Table of ContentsView AllTable of ContentsWhat Are Tricyclic Antidepressants?How Do TheyWork?When Do You Use ThemSide Effects and RisksPrecautions
Table of ContentsView All
View All
Table of Contents
What Are Tricyclic Antidepressants?
How Do TheyWork?
When Do You Use Them
Side Effects and Risks
Precautions
Depressionis a common but serious mental health condition that can significantly decrease quality of life and productivity.
Scientists still don’t know exactlywhat causes depression.Some factors that contribute to it include:
Tricyclic antidepressants (TCAs) were introduced in the late 1950s.They remain an option for people with depression because they are very effective. However, they are typically not a first-line treatment (initial treatment choice).
The following article covers the uses of TCAs and safety considerations to keep in mind if you take them.
What to Do If You’re Feeling Depressed or AnxiousIf you or a loved one is struggling with depression, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat800-662-4357for information on support and treatment facilities in your area.If you are having suicidal thoughts, dial988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor. If you or a loved one are in immediate danger, call911.
What to Do If You’re Feeling Depressed or Anxious
If you or a loved one is struggling with depression, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat800-662-4357for information on support and treatment facilities in your area.If you are having suicidal thoughts, dial988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor. If you or a loved one are in immediate danger, call911.
If you or a loved one is struggling with depression, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat800-662-4357for information on support and treatment facilities in your area.
If you are having suicidal thoughts, dial988to contact the988 Suicide & Crisis Lifelineand connect with a trained counselor. If you or a loved one are in immediate danger, call911.
As their name implies, TCAs are medications that contain three rings and a side chain.
TCAs available on the market include the following medications and recommended dosages for depression:
Keep in mind that TCAs are often dosed lower for other conditions than they are for severe depression. These lower dosages are effective and carry a lower risk of side effects.
How Do Tricyclic Antidepressants Work?
TCAs inhibit serotonin and norepinephrine reuptake in the brain.This means that TCAs increase the levels of these chemical messengers in the brain to counteract depression symptoms.
It takes about two to four weeks for symptoms of depression to improve after starting a TCA, but beneficial effects on chronic pain may be seen within just a few days.
TCAs combat depression and pain in a similar way to a newer class of antidepressants known asserotonin-norepinephrine reuptake inhibitors (SNRIs). Prescription SNRIs includeEffexor (venlafaxine)andCymbalta (duloxetine). Like TCAs, SNRIs increase the levels of both serotonin and norepinephrine.TCAs and SNRIs are helpful for chronic pain, as well as symptoms of depression such as:
The other major class of antidepressants prescribed isselective serotonin reuptake inhibitors (SSRIs), which increase levels of serotonin only. SSRIs do not treat chronic pain.They are most effective for symptoms of depression like:
TCAs work about as well for depression as newer antidepressants like SSRIs and SNRIs.But while each of these classes have some serious side effects to be aware of, TCAs are considered more dangerous in anoverdose.
When Do You Use Tricyclic Antidepressants?
The use of TCAs has decreased since the discovery of other classes of antidepressants beginning in the 1980’s.TCAs are still used to treatmajor depressive disorder (MDD), though typically only if other classes like SSRIs and SNRIs haven’t worked.
TCAs are generally not used for mild depression, but they may be helpful for severe cases. Symptoms of severe depression can include:
Two TCAs, Tofranil (imipramine) and Anafranil (clomipramine), are also used off-label foranxiety disorderslikegeneralized anxiety disorder (GAD). Although they’re effective, side effects limit their use. For this reason, TCAs are generally only used if other medications like SSRIs or SNRIs haven’t worked.
TCAs are very effective againstneuropathic (nerve) pain, which is a component of many conditions including:
Many of the studies of TCAs for nerve pain have used Elavil (amitriptyline) 25 to 150 mg per day.
Research shows that TCAs are also effective forsymptoms offibromyalgiaincluding fatigue, quality of sleep, and muscle stiffness. Again, they are typically not prescribed first-line but may be recommended if other medicines haven’t helped.
Lastly, low-dose TCAs are used for otherchronic painconditions including:
About 3 of every 4 antidepressants prescribed for chronic pain are TCAs. But interestingly, arecent reviewof the research found only low-quality evidence to support using TCAs for chronic pain conditions.
