# TCA's tricyclic antidepressants



## Arisa1536 (Dec 8, 2009)

Does anyone here have experience with TCA's? 
Interested in taking them for depression, major depression, dysthymia or anxiety?

There has been a lot of negativity from Doctors and psychiatrists to a degree when mentioning Tricyclic antidepressants but I guess thats because of the side effects, which include a ton of things


nausea, 
vomiting, 
stomach pain, 
loss of appetite or increased appetite
constipation or diarrhea;
weight changes; often moderate to severe
dry mouth, 
unpleasant taste
weakness, 
lack of coordination;
numbness or tingly feeling;
blurred vision,
 headache, 
ringing in your ears, tinnitus
mild skin rash;
breast swelling (in men or women)
increased sweating.
Tiredness
 vivid dreams
 Sexual dysfunction (more common in older tricyclics like Amitriptyline and Imipramine etc

Safest TCAs to take?
Well in my experience i have found Nortriptyline to be safe
It helps major depression and the double dip i get, its also not a common
weight gainer drug like the older pills are. I have not had sexual problems or vivid dreams on them either.
Aside from a slight headache and sleepiness which is beneficial for an insomniac like myself, i would say they are very good. 

Trimipramine has had positive reception and desimprimine but its no longer used in new zealand anymore, neither of the two are 
They can be toxic in high doses.

TCA's i have been prescribed in the past

Amitriptyline
Was suggested Dosulepin by Psychiatrist
Doxepin by doctor if nortriptyline do not work


The TCAs included are predominantly serotonin and/or norepinephrine reuptake inhibitors:
Amitriptyline (Elavil, Tryptizol, Laroxyl)
Amitriptylinoxide (Amioxid, Ambivalon, Equilibrin)
Butriptyline (Evadyne)
Clomipramine (Anafranil)
Demexiptiline (Deparon, Tinoran)
Desipramine (Norpramin, Pertofrane)
Dibenzepin (Noveril, Victoril)
Dimetacrine (Istonil, Istonyl, Miroistonil)
Dosulepin/Dothiepin (Prothiaden)
Doxepin (Adapin, Sinequan)
Imipramine (Tofranil, Janimine, Praminil)
Nitroxazepine (Sintamil)
Nortriptyline (Pamelor, Aventyl)

*More rare TCAs* (harder to get, no longer prescribed etc) nowadays are:
Imipraminoxide (Imiprex, Elepsin)
Lofepramine (Lomont, Gamanil)
Melitracen (Deanxit, Dixeran, Melixeran, Trausabun)
Metapramine (Timaxel)
Noxiptiline (Agedal, Elronon, Nogedal)
Pipofezine (Azafen/Azaphen)
Propizepine (Depressin, Vagran)
Protriptyline (Vivactil)
Quinupramine (Kevopril, Kinupril, Adeprim, Quinuprine)

I guess the main concern is overdosing, as with SSRI/SNRI medication the death risk is slightly lower, whereas taking a Tricyclic in overdose can lead to cardiac depression/arrest


----------



## mikoy (Aug 12, 2010)

I have experience with doxepin and amitryptyline:

doxepin - sedative, low antidepressant effect
amitryptyline - better anitdepressant effect but I think it's too weak in serotonin reuptake inhibition in compare to SSRI. I like anticholinergic and 5-ht2c antagonism effect of this drug. Now I'm on escitalopram and sometimes take 25 mg of amitryptyline.


----------



## Arisa1536 (Dec 8, 2009)

mikoy said:


> I have experience with doxepin and amitryptyline:
> 
> doxepin - sedative, low antidepressant effect
> amitryptyline - better anitdepressant effect but I think it's too weak in serotonin reuptake inhibition in compare to SSRI. I like anticholinergic and 5-ht2c antagonism effect of this drug. Now I'm on escitalopram and sometimes take 25 mg of amitryptyline.


