PsychRounds: The Psychiatry Podcast The Tricyclic Antidepressants (TCAs)
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Mar 19, 2025 Dive into the world of tricyclic antidepressants, exploring their history and chemical structure. Learn about the differences between secondary and tertiary TCAs and their effectiveness in treating mood disorders. Discover the pharmacokinetics, including dosing and overdose risks, and why careful monitoring is crucial. Get insights on commonly prescribed TCAs, particularly the versatile amitriptyline. Finally, unearth the potential of nortriptyline for severe depression and the vital considerations for drug interactions.
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TCAs: Dirty SNRIs with Rich Pharmacology
- TCAs act as "dirty" SNRIs by blocking serotonin and norepinephrine reuptake transporters.
- They also block histamine, alpha-1, and muscarinic receptors, contributing to their complex effects.
Monitor TCA Levels Closely
- Monitor plasma levels regularly to avoid TCA toxicity and confirm medication adherence.
- Avoid prescribing large quantities to patients with overdose risks due to narrow therapeutic index.
Urgent Treatment for TCA Overdose
- In TCA overdose, treat immediately with activated charcoal and sodium bicarbonate to prevent fatal heart arrhythmias.
- Recognize overdose as a medical emergency requiring urgent hospital care.