When Tricyclic Antidepressants May Be Your Better Option

Depression can be a debilitating condition, but for some people, tricyclic antidepressants may be a better option. In this video, I talk about the pros and cons of tricyclic antidepressants and how they may be a better choice for some people.

References
Hillhouse TM, Porter JH. A brief history of the development of antidepressant drugs: from monoamines to glutamate. Exp Clin Psychopharmacol. 2015;23(1):1-21. doi:10.1037/a0038550

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Disclaimer: All of the information on this channel is for educational purposes and not intended to be specific/personal medical advice from me to you. Watching the videos or getting answers to comments/question, does not establish a doctor-patient relationship. If you have your own doctor, perhaps these videos can help prepare you for your discussion with your doctor.

[ProductivePixie]

“Sometimes depression isn’t resistant to treatment. Sometimes the wrong treatment is being given.” A neurologist said that to me when I told him depression meds had been useless for me. He prescribed Imipramine and eventually added Pramipexole and it was like some flipped a light switch and just turned off my depression. Bonus: the Imipramine also helps with my interstitial cystitis. I am very happy that a healthcare provider helped me, but it was frustrating that after 15 years of GPs and psychiatrists, it took a neurologist to really help.

[kvkarthik]

Her voice clarity and content, is amazing!

[OceanicMarauder]

Im on a tricyclic antidepressant (I have severe reactions to ssri's and snri's) and it's been a lifesaver for me.

[coertmommsen]

Dear Dr. Marks, Thank you very much for this video. I'm so glad that you've brought up some of the essential advantages of Trycyclics. I'm not a medically trained professional (Retired Clinical Psychologist), but I can say that I have seen the Trycyclics in action from 1970 to 1980, and their effectiveness was spectacular, to say the least. I think the increase of ethical actions against practitioners (Some because of side effects) has probably led to doctors being careful to prescribe these. Also: I think the diagnostic category of Melancholic depression is perhaps based on Involutional Melancholia. The symptoms of I M are very unique and pathologically typical as described by Mayer--Gross et al. circa the 1960s.
It's important not to forget or suppress these lessons from the past. I feel sad when I hear of patients continuing to suffer because of not being considered for some of the very effective Trycyclic antidepressants. Thanks again, Dr. Marks! Coert Mommsen D.Phil.(Psychology) M.A. Clinical Psychology, EEG Technician. South Africa

[DrMukhtarYerima]

Educative as always. We in Africa have a lot of experience with Tricyclic Antidepressants (TCAs) being much cheaper and affordable than SSRIs and more readily available. And for severe depressive episodes TCAs have consistently proven to be effective. Anticholinergic side effects like dryness of the mouth, blurring of vision are common but thankfully patients develop tolerance to those within a few days to weeks. Urinary retention is commoner in people who already have urinary problems like elderly males with prostatic enlargement. By-and-large the tricyclics are very much effective and in use in Nigeria due to their availability, efficacy and affordability compared to other antidepressant classes. Lofepramine is said to be the only TCA that can be safe even in overdose but I have never prescribed it because it’s unavailable in Nigeria.

[elizabethsteele]

Yet another excellent video . In my experience, having tried at least 15 medications over the last 25 years, tricyclics also may be preferable for people who drink . Whenever I tapered down and stopped taking SSRI -SNRI 's I would stop drinking . When I started with another one, I would have strong alcohol cravings again . When I was on the tricyclics the cravings have been significantly less .

[vixenrevitup]

I have an extremely rare cranial nerve disorder called Glossopharyngeal Neuralgia (GPN). When AED’s failed to work, my neurologist and I settled on Clomipramine as the tricyclic antidepressant to try. It was chosen over others because I did have clinically diagnosed OCD at the time (and technically still do to this day). We noticed an immediate improvement in the pain GPN causes but it also caused some very strange side effects. Instead of obsessing over the things I normally did, I became immediately disinterested in everything, so much so that I developed medication induced depression. I also developed insomnia as well. I stayed on the medication for well over a year while my PCP tried to combat the depression angle without impacting the pain relief I was experiencing. The very first drug we tried was Duloxetine. I started at 30 mg and did notice slight improvement in my mood. Then when we tapered me to the 60 mg dose, I developed Serotonin Syndrome and could not move a muscle for two days because my entire body became rigid. Then we completed a gene test to determine what class of drugs was best for me. As it turned out, all of them except the tricyclic antidepressants were considered very dangerous for me to use. There was nothing in between as an option. After a little over a year, I could no longer handle the depression and insomnia and was weaned off the Clomipramine. We tried Lyrica for the GPN and it has since been working well. I recently began seeing a psychiatrist because my depression returned soon after I developed Fibromyalgia. This depression caused a shift to Excoriation Disorder alongside my OCD. We decided to try Amitriptyline with the permission of my neurologist to treat both the depression and GPN. Therapy has been helping with my OCD and excoriation symptoms. It’s been going much smoother than the Clomipramine ever did! Tricyclic antidepressants can work well, but you just have to find the right one!

