Tricyclic+Antidepressants

Tricyclic antidepressants (TCAs) are first generation antidepressants that were developed in the 1950’s. TCAs were primarily used for treating clinical depression, though sometimes they were also used for treating other types of mood disorders and anxiety issues. Tricyclic antidepressants were named after their unique chemical structure, as TCAs are made up of three unique rings of atoms (Sinacola & Peters-Strickland, 2012, p.26). Tricyclic antidepressants work by preventing the uptake of neurotransmitter substances back into the presynaptic cells (Sinacola & Peters-Strickland, 2012, p.26). Although TCAs were deemed as effective for their time, they are not considered to be “clean” medications, which means that tricyclic antidepressants often affect many non-targeted organs and body systems which exposes the client to increased risk factors (Sinacola & Peters-Strickland, 2012, p.26).

After TCAs were de veloped many people found that although TCAs were effective in treating depression they presented a number of anticholinergic side effects that included sedation, constipation, weight gain, difficulty urinating, dizziness, dry mouth, sexual dysfunctions, orthostatic hypotension, tachycardia, and blurred vision (Sinacola & Peters-Strickland, 2012, p.26). As a result of their toxic cardiovascular nature, TCAs also pose a serious risk of overdose for clients suffering with prolonged, severe suicide ideation (Sinacola & Peters-Strickland, 2012, p.26). TCAs were also problematic because they were deemed to be unsafe for specific populations including children, teens and the elderly. A few commonly known “brand” names of tricyclic antidepressants include: Anafranil, Ascendin, Elavil, Ludiomil, Norpramin, Pamelor, Aventyl, Surmontil, Tofranil, Vivactil. In the early 1980’s a second generation tricyclic antidepressant was developed called Desyrel which had the generic name trazodone. Trazdone affects the neurotransmitter serotonin and acts much like a serotonin receptor antagonist (Sinacola & Peters-Strickland, 2012, p.26). This TCA was a more popular choice for clinicians because it posed less risk of suicide and has fewer side effects than older generation TCAs. However, while trazodone had fewer side effects than older TCAs, it still had common the side effects of dry mouth and sedation (Sinacola & Peters-Strickland, 201 2, p.26). Tricyclic antidepressants stopped being a popular drug treatment for depression in the late 1980’s when the first serotonin selective reuptake inhibitors (SSRIs) were developed which posed much less risk to clients and also had considerably less side effects than the TCAs (Sinacola & Peters-Strickland, 2012, p.26). Tricyclic antidepressants are not used often by clinicians today because they have largely been replaced with the many better antidepressants that exist on the market today such as benzodiazepines, serotonin selection reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) which have far fewer risks and negative side effects associated with them.


 * Effects on Psychotherapy **

However, while TCAs are rarely prescribed today it is still important to know how they work and the risks and side effects that are associated with them, because as a psychotherapist if you had a client who was using TCAs it would be important to consider how the side effects of the medication would interfere with the psychotherapy process. For example, sedation is a common side effect associated with TCA use and as a psychotherapist it would be important to know whether or not the sedation was a side effect of the depression itself, or of the TCA medication, as if it was a product of the TCA drug treatment it may be important to look at other drug treatment options or what types of psychotherapy approaches would be most beneficial to the client. It would also be important to note the severity of the client’s depression and assess for suicide ideation because if the client is on TCAs they would have a much higher risk of overdose especially if they were dealing with moderate to severe depression.