Female pouring medication into her palm.Tetra Images / Getty Images
Tetra Images / Getty Images
As a whole, antidepressant medications are known to cause side effects that range from mild to serious.
Some clinical trials have shown that SSRIs and SNRIs are safer than TCAs from a side effect standpoint. But other research suggests that all of these classes have a similar safety profile, meaning the risk of significant side effects is about the same.
Potential side effects associated with the use of TCAs include:
Various strategies can be used to manage and mitigate these side effects. If you are experiencing side effects from a TCA, consult your healthcare provider or pharmacist. Consider the following tips as well:
There are some important considerations to keep in mind when prescribing or taking tricyclic antidepressants.
TCAs are contraindicated for the following groups (meaning they shouldn’t be taken):
TCAs have potential drug interactions with other medications, including:
If you are prescribed a TCA, your healthcare provider may recommend therapeutic drug monitoring to make sure the levels of medicine in your body are appropriate, especially when you are starting treatment or if you’re changing doses.
If you take high doses of TCAs (above the recommended amounts) discuss with your healthcare provider whether you need electrocardiogram monitoring (EKG) to monitor for heart abnormalities.
Be sure to discuss treatment safety and effectiveness at follow-up appointments, or with your pharmacist.
Summary
TCAs have been used to treat depression since the 1950s. They remain a treatment option but are not usually prescribed first-line due to potentially dangerous side effects and the risk of death that’s associated with an overdose.
If you are prescribed TCAs for depression, anxiety, or another condition, keep in mind that these medications can cause side effects. Common ones are constipation, weight gain, and sedation. More serious ones include seizures and heart problems.
In general, older people and those with heart disease or epilepsy should not take TCAs. These drugs may also be dangerous during pregnancy.
Because there are many options for the treatment of depression and chronic pain, be sure to discuss your symptoms and goals with your healthcare provider to optimize your therapy. If TCAs aren’t for you, there are many other medications that may help.
23 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Delcourte S, Etievant A, Haddjeri N.Role of central serotonin and noradrenaline interactions in the antidepressants' action: Electrophysiological and neurochemical evidence.Prog Brain Res. 2021;259:7-81. doi:10.1016/bs.pbr.2021.01.002Centers for Disease Control and Prevention.Mental Health Conditions: Depression and Anxiety.Otte C, Gold SM, Penninx BW, et al.Major depressive disorder.Nat Rev Dis Primers. 2016;2:16065. Published 2016 Sep 15. doi:10.1038/nrdp.2016.65Jørgensen CK, Juul S, Siddiqui F, et al.Tricyclic antidepressants versus ‘active placebo’, placebo or no intervention for adults with major depressive disorder: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis.Syst Rev. 2021;10(1):227. Published 2021 Aug 13. doi:10.1186/s13643-021-01789-0Ter Hark SE, Vos CF, Aarnoutse RE, et al.Biomarkers as predictors of treatment response to tricyclic antidepressants in major depressive disorder: A systematic review.J Psychiatr Res. 2022;150:202-213. doi:10.1016/j.jpsychires.2022.03.057Schneider J, Patterson M, Jimenez XF.Beyond depression: Other uses for tricyclic antidepressants.Cleve Clin J Med. 2019;86(12):807-814. doi:10.3949/ccjm.86a.19005Tian H, Hu Z, Xu J, et al.The molecular pathophysiology of depression and the new therapeutics.MedComm (2020). 