Tricyclic antidepressants, or TCAs, were among the first drugs marketed in the U.S. to treat depression. Their use continues despite the introduction of several other groups of antidepressant medications. TCAs, like all prescription antidepressants, carry a warning mandated by the U.S. Food and Drug Administration regarding the increased risk of suicidal thinking and behavior in children, adolescents and young adults associated with use of these medications.
Imipramine (Tofranil) was the first TCA marketed in the U.S. This drug is indicated for the treatment of endogenous depression, which is depression that occurs without apparent cause. With TCAs, improvement in depressive symptoms is usually not seen until 1 to 3 weeks after initiation of treatment. The typical adult dose of imipramine is 50 to 300 mg per day.
Amitriptyline is used to treat the symptoms of endogenous depression. It also has sedative effects. Amitriptyline and other TCAs may be used for conditions other than depression at the doctor’s discretion. The typical adult dose is 50 to 200 mg per day.
Amoxapine has antidepressive and mild sedative effects. It is used for the relief of depressive symptoms in people with endogenous, reactive and psychotic depression. Reactive depression occurs in response to a life-changing event such as the death of a loved one, a divorce or the loss of a job. Psychotic depression is a severe form of depression wherein the sufferer loses touch with reality and has hallucinations or delusions. The typical adult dose of amoxapine is 200 to 300 mg per day.
Although clomipramine (Anafranil) is in the tricylic antidepressant drug group, it is used to treat the symptoms of obsessive compulsive disorder, or OCD. The drug is approved for both children, age 10 and older, and adults for this indication. The typical adult dose is 100 to 200 mg per day. The typical daily dose for children is 3 mg per kilogram of body weight or 200 mg, whichever is less.
Desipramine (Norpramin) is recommended for the treatment of general depressive symptoms without distinction between endogenous versus reactive depression. The typical adult dose is 100 to 200 mg per day.
Doxepin (Silenor) is used for the treatment of depression and other psychological symptoms including anxiety, tension, sleep disturbances, fear and worry. It may be helpful in treating mental health-related sleep disturbances and lack of energy. The recommended adult dose of doxepin is 75 to 150 mg per day.
Nortriptyline (Pamelor) is used for the treatment of depression. It is reportedly more likely to be effective for endogenous depression compared to other forms of the condition such as reactive depression. The typical adult dose of nortriptyline is 75 to 100 mg per day.
Protriptyline (Vivactil) is used for the treatment of depressive symptoms in people with endogenous depression, especially those who lack energy and are socially withdrawn. The typical adult dose of protriptyline is 15 to 40 mg per day.
Trimipramine (Surmontil) is used for the treatment of depressive symptoms, especially those associated with endogenous depression. This medication may also relieve anxiety. The typical adult dose of trimipramine is 75 to 150 mg per day.
- Physicians' Desk Reference 2014; PDR Staff
- Goodman and Gilman's The Pharmacological Basis of Therapeutics, 12th Edition; Laurence Brunton, et al.
- DailyMed: Tofranil
- DailyMed: Amitriptyline Hydrocholoride
- DailyMed: Amoxapine
- DailyMed: Anafranil - Clomipramine Hydrochloride
- DailyMed: Norpramin - Desipramine Hydrochloride
- DailyMed: Silenor - Doxepin Hydrochloride
- DailyMed: Pamelor - Nortriptyline Hydrochloride
- DailyMed: Protriptyline