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TRICYCLIC ANTIDEPRESSANTS Try sigh click (Hawke's Bay District Health Board New Zealand)

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TRICYCLIC ANTIDEPRESSANTS
Try – sigh – click
Why have I been prescribed a tricyclic?
Tricyclics are a group of medicines used to treat depression. Depression is a common condition. It is different from the
normal “ups and downs” of everyday life. People with depression may feel sad most of the time and cannot see an end to
their sadness. Tiredness and poor sleep are very common, and so are changes in appetite. Many people also find that they
simply cannot enjoy any of life’s pleasures.
Depression can be treated in many ways. Antidepressants are often used because they are effective for most people.
Other “talking” therapies are also effective in depression. Antidepressants can generally be relied upon to relieve the
symptoms of depression in most people. The tricyclics can also be helpful in treating other conditions, such as anxiety,
sleep problems, panic, obsessive-compulsive disorder and social phobia.
What exactly are tricyclics?
The tricyclics are antidepressants. They are not tranquillisers or sleeping tablets. The tricyclics have been used for many
years to treat depression. Some examples of tricyclic antidepressants are amitriptyline (‘Tryptizol’), amoxapine (‘Asendis’),
clomipramine (‘Anafranil’), dothiepin or dosulepin (‘Prothiaden’), doxepin (‘Sinequan’), imipramine (‘Tofranil’), lofepramine
(‘Gamanil’), nortriptyline (‘Allegron’) and trimipramine (‘Surmontil’). There are some others.
Are the tricyclics safe to take?
It is usually safe to have tricyclics regularly as prescribed by your doctor, but they don’t suit everyone. Let your doctor know
if any of the following apply to you, as extra care may be needed:
a) if you have epilepsy, diabetes, phaeochromocytoma or glaucoma, or suffer from heart, liver, thyroid, kidney, or prostate
trouble;
b) if you are taking any other medication. This includes medicine from your pharmacist, such as antihistamines, St. John’s
wort or cimetidine (‘Tagamet’);
c) if you are pregnant, breast feeding, or wish to become pregnant.
What should I do if I miss a dose?
Never change your dose without checking with your doctor. If you forget a dose, take it as soon as you remember, as long
as it is within a few hours of the usual time.
How should I take a tricyclic?
Look at the label on your medicine; it should have all the necessary instructions on it. Follow this advice carefully. If you
have any questions, speak to your pharmacist, doctor or nurse. Most medicines are now dispensed with an information
leaflet for you to read. They are often best taken at night, as the drowsiness may help you sleep.
Are tricyclics addictive?
Tricyclics are not addictive, but need to be treated with respect. Some people do get some “discontinuation” effects if they
stop their tricyclic suddenly. These effects include anxiety, dizziness, feeling sick and not being able to sleep. Some people
feel confused and “out of sorts”. These symptoms are less severe if you come off tricyclics slowly. It is best to discuss this
with your doctor.
What will happen to me when I start taking my tricyclic?
All antidepressants work slowly. People tend to feel better over a period of weeks rather than days. Different symptoms
may get better at different times. Most people find that they feel noticeably better after about two or three weeks. However,
the full effect of antidepressants is usually felt only after about four to six weeks. It is very important to continue to take
antidepressants so that the full effects can be felt. Speak to your pharmacist, doctor or nurse if you have any questions
about this.
Unfortunately, you might get some side effects before your mood gets any better. Most of these side effects should go
away after a week or so. Look at the table over the page. It tells you what to do if you get any side effects. Not everyone will
get the side effects shown. There are many other possible side effects. Ask your pharmacist, doctor or nurse if you are
worried about anything else that you think might be a side effect.
Side effect What is it? What should I do if it happens to me?
COMMON
Dry mouth. Not much saliva or spit. Sugar-free boiled sweets, chewing gum or eating citrus fruits
usually helps. If not, your doctor can give you a mouth spray.
A change in medicine or dose may be possible.
Blurred vision Things look fuzzy and you can’t focus properly. See your
doctor if you are worried. You won’t need glasses.
Feeling "bunged up" inside. You can't pass a
motion or stool.
Eat more fibre e.g. bran, fruit and vegetables. Do more
walking. Make sure you drink plenty of fluid. A mild laxative
from a pharmacy might help.
ANTI-
CHOLINERGIC
EFFECTS
Difficulty in passing urine Contact your doctor now.
DROWSINESS Feeling sleepy or sluggish. It can last for a few
hours after taking your dose.
Don't drive or use machinery. Ask your doctor if you can take
your tricyclic at a different time.
WEIGHT GAIN A bigger appetite and putting on weight. Avoid fatty foods like chocolate, crisps and fizzy drinks. A diet
full of vegetables and fibre will usually help, as will physical
activities such as walking. If it becomes a problem or you are
worried, ask to see a dietician.
UNCOMMON
HEADACHE When your head is pounding and painful. It should be safe to take aspirin or paracetamol.
NAUSEA Feeling sick. Taking each dose with or after food may help. If it is bad,
contact your doctor.
PALPITATIONS A fast heart beat. It is not usually dangerous. It can easily be treated if it lasts a
long time. Tell your doctor about it.
POSTURAL
HYPOTENSION
A low blood pressure. You may feel faint when
you stand up.
Try not to stand up too quickly. If you feel dizzy, don’t drive.
This dizziness is not dangerous
SEXUAL
DYSFUNCTION
Lack of libido or no interest in sex. Inability to
maintain an erection or have an orgasm.
Discuss this with your doctor when you next meet.
SWEATING Sweating more than normal, especially at night. If it is bad, see your doctor.
RARE
TREMOR Feeling shaky. Contact your doctor now.
What about alcohol?
It is officially recommended that people taking tricyclics should not drink alcohol. This is because both tricyclics and alcohol can cause
drowsiness. If the two are taken at the same time, severe drowsiness can result. This can lead to falls or accidents. As well as this,
drinking alcohol often makes depression worse. Excessive drinking is especially likely to do this. Once people are used to taking
medication, they can sometimes drink alcohol in small amounts without any harm. Avoid alcohol altogether for the first one or two
months. After this, if you want a drink, try a glass of your normal drink and see how you feel. If this doesn’t make you feel drowsy, then
it is probably OK to drink small amounts. It pays to be very cautious because alcohol affects people in different ways, especially when
they are taking medication.
Don’t stop taking your medication because you fancy a drink at the weekend. If you do drink alcohol, drink only small amounts. Never
drink any alcohol and drive while on tricyclics. Discuss any concerns you may have with your doctor or pharmacist.
When I feel better, can I stop taking them?
No. If you stop taking tricyclics, your original symptoms may return. To reduce your chances of becoming depressed again, you may
need to take your antidepressant for at least 6 months after you feel better, and sometimes longer. This is not thought to be harmful.
You should decide with your doctor when you can come off it.
Remember, leaflets like this can only describe some of the effects of medication. You may find other
books or leaflets also useful. If you have access to the internet you may find a lot of information
there as well, but be careful, as internet based information is not always accurate.
2001 United Kingdom Psychiatric Pharmacy Group www.ukppg.org.uk
This leaflet is to help you understand about your medicine. It is not an official manufacturer's Patient Information Leaflet.
For more information call the UKPPG National Telephone Helpline, 11am to 5pm, Monday to Friday on 020 7919 2999 or
visit www.nmhct.nhs.uk/pharmacy
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Completed 29 July 2020

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