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Tricyclic antidepressants (TCAs) are used to treat major depression, OCD, bedwetting (nocturnal enuresis), and fibromyalgia.
These medications work by blocking the reuptake of norepinephrine and serotonin, increasing their levels in the brain.
Most TCAs end in "-ipramine" or "-triptyline," except for doxepin and amoxapine. Common examples include amitriptyline (for depression and chronic pain), desipramine (for depression with fewer side effects), clomipramine (for OCD), imipramine (for bedwetting), and nortriptyline (which causes less hypotension than other TCAs).
While effective, tricyclic antidepressants have a narrow therapeutic index, meaning overdose can lead to cardiotoxicity, which may be treated with sodium bicarbonate.
Drug Names
A way to remember Tricyclic Antidepressants is by their suffixes (-ipramine, -triptyline), with exceptions like doxepin and amoxapine.
The mnemonic "CIA Love Dating Nerds" can help recall the most common TCAs:
- Clomipramine - Used for OCD.
- Imipramine - Treats nocturnal enuresis.
- Amitriptyline - Used for depression, chronic pain, and fibromyalgia.
- Lofepramine - A newer TCA with fewer anticholinergic effects.
- Doxepin - Used for depression and anxiety but has a narrow therapeutic index.
- Nortriptyline - Causes less hypotension than other TCAs.
Indications
Tricyclic Antidepressants (TCAs) are used to treat several conditions, including:
- Major depressive disorder (second-line treatment after SSRI & SNRI)
- Neuropathic pain
- Nocturnal enuresis (bedwetting)
- Obsessive-compulsive disorder (OCD)
- Fibromyalgia
They also help with migraines and tension headaches.
Adverse Effects
While TCAs are effective in treating various conditions, they are also associated with several adverse effects, including:
- Anticholinergic effects (e.g., dry mouth, blurred vision, constipation, urinary retention)
- Cardiotoxicity, especially in overdose situations (e.g., arrhythmias, prolonged QT interval)
- Nocturnal enuresis (bedwetting)
- Sedation and drowsiness
- Weight gain
- Orthostatic hypotension (dizziness upon standing)
- Excessive sweating, particularly at night
- Sexual dysfunction (e.g., reduced libido, erectile dysfunction)
Check out our detailed guides on MAOIs and Atypical Antidepressants to further boost your pharmacology exam prep and master essential drug mnemonics!