Tricyclic Antidepressants

Excerpt

Tricyclic antidepressants (TCAs) constitute a class of medications used to manage and treat major depressive disorder (MDD). These medications function by inhibiting the reuptake of neurotransmitters, such as serotonin and norepinephrine, which can modulate mood, attention, and pain in individuals. The U.S. Food and Drug Administration (FDA) has approved different TCAs for specific indications based on clinical trials and proven evidence of their effectiveness and safety for specific medical conditions. Evidence-based guidelines recommend TCAs as a second-line treatment for MDD following selective serotonin reuptake inhibitors (SSRIs). Although TCAs demonstrate equivocal efficacy with SSRIs when treating MDD, these medications cause more significant adverse effects due to their anticholinergic activity and lower threshold for overdose. Due to these factors, TCAs are typically not considered the first-line treatment for MDD, even though they have been proven highly effective in managing severe or treatment-refractory depression. This activity highlights the mechanism of action, indications, contraindications, adverse event profile, monitoring protocols, relevant interactions, off-label uses, and other pivotal facets of TCA therapy to enhance the competence of interprofessional healthcare team members when caring for patients with MDD and related conditions.