Hey thanks for your input
how do u find the side effects on Amitrip?
I notice you are on a low dose of Escitalopram well not low but its not high either, so do u find 25 mg of amitriptyline helps when u add it to an ssri?
because TCAs are pretty low Serotonin inhibitors its good to augment it with something in the SSRI/SNRI class if u can handle the side effects

Doxepin didn't help your depression?
Its not as strong or potent as Amitriptyline though


----------



## burner00 (Oct 11, 2009)

TCA's are pretty good if you want dry mouth.


----------



## Arisa1536 (Dec 8, 2009)

As long as you drink plenty of water they are good 
anyway, i needed to up my water intake as i was not drinking enough.
I have found noriptyline basically side effect free
I combine them with effexor though as i do not know how anti depressing they would be on their own:um


----------



## jim_morrison (Aug 17, 2008)

For those who are using them purely as a sedative, I think Trazodone may be preferable to a Tricyclic for that purpose. Similar idea; cheap, old school antidepressant which is mainly used for insomnia these days, but better tolerated generally.


----------



## mikoy (Aug 12, 2010)

Hey. I'm side effects free on 25 mg of amitryptyline (it's quite low dose). 
I'm on 10 mg escitalopram becouse it's my third week, and I still got side effects :f (anxiety and sweating).


----------



## Medline (Sep 23, 2008)

As a sedative I agree trazodone is better IMHO, lower dose mirtazapine is an option too. In general TCAs are useful for depression, with or without anxiety, but not the anergic type of depression. Here activating drugs are preferable.

For people with "just" SA TCAs have never shown to be effective, for some they can work of course. I have tried them and not just didn't they help me I hate "dumb drug" anti-cholinergic SE's.


----------



## Ramondo (Feb 16, 2011)

Yeah, I used to be on doxepin (or dothiepin, I can't remember) about 20 years ago. Then, I took SSRIs, and now trying SNRI, duloxetine (Cymbalta).

Yes, the TCA's are more dangerous in overdose, but I think the main reason for the loss of popularity is that the newer drugs have fewer side effects in most people.


----------



## upndownboi (Oct 7, 2010)

I voted no, but I want to. I'd like to get nortryptiline prescribed with prozac but am worried he won't go for it, perhaps citing serotonin syndrome or something else.


----------



## Arisa1536 (Dec 8, 2009)

upndownboi said:


> I voted no, but I want to. I'd like to get nortryptiline prescribed with prozac but am worried he won't go for it, perhaps citing serotonin syndrome or something else.


Yeah i understand and i know doctors tend to cringe at the thought of mixing both although people do it and TCAs do seem to be sedating whereas SSRI's can stimulate so the mixture may be good, it depends on the dosage of both medications but i did read fluoxetine can be dangerous mixed with tricyclics but :lol then again so can effexor and i take nortrip and effexor so its not a one size fits all thing

i do not know how effective a TCA would be on its own
has anyone been on a TCA and nothing else for Depression SAD and Anxiety?


----------



## Arisa1536 (Dec 8, 2009)

Here is a link i found while searching around side effects of Nortriptyline (Pamelor)
Nortrip-side-effects


----------



## bben (Oct 24, 2009)

they suck and have a ton of side effects


----------



## Arisa1536 (Dec 8, 2009)

bben said:


> they suck and have a ton of side effects


Thats from your experience though

I am finding them really sedating without making me feel lethargic or depressed. I have less anxiety, better sleeping patterns and have recently noticed a decrease in the need to eat everything i see which was common when my maj depression kicked in. so they take a bout 4-6 weeks to work but once they kick in its good 

Then again, apparently they can be toxic to the prostate? so possibly not the best option for guys:um


----------



## jim_morrison (Aug 17, 2008)

Arisa1536 said:


> Yeah i understand and i know doctors tend to cringe at the thought of mixing both although people do it and TCAs do seem to be sedating whereas SSRI's can stimulate so the mixture may be good, it depends on the dosage of both medications but i did read fluoxetine can be dangerous mixed with tricyclics but :lol then again so can effexor and i take nortrip and effexor so its not a one size fits all thing


That's moreso because Fluoxetine happens to inhibit the liver enzyme responsible for breaking down Nortriptyline, rather than due to any serotonergic reaction.

