Tricyclic Antidepressants, or TCAs

Tricyclic Antidepressants, or TCA:
Cyclic antidepressants are named tri (3), or tetra (4), depending on the # of rings in their chemical makeup.
Maprotiline is a Tetracyclic antidepressant because it has 4 rings.

All of the medications listed below are Tricyclic antidepressants:

  • Amitriptyline
    • Initial dose:
      25 to 100mg per day in 3 to 4 divided doses or 50 to 100 mg at bedtime.
    • Maintenance dose:
      25 to 150 mg per day in single or 3 to 4 divided doses.
Amitriptyline

Amitriptyline

  • Amoxapine
    • Initial dose:
      50mg 2, or 3x daily.
      Depending on tolerance, the dosage can be increased to 100mg 2, or 3x daily by the end of the 1st week. When an effective dosage is established, the drug may be given in a single dose (nor more than 300mg) at bedtime.
    • Maintenance: 200-300mg/daily. 
Amoxapine

Amoxapine

  • Desipramine (Norpramin)
    • Initial dose: 75mg/day orally given as a single dose or in divided doses.
    • Maintenance dose: 100-200mg/day.
Desipramine

Desipramine

  • Doxepin
    • For Mild Depression:
      Initial dose: 25mg/day in 1 to 3 divided doses.
      Maintenance dose: 25-50mg/day in 1 to 3 divided doses.
    • For Moderate Depression:
      Initial dose: 75mg/day in 1 to 3 divided doses.
      Maintenance dose: 75-150mg/day in 1 to 3 divided doses.
  • For Severe Depression:
    Initial dose: 150mg/day in 1 to 3 divided doses.
    Maintenance dose: 150-300mg/day in 1 to 3 divided doses.

    Doxepin carton

    Doxepin carton

  • Imipramine (Tofranil)
    • Hospitalized Patients:
      Initial dose: 100mg/day given in 3 to 4 divided doses.
      Maximum dose: 300mg/day.
    • Outpatients:
      Initial dose: 75mg/day given in 3 to 4 divided doses.
      Maximum dose: 300mg/day.
    • Intramuscular: Up to 100mg/day in divided doses.
tofranil-25mg

Tofranil 25mg

  • Nortriptyline (Pamelor)
    • 25-150 mg/day orally in divided doses or 1 dose.
Nortriptyline

Nortriptyline

  • Protriptyline (Vivactil)
    • 15 -40mg/day divided into 3 or 4 doses, up to 60mg/day, if necessary.
Protriptyline-hydrochloride

Protriptyline-hydrochloride

  • Trimipramine (Surmontil)
    • Outpatients:
      Initial: 75mg/day, orally in divided doses.
      Titration: May increase up to 150mg/day.
      Usual range: 50-150mg/day.
    • Hospitalized patients: 100mg/day, orally in divided doses.
      Titration: May increase gradually over a few days to 200mg/day.
      If there is no improvement after 2 to 3 weeks, the dose may be increased to 250 to 300 mg per day.
      Maximum Dose: 300 mg per day.
Trimipramine

Trimipramine

Common Side Effects:

  • 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

IMPORTANT: Pharmaceutical companies HAVE to list every side effect reported during clinical trails. So, just because a medication lists a certain side effect DOES NOT MEAN YOU will have it. In fact, most people experience very few side effects and with continued use (2 weeks and beyond), most of the initial side effects dissipate, or resolve completely. Additionally, the dosages listed above are FDA approved for treating Depression in an otherwise healthy Adult. For more specific information in treating your symptoms, consult your doctor. 

**Nearly all of the medications listed above have been replaced by newer antidepressants with less side effects. See my posts on SSRIs and SNRIs **

Advertisements

About medicalpsych

Dr. Jon Chandler is a Licensed Medical (Prescribing) Psychologist serving the Greater New Orleans, Louisiana area.

Posted on March 5, 2014, in Uncategorized and tagged , , , , , , , , , , , , , , . Bookmark the permalink. Leave a comment.

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: