unlikely to occur if you reduce the dose gradually. If withdrawal symptoms do occur, they will usually last less than two weeks. An option if they do occur is to restart the drug and reduce the dose even more slowly.

© EMIS and PIP 2006   Updated: June 2006   PRODIGY Validated