Antidepressants (TCAs)
- Older broad monoamine-reuptake inhibitors
- Depression: usually later-line now
- Useful niches: pain, migraine, sleep, OCD
- clomipramine: potent SRI; OCD
- nortriptyline: cleaner TCA option
- Antimuscarinic + orthostasis + weight gain
- QRS widening + dangerous overdose toxicity
Class at a glance
- Older broad monoamine-reuptake inhibitors
Members / distinctions
- Depression: usually later-line now
Clinical role
- Useful niches: pain, migraine, sleep, OCD
- clomipramine: potent SRI; OCD
- nortriptyline: cleaner TCA option
Safety / monitoring
- Antimuscarinic + orthostasis + weight gain
- QRS widening + dangerous overdose toxicity
Pearls
- Secondary amines (nortriptyline, desipramine): less sedation, constipation
- Caution in constipation-predominant IBS
- Pregnancy: neonatal jitteriness and seizures
Self-check
- What useful nondepression niches do TCAs have?
Pain, migraine, sleep, and OCD. - What cardiac toxicity makes TCA overdose dangerous?
QRS widening.
Drugs in this class (9)
Antidepressants (TCAs) prescription history
Animated chart of estimated U.S. prescriptions per year, Antidepressants (1957–2026). TCA / tetracyclic highlighted from 1959.
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