Due to the toxicity of TCA's in overdose, this is why something that stops it from breaking down properly could be dangerous.


----------



## Arisa1536 (Dec 8, 2009)

So its true that fluoxetine is not good when taken with any TCA?
I did read on my drug sheet that fluoxetine was mentioned as being a med that should be avoided as its_ not recommended _ but its not the same as the MAOI warnings though
you need to be cold turkey off them for at least fourteen days


----------



## upndownboi (Oct 7, 2010)

a very small daily dose of nortrip would effectively be boosted to a normal dose in vivo/body by fluoxetine. but i think it maybe is to be done only with careful monitoring of person's nortrip levels.


----------



## jim_morrison (Aug 17, 2008)

Zoloft or Lexapro would probably be more suitable for combination with Nortriptyline, as they don't mess with liver enzymes very much.

Ofcourse there are also selective NRI's such as Reboxetine to be considered, however it seems to be a clinical observation that the Noradrenergic TCAs such as Nortriptyline work better, I'm not exactly sure why, perhaps their additional effects on 5HT2c are synergistic, or some other mechanism.

Some sources state that Zoloft has some weak DRI properties, and that it suposedly has less or no effect of cognitive vigilance compared with the other SSRI's due to this property.


----------



## Arisa1536 (Dec 8, 2009)

Well if i am able to tolerate a moderate dose of SNRI medication along side a high dose of Nortriptyline (150 mg) then i would think it would work well with an SSRI, like jim said, lexapro or Zoloft would be better and lexapro has less side effects in general and its like its older cousin Celexa in the sense it does not have horrendous withdrawals or come downs.

you should be able to get a decent TCA prescribed to you
I would stay away from some of the older more toxic ones
Apparently, Trimipramine is also good, its no longer used here but if i was not on nortrip i would be inclined to look into trying to obtain it

It is only a moderate reuptake inhibitor of norepinephrine, and a weak reuptake inhibitor of serotonin and dopamine. Its main effects are due to considerable receptor antagonism as follows:
Extremely strong: *H1*
Strong:* 5-HT2, mACh, α1-adrenergic*
Moderate: *D2*
Weak: *5-HT1, α2-adrenergic*

It is also a more effective sedative than amitriptyline with less than half of the side effects as tested in a group of 28 patients who found it superior to Amitriptyline for sleep, chronic pain and sleeping anxiety and insomnia.
It has antidepressant, anxiolytic, antipsychotic, sedative, and analgesic effects.

for more info go to drugs.com/trimipramine

Overall i think i may have found my long term antidepressant, if the side effects stay away as they have done and my appetite pretty much stays the same as the meds kick in then i would be very impressed 
So far in the three weeks i have taken it i have had 1/18th of the side effects i had with Effexor and all the SSRI's i tried.
Seriously the only two side effects have been Dry mouth and Headache and all the dry mouth does is encoruage water intake to increase and thats a good thing  and headaches can be eased with a small dose of pain killers as nortrip increases the analgesic and sedative effects of pain and benzo medications


----------



## ladysmurf (Jan 3, 2012)

Well,

I tried all SSRI's and none of them worked, so my doctor suggested a Tricyclic anti-depressant. Hopefully that will do the trick, I am so tired.


----------



## constantiu (Oct 17, 2015)

I had such an awful experience


----------



## Qolselanu (Feb 15, 2006)

I've been on 75mg Nortriptyline for a few years now. I got lucky with the side effects. I only get the dry mouth. Of course I don't think its actually helping my depression at all. But that is anti-depressants for you...


----------



## zeusko87 (Sep 30, 2014)

i have heard that high doses of clomipramine (150-200) work great for social anxiety


----------

