Kevin Leehey, M.D.
1980 E. Ft. Lowell Road, Suite 150 Tucson, Arizona 85719 (520) 296-4280 Fax: (520) 296-3835

TRICYCLIC ANTIDEPRESSANTS
OLDER MEDICATIONS FOR DEPRESSION AND ANXIETY

Download PDF Version

 
Group Main Use Medication
Brand/Generic
Form Dose Schedule Dose Range Most Common Side Effects for Group Pros for Group Cautions for Group
TCA
Tricylic Antidepressants

(depression, anxiety panic, migraines, sleep)
Elavil
(Amitriptyline)


Pamelor
(Nortipyline)


Sinequan
(Doxepin)
(Silenor)


Tofranil
(Imipramine)
Tablets
(not scored)
10, 25, 50, 75, 100, 150mg



Capsules
Doxepin
Pamelor

Liquid
Pamelor
Doxepin
Usually once a day in the evening


Split dose may be useful (a.m. and p.m.)

Silenor is a brand of Doxepin for sleep that comes in only 3 and 6mg sizes.
Child: 25-100 mg

Adoles: 50-150 mg

Adult: 100-300mg

Blood levels may help guide dose.

Nortiptyline and Anafranil doses lower.
Sedation, dry mouth, constipation. Dizziness, high heart rate, fatigue, blurry vision. May worsen abnormal heart rate or glaucoma or slow urination if enlarged prostrate. Occasional sexual side effects. Side-effects usually lessen with time. Broad range of effects in depression, panic attacks, sleep, pain, headaches, bed-wetting, ADHD, post traumatic stress.

Does not cut appetite. Helps sleep.

Used to prevent migraines. Helps chronic pain. 50 years of well studied experience.








Vivactil is more likely to energize than other TCA's.
Affects many transmitters so relatively more side effects.

May be dangerous in overdose.

Labs and EKG usually advised to monitor heart, liver, and level in blood.

May increase appetite. Probably less effective than SRI for anxiety except panic.
Surmontil
(trimipramine)
capsules
25, 50, 100mg
Start 25 mg
2 to 3 times daily
50-150mg
max 200mg
Vivactil
(protriptyline)
tablets
5, 10mg
Start 5mg
2 or 3 times daily
15-40mg
max: 60mg
  Anafranil
Clomipramine
capsule
25mg
50mg
75mg
Evening  25-300 mg Same as other TCA May be the most effective medication for obsessive-compulsive disorder (The only TCA that often helps due to also having SRI action)

Children often tolerate better than adults.
Same as other TCA although probably the most side effects, especially for adults.

All these medications should be taken 7 days a week to be effective. Simultaneous use of alcohol or cigarettes and especially street drugs should be avoided. All antidepressants may increase mania risk in persons with Bipolar (manic-depressive) disorder. All medications should be avoided if possible in pregnancy. This chart is intended to be a summary guide, not a full and complete list.

dep3.html (7/16)