A-Z

Antidepressants

Using an antidepressant – tricyclics (TCAs)

Tricyclic antidepressants (TCAs) are an older type of antidepressant. They are no longer regarded as a first-line treatment for depression because an overdose can be dangerous. They may be prescribed for people with severe depression that fails to respond to other treatments. A tricyclic may also be recommended for other mental health conditions such as obsessive-compulsive disorder and bipolar disorder.
 
Examples of Tricyclic antidepressants include:
 
  • amitriptyline (Tryptizol)
  • clomipramine (Anafranil)
  • imipramine (Tofranil)
  • lofepramine (Gamanil)
  • nortriptyline (Allegron)
 
A few people we interviewed had been prescribed a tricyclic antidepressant at some time. Some took them years ago before SSRIs were developed. Others had been prescribed them because their symptoms had not improved after trying one or several other antidepressants. Some of the people we interviewed were also taking other medicines such as antipsychotics or medicines for anxiety. It could be difficult to tease out the effects of each separately (see ‘Taking other medicines with antidepressants). People who had taken this class of antidepressant usually had a history of severe or persistent depression. Not everyone was certain why a particular antidepressant had been prescribed. People who had taken several or many different antidepressants over time could find it hard to recall details about each one.
 
As with all antidepressants, people reacted differently to tricyclics. Many had mixed feelings about them. Caroline was prescribed amitriptyline when she was first diagnosed with depression some years ago and felt it worked, but she had felt ‘high’ on it and ‘not like me’. Her GP only prescribed it for a short period. Sonia felt lofepramine was effective the first time she took it, but not on a later occasion. She wanted to take it because it reduced her appetite and helped her lose weight. She explained she had an eating disorder, and taking it may not have helped her. Other side effects people mentioned were ‘restless leg syndrome’, a metallic taste, and constipation. Janet was prescribed a laxative to prevent the constipation from lofepramine.
 
(See ‘Coping with antidepressant side effects’, ‘Taking other medicines with antidepressants’ and ‘Managing antidepressants’). 
 

Caroline took amitriptyline for depression and said ‘it worked fine’...

Text only
Read below

Caroline took amitriptyline for depression and said ‘it worked fine’...

Age at interview: 60
Sex: Female
HIDE TEXT
PRINT TRANSCRIPT
So I went to see my GP and he was very, very good and he said okay look you’re not feeling well this week you should try and do various things to make you feel better but if you don’t feel better in a week come back, so I didn’t feel better in a week so I came back and he prescribed amitriptyline and I had to take it at night because it would make me feel dozy after I’d taken it and indeed it did. I didn’t feel less depressed I felt rather sick for a while, I didn’t feel less depressed for a few weeks but what happened was exactly what it said on the packet, after a few weeks I started feeling slowly better and better it was like having a big pair of hands. And after a few months, I don’t remember how long it was I took it for, but after a few months I was buzzing round the ceiling it was very, I thought it was a pharmacological high and then my GP said ‘Oh I think it’s time for you to come off that,’ and I felt really heartbroken having to come off and he said ‘Sorry but you’ve had your course and now you come off.’ And I remember okay I’m going to write you, I forget, three months more prescription but come off gradually and I remember working out the, the, so instead of taking it every day if I’d miss every three days and then I’d miss every two and then it would be every other day – it just tailed off.
 
But that worked fine and I was fine for about 10 years.
 

Sonia had mixed results with lofepramine. She liked it because...

Sonia had mixed results with lofepramine. She liked it because...

Age at interview: 31
Sex: Female
Age at diagnosis: 17
SHOW TEXT VERSION
PRINT TRANSCRIPT
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 when ‘he didn’t think the SSRIs were working effectively’. She tried both lofepramine and dosulepin at different times they relieved her symptoms to an extent but looking back she said she felt ‘doped up’ and says 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 had felt ‘completely flattened’ when taking amitriptyline. A doctor may prescribe this type of antidepressant for someone because the sedative effects can help. Gerry was prescribed trimipramine for about a month in addition to an SSRI to help him sleep better. 
 

When Gerry started taking sertraline...

Text only
Read below

When Gerry started taking sertraline...

Age at interview: 31
Sex: Male
Age at diagnosis: 29
HIDE TEXT
PRINT TRANSCRIPT
It was sertraline that I started on and now let me think. Then I, then I was on, yes so I started on sertraline and I started the talk therapy and really the combination of the two I’d started to pretty quickly feel better again. I want to say maybe, maybe three or, about three or four weeks after I’d been on, it would be about… yes since I’d got antidepressants… I’d start on the actual, for the first I’d say five to seven days they were very, very, I kind of realised that the power that the drugs had and caused a feeling like sort of, I can’t even remember what I really felt like, I just remember being quite distressed because I felt a bit spaced out for about the first five to seven days and being like’ oh should I persevere with this because, you know, it’s kind of not, it’s not really helping me’. But I’d read Google and I’d read a lot of people’s stories saying like it will sort of kick in after two to four weeks so I thought well I’ll keep on going. so I kept on going and it probably was about two or three weeks in, into my course of antidepressants when I did start to say well like hold on there’s a bit of a mood shift here, you know, I could feel the, the heaviness lift and I felt more relaxed I wasn’t having the, you know, I was still having anxious thoughts but I wasn’t, the actually physical manifestation of anxiety that sort of pang that used to hit me there, it wasn’t that, that abated you know, it kind of you know, they almost levelled me off.
 

Sharon felt she was ‘just going through the motions’ when she...

Sharon felt she was ‘just going through the motions’ when she...

Age at interview: 37
Sex: Female
Age at diagnosis: 22
SHOW TEXT VERSION
PRINT TRANSCRIPT
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...

Thomas stopped taking amitriptyline after a time...

Age at interview: 34
Sex: Male
SHOW TEXT VERSION
PRINT TRANSCRIPT
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 had 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'). Both Michael and Janet, now in their 70’s, took amitriptyline when first diagnosed with depression, before the newer antidepressant medicines came in. Michael has a long history of depression and has never felt that the antidepressants he has taken have done 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. ‘I just kept taking the pills and doing what people told me’. Janet said she felt ‘dopey and tired’ on amitriptyline and still depressed. 
 

SHOW TEXT VERSION
PRINT TRANSCRIPT
 

Janet was first prescribed amitriptyline in her 20s after the birth...

Janet was first prescribed amitriptyline in her 20s after the birth...

Age at interview: 71
Sex: Female
Age at diagnosis: 28
SHOW TEXT VERSION
PRINT TRANSCRIPT
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

Age at interview: 34
Sex: Male
SHOW TEXT VERSION
PRINT TRANSCRIPT
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.


Last reviewed June 2016.
donate
Previous Page
Next Page