Tricyclics get their name from the three rings in their chemical compositions .  We all know how important the shape of a drug's molecular structure is when choosing a medication.

For those of you with  Major Depressive Disorder  or bipolar depression we feel that these are the official antidepressants of last resort. Honestly you're better off evaluating the MAOIs trying to get your doctor to prescribe something experimental than most of these. The jury is still out as to whether or not a CNS med like Adderall is better for recalcitrant depression than a TCA. It all depends on if you really have a depression disorder, and not a type of ADD where depression is a major symptom. Hey, that's where brain scans make this diagnosis business all the easier.

If you have mild to moderate unipolar depression or various other types of depression other than  Major Depressive Disorder  the TCAs in low dosages are fine first-line meds.  They've been around forever and are still used.  If you're 'just' moderately depressed you shouldn't be messing with an SSRI or any of the other antidepressants listed in this site anyway, as they are all for major depressive disorder, i.e. when you're depressed.as.fuck.  It's when the TCAs are applied to more intense depressions and used in their higher, allegedly safe dosages that people report nasty problems and little effect.  And in Bipolarland the TCAs tend to exacerbate mania and/or rapid cycling, if they do anything at all.  So for the old-fashioned blues and blahs, these old-fashioned meds are fine, just so long as you keep the dosage low.  Many of the TCAs, especially Tofranil (imipramine),  are good meds for migraines and other neuropathic pain disorders if the anticonvulsants don't do anything for you.  However it could be that cost is a factor in the popularity of generic imipramine, and has little to do with it being particularly effective.

The main problem I have with TCAs is Mouse found them to be exceedingly awful and I just have a personal autistic-bipolar-epileptic prejudice against antidepressants.  So part of it is mainly us, not them.

Mouse found all of the tricyclics to be icky. They all gave her nasty tachycardia (abnormally fast heartbeats) and assorted heart rhythm problems that caused her to pass out a couple of times. She had to exercise like a maniac every day to keep her weight down to 155 pounds. That's about fifty pounds more than she weighs now.  All that and they didn't do that much for her depression. The TCAs are really out of favor with psychiatrists these days, and would most likely be prescribed only if nothing else worked, yet before any last resort medications or treatments.  However general practitioners who are treating people for depression and assorted ailments will often turn to them first.  It's a cultural thing.

The thing that's not just our deal but the main reason I'm leery of them is that it's far too easy to do some real damage to yourself if you overdose on them.  Especially if you wash them down with alcohol.  That's one hospital stay that could last a very, very long and expensive time.  That's just not an issue with the modern meds.  Sure, if you take a month's worth it'll be icky, but it won't be that icky.

A recent study comparing Elavil (amitriptyline) to Effexor (venlafaxine) for Major Depressive Disorder (i.e. you feel  depressed.as.fuck or like Whale Shit at the Bottom of the Ocean) found that the Effexor (venlafaxine) was both more effective as an antidepressant and its side effects sucked less.  That Effexor (venlafaxine) was more effective is new information, but that it sucked less isn't.  Well, OK, that Effexor (venlafaxine) sucked less is new information.  Effexor (venlafaxine) is the new generation antidepressant that everyone loves to hate.  But that goes to show you how comparatively icky the TCAs tend to be.  You randomize 160 of people, give 117 of them drugs and the half of those taking the TCA hate it more than the half of those taking Effexor (venlafaxine).  That just illustrates part of what makes the newer meds more effective.  In your brain the newer meds aren't that much more effective than TCAs, but people tolerate them better, so are able to keep taking them, and that just makes them more effective by default.

Limbitrol (chlordiazepoxide and amitriptyline HCl ). Limbitrol is a combination tranquilizer and antidepressant, with chlordiazepoxide an old-school benzodiazepine. We can just imagine this being the pill of suburban housewives in the sixties and seventies. Highly addictive, euphoric and compliant-making, it was probably the inspiration for The Stepford Wives. Freakiest side effects: paralyzed intestines, increased libido. Initial dose is three or four tablets a day in divided doses. The double strength tablets are recommended for the severely depressed. If no positive results are felt after a month, you can go up to six tablets a day. Once you feel chipper you should start working down, preferably to a maintenance dose of just two tablets a day. No half-life data are given. ICN.

Norpramin (desipramine hydrochloride). Freakiest side effects: enlargement of breasts for both men and women, "disturbance of accommodation." The usual adult dose is 100 to 200 mg per day. In more severely ill patients, dosage may be further increased gradually to 300 mg/day if necessary. Dosages above 300 mg/day are not recommended. Initial therapy may be administered in divided doses or a single daily dose. Maintenance therapy may be given once a day. Plasma level variations and half-life varied too wildly to pin down a half-life. Hoechst Marion Roussell.

Sinequan (doxepin HCl) Freakiest side effects: like other TCAs, Sinequan swells your breasts and balls. a starting daily dose of 75 mg is recommended. Dosage may subsequently be increased or decreased at appropriate intervals and according to individual response. The usual optimum dose range is 75 mg/day to 150 mg/day. In most severely ill patients higher doses may be required with subsequent gradual increase to 300 mg/day if necessary. Additional therapeutic effect is rarely to be obtained by exceeding a dose of 300 mg/day. No half-life data are given. Pfizer.

Surmontil (trimipramine) Freakiest side effects: good old black tongue and excessive breast milk when no nursing infants are present. Initially, 75 mg/day in divided doses, increased to 150 mg/day. Dosages over 200 mg/day are not recommended. Maintenance therapy is in the range of 50 to 150 mg/day. For convenient therapy and to facilitate patient compliance, the total dosage requirement may be given at bedtime. hospitalized patients start at 100 mg/day in divided doses. This may be increased gradually in a few days to 200 mg/day, depending upon individual response and tolerance. If improvement does not occur in 2 to 3 weeks, the dose may be increased to the maximum recommended dose of 250 to 300 mg/day. Wyeth.

Vivactil (protriptyline HCl). Freakiest side effects: All the usual TCA effects. Initial dose is 15 to 40 mg a day, divided into 3 or 4 doses. The dose may be increased up to a maximum of 60 mg a day, with all increases made in the morning dose. Merck.

For more information: http://www.fda.gov/cder/ogd/rld/16012s38.pdf