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Tricyclic antidepressants - Side effects

Date Created: 07/03/1999 Last Modified: 19/01/2002 Last Checked: 07/10/2002

The receptor affinities for H1, A1, Muscarinic (m1-6 subtypes) etc determine much of the profile of side effects. This varies a lot between the various available TCAs (see detailed information on receptor affinities in other notes)

The overall severity of adverse effects (if used at appropriate doses--with blood level monitoring as needed) is probably:

Best --nortriptyline, desipramine and lofepramine

Intermediate --Amitriptyline and clomipramine

Worst -- probably doxepin, trimipramine and dothiepin (weak and more toxic in OD).

It is difficult to justify the clinical use of these last three drugs for depression, some toxicologists feel they should no longer be on the market. Doxepin, in doses of 10-50 mg, is an excellent sedative / antihistamine (it is the most potent antihistamine currently available); but it should not be regarded as an antidepressant drug.