top of page

medication / antidepressants / tricyclics and heterocyclics 

Tricyclics and heterocyclics



Mental health problems

  • Depression

  • Prevention of recurrent depressive episodes

  • Anorexia, bulimia

  • Alcoholism, drug addiction

  • Obsessive compulsive disorders, phobias, post-traumatic stress disorder

  • Generalized anxiety, panic disorder

  • Aggressive behaviors

  • Attention Deficit Hyperactivity Disorder in Children (ADHD)


Physical health issues

  • Sleeping troubles

  • Migraines, chronic neuropathic pain

  • Fibromyalgia



  • Enuresis (urinary incontinence in children)



Physical health issues

  • Certain problems with the heart, liver, kidneys, urinary retention

  • Closed-angle or narrow-angle glaucoma

  • Can make some breathing problems worse

  • People prone to seizures

mental health problem

  • Bipolar affective illness (risk of triggering an episode of mania)



  • Use half an adult dose

  • Confusion, disorientation and delirium when combined with other medications

  • Risk of falling due to hypotension



  • Some are safe, consult a doctor



  • Generally poorly tolerated

Side effects

They depend on the dosage and duration of treatment, the metabolism of the individual and the context in which he lives.


Common side effects



  • Dry mouth

  • Drowsiness, sedation (Elavil, Tofranil, Surmontil)

  • Sudden drop in blood pressure, dizziness and vertigo (Tofranil); rarer with others

  • Blurred vision

  • Concentration difficulties

  • Restlessness, anxiety



Weight gain (Elavil, Anafranil, Tofranil)



  • Constipation

  • Nausea



Increased or irregular heartbeat



Various sexual disorders



Marked sunburn


Less common side effects



  • Difficulty urinating

  • Liver-related disorders



Sleep disturbances, nightmares






  • Dry eyes

  • Metallic taste in the mouth

  • Speech difficulty

  • Confusion

  • Seizures, very high risk (Ludiomil)

  • Appearance of angle-closure glaucoma in predisposed subjects



  • Lack of coordination, tremors

  • Edema (swelling)



Loss of appetite



Decreased white blood cell count



Onset of an episode of mania or hypomania



Discontinuation symptoms if treatment stopped abruptly (e.g. dizziness, sleep disturbances, agitation, anxiety, sensory disturbances)

Drugs interactions


Mental health problems

  • Anxiolytics (or tranquilizers)  and hypnotics (or sleeping pills), antipsychotics (or neuroleptics) and antihistamines increase

  • drowsiness and confusion

  • Antipsychotics (or neuroleptics)  increase difficulty urinating, constipation and a feeling of dryness in the mouth

  • The combination with another tricyclic antidepressant or MAOI should be avoided  at all costs, because it could be fatal

  • Combination with an SSRI may increase the effects of the tricyclic


Physical health issues

  • Meperidine (Demerol) can cause respiratory arrest

  • Drugs used to lower blood pressure: increased hypotensive effect



  • Alcohol increases the sedative effect

  • Narcotics (heroin, morphine, methadone) can cause respiratory arrest

Overdose Risks


Tricyclic antidepressants are responsible for most drug overdose deaths; fortunately, their use has greatly diminished.

Withdrawal symptoms

Psychotropic drugs act in the brain just as they do in the rest of the body; and as we have seen, each person reacts differently. It's the same with weaning; the person's metabolism, the type of drug, the dose as well as the duration of the intake and its half-life, explain that the withdrawal effects are varied. We have listed the potential and main withdrawal symptoms of each class of psychotropic drugs. This list is incomplete, as not all withdrawal effects are listed; moreover, knowledge is rapidly evolving in this field. A person may have no withdrawal symptoms or experience one, a few, or even many. The medication reduction journey is specific to each person, just as each process is unique. For example, a person can take the same medicine twice at the same dose and the effects will be different. Gradual reduction, like removing 10  % of dose per week/month, reduces the frequency or intensity of withdrawal symptoms and the incidence of rapid relapses. It is very important to undertake this process with the collaboration of your doctor. The pharmacist also plays a key role and can provide guidance to monitor withdrawal effects for each medication. Most people who will have withdrawal symptoms will tolerate them without problems for the short duration of these symptoms.


Common and frequent withdrawal symptoms for all classes:  anxiety,  nervousness,  hustle,  sleeping problems,  greater need to rest, sleep,  irritability,  fatigue

Withdrawal symptoms for tricyclic antidepressants:

Tricyclic antidepressants cause the same withdrawal effects as SSRIs, but differ in the  physical effects:


Flu-like effects:

  • Headaches (headaches)

  • sweating

  • Fatigue

  • General malaise

  • Muscle aches

  • Diarrhea

  • Nausea

  • Vomiting

  • Runny nose

  • Salivation

  • Palpitations


Cardiac arrythmia


Note: Mirtazapine (Remeron) gives very few symptoms of  withdrawal, but can sometimes cause anxiety, insomnia and  nausea.

bottom of page