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Tricyclic Antidepressants (TCAs)

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By Editorial Team

2 min read

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

Postpartum depression (PPD) affects many women after childbirth, making it difficult to enjoy the early stages of parenthood. But 1 promising treatment option is tricyclic antidepressants (TCAs).

TCAs are a class of medicine used to treat various mental health disorders, including major depressive disorder (MDD) and anxiety. They were among the earliest forms of antidepressants. TCAs were first introduced in 1959.1-3

Now, “second-generation” antidepressants – like SSRIs – are more commonly used to treat depression. This is because newer antidepressants are generally safer. They also have fewer negative side effects. But TCAs still may be a good option if other antidepressants have not worked to treat PPD.1-3

How do tricyclic antidepressants (TCAs) work?

TCAs help regulate mood by increasing serotonin and norepinephrine levels in the brain. Serotonin and norepinephrine are chemicals the brain uses to send messages (neurotransmitters) to the body as well as hormones. They play a crucial role in regulating mood and emotion, and they may be off balance in people with depression.1,2

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How are TCAs beneficial for postpartum depression?

Since TCAs are approved to treat depression, they can help relieve the persistent feelings of sadness and hopelessness associated with PPD. In people with PPD, TCAs can:1,4

  • Stabilize mood
  • Lower anxiety
  • Help with sleep problems

Examples of TCAs

Several TCAs are approved by the US Food and Drug Administration (FDA) to treat depression. The choice of which medicine to use depends on individual factors and preferences. Your doctor will be able to help determine if TCA medicine is right for you.2,3

Common examples of TCAs include:2,3

  • Amitriptyline (Elavil®)
  • Nortriptyline (Pamelor®)
  • Imipramine (Tofranil®)

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. Side effects of TCAs may include:2,3

  • Dry mouth
  • Drowsiness
  • Dizziness
  • Blurred vision
  • Constipation
  • Increased appetite
  • Weight gain

TCAs have a boxed warning, the strictest warning from the FDA. They have this warning because TCAs can increase thoughts of suicide or self-harming behaviors, especially in people under age 25.1

These are not all the possible side effects of TCAs. Talk to your doctor about what to expect when taking a TCA. You also should call your doctor if you have any changes that concern you when taking TCAs.

Other things to know

It is generally considered safe to breastfeed while taking TCAs. However, low levels of these drugs can pass through breast milk. There have been some reports of sedation, irritability, poor feeding, and colic in infants whose mothers took TCAs.1,3

TCAs may not be suitable if you have specific health conditions. Tell your doctor if you have heart disease or epilepsy, as TCAs can cause complications with these diseases.2,3

Because some TCAs can cause drowsiness, avoid activities like driving until you know how the medicine affects you.2,3

Each person's response to TCAs will be different. Possible side effects should be weighed against the benefits. Before beginning treatment for postpartum depression, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.