Antidepressants
TCA class antidepressants
Tricyclic antidepressants (TCAs) are an older type of antidepressant. They are no longer regarded as a first-line treatment for depression because an overdose with them can be dangerous.
TCAs may be prescribed for people with severe depression that does not respond to other treatment options. A tricyclic may also be recommended for other mental health conditions such as obsessive-compulsive disorder (OCD) and bipolar disorder (BPD).
Examples of tricyclic antidepressants include:
- amitriptyline (Tryptizol)
- clomipramine (Anafranil)
- imipramine (Tofranil)
- dosulepin (Dothiepin, Prothiaden)
Experiences being prescribed TCA antidepressants
A few people we interviewed had been prescribed a tricyclic antidepressant at some point during their treatment. Some took them years before SSRIs were developed and others had been prescribed them because their symptoms had not improved after trying one or several other types of antidepressants.
Some of the people we interviewed were also taking other medicines such as antipsychotics or medicines for anxiety. It can be difficult to separate out the effects of each medication while taking more than one (see also ‘Taking other medicines with antidepressants’).
People we spoke with who had taken a TCA class of antidepressant usually had a history of severe or persistent depression. Not everyone was certain why a particular antidepressant had been prescribed to them.
As with all antidepressants, people reacted differently to tricyclics and people we spoke with had mixed feelings about them. People who had taken several or many different antidepressants over time could find it hard to recall details about each one.
Caroline was prescribed amitriptyline when she was first diagnosed with depression and felt that it worked, but she felt ‘high’ while she was on it and did not feel like herself. Her GP only prescribed it for a short period.
Experiences and side effects with TCA antidepressants
Sonia felt that lofepramine was effective the first time she took it but was not effective for her later on. She wanted to take it because it reduced her appetite and helped her lose weight. She explained that she had an eating disorder and taking it may not have helped her.
Other side effects people mentioned included ‘restless leg syndrome’, a metallic taste in the mouth, and constipation. Janet was prescribed a laxative to prevent the constipation from lofepramine.
See also ‘Coping with antidepressant side effects’, ‘Taking other medicines with antidepressants’ and ‘Managing the use of antidepressants’.
Sonia had mixed results with lofepramine. She liked it because it reduced her appetite.
Sonia had mixed results with lofepramine. She liked it because it reduced her appetite.
In 2003 I got very, very depressed and was prescribed lofepramine, if I remember right lofepramine by my GP, again wasn’t really told anything about it and I didn’t, I wasn’t really interested I just wanted something to make me feel better, I was kind of, you know, I didn’t really care what it was. It seemed to work quite well and then it seemed to stop working.
I convinced him to let me try lofepramine again because it had worked in the past and so he said he would. He was quite, he was very good, he gave me information about the drug, he said to me, he kind of left it up to me in terms of, he said this is the dosage you can go up to, try it on this dosage, if it’s not working you can increase it yourself up to a certain point but do kind of come back and he was very insistent that I call him if I needed help or, you know, and have regular appointments with him to kind of check up on things.
Unfortunately it didn’t work and that Christmas I was admitted to hospital again.
Lofepramine I loved, sorry going back to the Tricyclic, I love lofepramine and the reason I wanted to go back on it the second time was a ridiculously vain reason but I remembered that it made me, it just, it stopped my appetite, I had absolutely no desire to eat at all and for me I wanted that back, I wanted, you know, I wanted to lose weight I wanted to not eat so I was just like yes give me a drug that makes me not want to eat and I’ll be more than happy.
Sharon had recurrent episodes of depression for most of her adult life, and at one point, her doctor suggested she try a tricyclic because they ‘didn’t think the SSRIs were working effectively’.
She tried both lofepramine and dosulepin at different times, and while they relieved her symptoms to an extent, looking back, she said she felt ‘doped up’, and 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 felt ‘completely flattened’ when taking amitriptyline.
A doctor may also prescribe a TCA type of antidepressant for someone because the sedative effects can help. Gerry, for example, was prescribed trimipramine for about a month in addition to an SSRI to help him sleep better.
Sharon felt she was ‘just going through the motions’ when she took a tricyclic antidepressant.
Sharon felt she was ‘just going through the motions’ when she took a tricyclic antidepressant.
When you went on the Tricyclics then did they alter your mood? Did they have an effect?
Mm they sort of doped me up really.
So you felt a bit blank did you?
Yeah, yeah. But I wasn't, I didn't feel that I could function and carry on normally. I didn't feel alert, I felt very sort of floating, relaxed and - which was nice and sometimes it was very nice to not feel anything but you can't go on like that, like it's not how you live.
And how, yeah I mean how did it impact on your day to day life would you say?
I functioned, I just, I got up, I fed the children, I took them to school, I'd come home, I'd sit – just sit with no music, no telly or I'd sleep and then I'd pick the kids up and make them dinner and put them to bed and then I'd go to bed and I did that for months.
So did you discuss that aspect of it with your doctor at all?
I don't think so no, because I don't think at the time I thought about it. I was just going through the motions.
Because when you're in that state it's quite hard to actually think about it clearly.
Yeah because, because your thinking's different anyway and it was, it was just, it was like being in a permanent state of drunkenness I suppose just mildly. But, so you weren't that bothered because it was, it was OK because you weren't feeling bad, it didn't matter that you weren't feeling good either and you just carried on with it.
Thomas stopped taking amitriptyline after a time because he found it impossible to function on it, and it had no effect on the depression.
Thomas stopped taking amitriptyline after a time because he found it impossible to function on it, and it had no effect on the depression.
I still remember picking it up at the pharmacy and, and taking it out of its box and looking at it and deciding whether or not I should take it. But I took it, and it felt like I was being hit by a tank somehow. I just felt completely flattened. I couldn’t really function. I remember going to the cinema and again it being quite dark and falling asleep during the film and then waking up hours later, and this was on quite a low dose of amitriptyline. It was only a starting dose and I remember spending hours and hours and hours just lying in bed. It just completely sedated me.
It seemed to do nothing for me. My GP at the time said, “Well, you know, you have to give it some time, it’s a tricyclic antidepressant, they take a few weeks for it to kick in, or a few months maybe. You have to give it some time.”
I didn’t know how I was going to cope with this because I couldn’t, I couldn’t function, I couldn’t get myself out of bed. I couldn’t get myself to the lab. It was so sedating. That was the main thing I remember about amitriptyline and it gave me a funny taste in my mouth. One I’d never had before.
So I quickly after not very long, I discontinued amitriptyline. I said, “I can’t cope with this, it’s not giving me any kind of benefit and it is just knocking me out. Its, not.... it’s not helping me.
Many people found it hard to remember how they 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').
Michael and Janet, who were in their 70’s, both took amitriptyline when they were first diagnosed with depression before the newer SSRI type antidepressants became available.
Michael had a long history with depression and said he never felt that the antidepressants he took did 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. He told us, ‘I just kept taking the pills and doing what people told me’.
Janet said she felt ‘dopey and tired’ on amitriptyline and was still depressed.
Janet was first prescribed amitriptyline in her 20s after the birth of her baby. She didn’t like how it made her feel and felt it hadn’t helped her.
Janet was first prescribed amitriptyline in her 20s after the birth of her baby. She didn’t like how it made her feel and felt it hadn’t helped her.
I first came to, became depressed after the, quite some time after the birth of my daughter, I was 28 at the time, about 28… it, my general health hadn’t really been following her birth, in that I was losing weight, I lost weight in fact in my pregnancy it wasn’t really clear cut what was wrong for quite a little while but my GP was very good and noticed that I worried a tremendous amount and he put me onto a drug called Valium which is no longer used and just to calm me down because he said I’d burn myself out otherwise. And he… put me in touch with a psychiatrist for reasons nothing to do with my depression but because I was seen by the psychiatrist he ended up treating me. I went onto Tricyclic drugs… amitriptyline was the first drug and I was, I felt very dopey and tired with this drug I didn’t like it at all, I didn’t like being on it… I didn’t really get any better and I was eventually hospitalised.
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.
Thomas noted that tricyclics are risky for people who are likely to overdose.
Thomas noted that tricyclics are risky for people who are likely to overdose.
Perhaps the reason why I’m still able to talk to you today and not dead is because I changed from amitriptyline to Cipramil. I later found that amitriptyline’s quite toxic, can put you in a coma. The tricyclics are cheaper.
So if you had overdosed on it?
If I had overdosed and there was a period of one week between overdosing. I took my overdose then changed from amitriptyline to Cipramil. If I’d had that pack of amitriptyline I would probably have been in a coma, possibly dead, I don’t know. I don’t know what would have happened. But these tricyclics, the cheaper ones which tend to be prescribed more often, because they are cheap and they’re older, are quite toxic. But you’re never told that. And it’s a major source of poisoning they reckon. And I don’t, I don’t think people know about that. I think if you’re going to prescribe an antidepressant you should prescribe an SSRI, fluoxetine, Prozac or one of these sooner, and not prescribe tricyclics.
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