2022;3(3):e156. Published 2022 Jul 21. doi:10.1002/mco2.156U.S. Food and Drug Administration.Anafranil® (Clomipramine Hydrochloride Capsules) prescribing information.Obata H.Analgesic mechanisms of antidepressants for neuropathic pain.Int J Mol Sci. 2017;18(11):2483. Published 2017 Nov 21. doi:10.3390/ijms18112483Rihmer Z, Dome P, Katona C.Serotonin and depression - a riposte to Moncrieff et al. (2022).Neuropsychopharmacol Hung. 2022;24(3):120-125.Wang SM, Han C, Bahk WM, et al.Addressing the side effects of contemporary antidepressant drugs: A comprehensive review.Chonnam Med J. 2018;54(2):101-112. doi:10.4068/cmj.2018.54.2.101López-Muñoz F, Alamo C.Monoaminergic neurotransmission: the history of the discovery of antidepressants from 1950s until today.Curr Pharm Des. 2009;15(14):1563-1586. doi:10.2174/138161209788168001Vos CF, Aarnoutse RE, Op de Coul MJM, et al.Tricyclic antidepressants for major depressive disorder: a comprehensive evaluation of current practice in the Netherlands.BMC Psychiatry. 2021;21(1):481. Published 2021 Oct 1. doi:10.1186/s12888-021-03490-xBandelow B, Michaelis S, Wedekind D.Treatment of anxiety disorders.Dialogues Clin Neurosci. 2017;19(2):93-107. doi:10.31887/DCNS.2017.19.2/bbandelowStrawn JR, Geracioti L, Rajdev N, et al.Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review.Expert Opin Pharmacother. 2018;19(10):1057-1070. doi:10.1080/14656566.2018.1491966Finnerup NB, Attal N, Haroutounian S, et al.Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis.Lancet Neurol. 2015;14(2):162-173. doi:10.1016/S1474-4422(14)70251-0Pittenger C, Bloch MH.Pharmacological treatment of obsessive-compulsive disorder.Psychiatr Clin North Am. 2014;37(3):375-391. doi:10.1016/j.psc.2014.05.006Ferreira GE, Abdel-Shaheed C, Underwood M, et al.Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews.BMJ.2023;380:e072415 doi:10.1136/bmj-2022-072415Kelly K, Posternak M, Alpert JE.Toward achieving optimal response: understanding and managing antidepressant side effects.Dialogues Clin Neurosci. 2008;10(4):409-418. doi:10.31887/DCNS.2008.10.4/kkellyIpek E, Oktay AA, Krim SR.Hypertensive crisis: an update on clinical approach and management.Curr Opin Cardiol. 2017;32(4):397-406. doi:10.1097/HCO.0000000000000398National Library of Medicine. StatPearls.Tricyclic Antidepressants.Foong AL, Grindrod KA, Patel T, et al.Demystifying serotonin syndrome (orserotonin toxicity).Can Fam Physician. 2018;64(10):720-727.U.S. Food and Drug Administration.Amitriptyline Hydrochloride Tablets prescribing information.
23 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Delcourte S, Etievant A, Haddjeri N.Role of central serotonin and noradrenaline interactions in the antidepressants' action: Electrophysiological and neurochemical evidence.Prog Brain Res. 2021;259:7-81. doi:10.1016/bs.pbr.2021.01.002Centers for Disease Control and Prevention.Mental Health Conditions: Depression and Anxiety.Otte C, Gold SM, Penninx BW, et al.Major depressive disorder.Nat Rev Dis Primers. 2016;2:16065. Published 2016 Sep 15. doi:10.1038/nrdp.2016.65Jørgensen CK, Juul S, Siddiqui F, et al.Tricyclic antidepressants versus ‘active placebo’, placebo or no intervention for adults with major depressive disorder: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis.Syst Rev. 2021;10(1):227. Published 2021 Aug 13. doi:10.1186/s13643-021-01789-0Ter Hark SE, Vos CF, Aarnoutse RE, et al.Biomarkers as predictors of treatment response to tricyclic antidepressants in major depressive disorder: A systematic review.J Psychiatr Res. 2022;150:202-213. doi:10.1016/j.jpsychires.2022.03.057Schneider J, Patterson M, Jimenez XF.Beyond depression: Other uses for tricyclic antidepressants.Cleve Clin J Med. 2019;86(12):807-814. doi:10.3949/ccjm.86a.19005Tian H, Hu Z, Xu J, et al.The molecular pathophysiology of depression and the new therapeutics.MedComm (2020). 