Tricyclic antidepressants (TCA’s) maybe considered if first line treatments are unsuccessful.  These are as effective in treating depression but tend to be associated with more side effects than SSRIs.

Tricyclic antidepressants (TCAs)  have been in use for more than 40 years. Despite this, we do not know exactly how they work. However, they do affect the chemicals noradrenaline (also known as norepinephrine) and serotonin. These chemicals are neurotransmitters and they are made by the cells in the brain. Neuorotransmitters are the means by which the brain cells connect and communicate with each other. The tricyclic antidepressants increase the amount of noradrenaline and serotonin in the brain. They also effect other neurotransmitters which cause some side effects (such as dry mouth). Over many years of study and use tricyclics have been shown to improve symptoms of depression and anxiety. They also reduce obsessions and compulsions in obsessive-compulsive disorders (OCD).

Common side effects include:

Sleepiness (care needed with driving)

Dizziness on standing

Difficulty passing urine (especially in men)

Blurring of vision and problem with close vision (especially if you need glasses)

Tremor (slight shake of muscles of arms and hands)

Constipation

Confusion

Reduced sex drive and possible impotence

Weight gain

Increase and stabilise sleep