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

• 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

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

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

• 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

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

Nortriptyline

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

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

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 **