Cyclic antidepressants approved to treat depression
Cyclic antidepressants are designated as tricyclic or tetracyclic, depending on the number of rings in their chemical structure — three (tri) or four (tetra). Those approved by the Food and Drug Administration to treat depression are listed below.
Tricyclic antidepressants:
- Amitriptyline
- Amoxapine
- Desipramine (Norpramin)
- Doxepin
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
Maprotiline is a tetracyclic antidepressant.
Some of these medications are available as liquids (oral solutions).
Sometimes, these antidepressants are used to treat conditions other than depression, such as anxiety disorders or nerve-related (neuropathic) pain.
Tricyclic antidepressants (TCAs) are a class of antidepressant associated with sedation, dry mouth, blurred vision, constipation, urinary retention, and increased pressure in the eye. They are also associated with hypertension, abnormal heart rhythms, anxiety, insomnia, seizures, headache, rash, nausea, and vomiting, abdominal cramps, weight loss, and sexual dysfunction. Tricyclic antidepressants rarely cause liver failure.
Side effects and cautions
Side effects of cyclic antidepressants vary somewhat from medication to medication and usually don’t last long. The most common side effects of cyclic antidepressants include:
- Dry mouth
- Blurred vision
- Constipation
- Urinary retention
- Drowsiness
- Increased appetite leading to weight gain
- Drop in blood pressure when moving from sitting to standing, which can cause lightheadedness
- Increased sweating
Other side effects may include:
- Disorientation or confusion, particularly in older people when the dosage is too high
- Tremor
- Increased or irregular heart rate
- More-frequent seizures in people who have seizures
- Difficulty achieving an erection, delayed orgasm or low sex drive
Read the package insert for additional side effects and talk to your doctor or pharmacist if you have questions.
Some tricyclic antidepressants are more likely to cause particular side effects. For example, amitriptyline, doxepin and trimipramine are more likely to make you sleepy than are other tricyclic antidepressants. Amitriptyline, doxepin and imipramine are more likely to cause weight gain than are other tricyclic antidepressants. Nortriptyline and desipramine appear to have better tolerated side effects.