[Rodney-]

This was very informative. I'm going to save this video and keep notes for later particularly when consulting with psychiatrists and others regarding clients battling severe depression.

[serbadork]

Tricyclic and Tetracyclic antidepressants have been on the back of my mind a lot lately; mostly because i wanna go back on meds for my depression and anxiety, but had a *horrible* time when i was prescribed an SSRI and a Benzodiazepine the last time i was on medication. This video came out at a great time for me. Thank you so much for making it!

[meagain]

Her videos are amazing. She makes me feel so calm.

[ashleylynn]

Thank you for making this video. I wish I had this years ago, but I did at least educate myself some in the past to help advocate for myself. I experienced a lot of issues with SSRIs and SNRIs, which I later learned was because serotonin syndrome. One of the docs I saw early on completely disregarded me expressing concerns over the side effects I had from SSRIs and asking to try anything that wasn't an SSRI. I ended up stopping treatment completely for several years because of that doctor and also had an attempt after. The next doctor tried SNRIs but listened when I was sick from those and ended up putting me on a med that was new on the market at that time. The side effects on that had me off of them within 3 days. That was when we tried tricyclics. They have completely changed my life. Though, none of the doctors that have prescribed them ever mentioned the side effects. All of my doctors have known I have dysautonomia (orthostatic is a big issue in that) and said nothing. Luckily, I didn't see an increase in the orthostatic symptoms I already experienced prior, so we're all good there.

[samanthabennington]

Love your videos! They have helped me understand my condition and other issues so much better, thank you! 💗

[RotationAxle]

Nortriptyline was prescribed to me as I developed chronic migraines and also have some issues with back pain from slipped discs. It was supposed to be a better option than the related amitriptyline due to having a better side effect profile. While I did still have some side effects like dry mouth, vivid dreams, and constipation when first starting, it's not as bothersome and it helped to titrate up slowly. This is a really good video discussing the various uses of the tricyclics. Interesting to know they are still widely used for a variety of things today - they're one of the first line treatments to try for chronic migraine prevention

[emperorlelouch]

Wowwww. This might actually be exactly what I need in my life. The Melancholic depression hit really hard with me and I definitely feel like I could use this. Thank you Dr. Tracy Marks🙏🏽

[tayzonday]

My psychiatrist just suggested I add 5mg Trintellix to my 30mg Vyvanse. $350/month copay after $100 discount in the United States. It costs $33/month in the United Kingdom. I’m hesitant to pay that much.

[chrisfoucher]

Your videos are amazing. They are extremely helpful and informative. Thank you.

[jessicagotlib]

I'm from Brazil and doctors here still highly recommend tricyclics. at least in my experience, I've taken some of them treating myself for depression in the last ten years.

[DanielSRosehill]

Another use for tricylics that's very much still relevant in their use in treating functional GI disorders. I developed functional dyspepsia after having my gallbladder removed. It's been an ENORMOUS struggle getting my psychiatrist to sign off on prescribing a TCA or co prescribing a low-dose one alongside an SSRI because, in his view, tricyclics are dinosaurs that have been replaced by the SSRIs and SNRIs. It's a pity that there isn't great cross-talk between the various medical specialties!

[beverlyjones]

Hello, I found worthwhile relief many years ago while taking Surmontil, a tricyclic. Not so on the more recent SSRI’s. Thanks for the great work you do Tracy.❤

[chelseamell]

Just saying hello. :) I really appreciate the down-to-Earth manner in which you discuss what can be - to some - difficult topics. As someone who has dealt with mental health issues for much of my life, I took several psychology classes in highschool and early college because I wanted a way to find out what was "wrong" with me. However, it was not particularly fruitful because, as you have explained very diligently, we cannot diagnose ourselves. After seeking the help of a mental health professional, I have narrowed my scope of inquisition to the specific condition which I have been diagnosed. You have provided a great deal of insight and have given me the ability to ask my doctor the right questions to get the best treatment. Anywho, just saying hello, and also thank you.