2022;3(3):e156. Published 2022 Jul 21. doi:10.1002/mco2.156U.S. Food and Drug Administration.Anafranil® (Clomipramine Hydrochloride Capsules) prescribing information.Obata H.Analgesic mechanisms of antidepressants for neuropathic pain.Int J Mol Sci. 2017;18(11):2483. Published 2017 Nov 21. doi:10.3390/ijms18112483Rihmer Z, Dome P, Katona C.Serotonin and depression - a riposte to Moncrieff et al. (2022).Neuropsychopharmacol Hung. 2022;24(3):120-125.Wang SM, Han C, Bahk WM, et al.Addressing the side effects of contemporary antidepressant drugs: A comprehensive review.Chonnam Med J. 2018;54(2):101-112. doi:10.4068/cmj.2018.54.2.101López-Muñoz F, Alamo C.Monoaminergic neurotransmission: the history of the discovery of antidepressants from 1950s until today.Curr Pharm Des. 2009;15(14):1563-1586. doi:10.2174/138161209788168001Vos CF, Aarnoutse RE, Op de Coul MJM, et al.Tricyclic antidepressants for major depressive disorder: a comprehensive evaluation of current practice in the Netherlands.BMC Psychiatry. 2021;21(1):481. Published 2021 Oct 1. doi:10.1186/s12888-021-03490-xBandelow B, Michaelis S, Wedekind D.Treatment of anxiety disorders.Dialogues Clin Neurosci. 2017;19(2):93-107. doi:10.31887/DCNS.2017.19.2/bbandelowStrawn JR, Geracioti L, Rajdev N, et al.Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review.Expert Opin Pharmacother. 2018;19(10):1057-1070. doi:10.1080/14656566.2018.1491966Finnerup NB, Attal N, Haroutounian S, et al.Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis.Lancet Neurol. 2015;14(2):162-173. doi:10.1016/S1474-4422(14)70251-0Pittenger C, Bloch MH.Pharmacological treatment of obsessive-compulsive disorder.Psychiatr Clin North Am. 2014;37(3):375-391. doi:10.1016/j.psc.2014.05.006Ferreira GE, Abdel-Shaheed C, Underwood M, et al.Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews.BMJ.2023;380:e072415 doi:10.1136/bmj-2022-072415Kelly K, Posternak M, Alpert JE.Toward achieving optimal response: understanding and managing antidepressant side effects.Dialogues Clin Neurosci. 2008;10(4):409-418. doi:10.31887/DCNS.2008.10.4/kkellyIpek E, Oktay AA, Krim SR.Hypertensive crisis: an update on clinical approach and management.Curr Opin Cardiol. 2017;32(4):397-406. doi:10.1097/HCO.0000000000000398National Library of Medicine. StatPearls.Tricyclic Antidepressants.Foong AL, Grindrod KA, Patel T, et al.Demystifying serotonin syndrome (orserotonin toxicity).Can Fam Physician. 2018;64(10):720-727.U.S. Food and Drug Administration.Amitriptyline Hydrochloride Tablets prescribing information.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Delcourte S, Etievant A, Haddjeri N.Role of central serotonin and noradrenaline interactions in the antidepressants' action: Electrophysiological and neurochemical evidence.Prog Brain Res. 2021;259:7-81. doi:10.1016/bs.pbr.2021.01.002Centers for Disease Control and Prevention.Mental Health Conditions: Depression and Anxiety.Otte C, Gold SM, Penninx BW, et al.Major depressive disorder.Nat Rev Dis Primers. 2016;2:16065. Published 2016 Sep 15. doi:10.1038/nrdp.2016.65Jørgensen CK, Juul S, Siddiqui F, et al.Tricyclic antidepressants versus ‘active placebo’, placebo or no intervention for adults with major depressive disorder: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis.Syst Rev. 2021;10(1):227. Published 2021 Aug 13. doi:10.1186/s13643-021-01789-0Ter Hark SE, Vos CF, Aarnoutse RE, et al.Biomarkers as predictors of treatment response to tricyclic antidepressants in major depressive disorder: A systematic review.J Psychiatr Res. 2022;150:202-213. doi:10.1016/j.jpsychires.2022.03.057Schneider J, Patterson M, Jimenez XF.Beyond depression: Other uses for tricyclic antidepressants.Cleve Clin J Med. 2019;86(12):807-814. doi:10.3949/ccjm.86a.19005Tian H, Hu Z, Xu J, et al.The molecular pathophysiology of depression and the new therapeutics.MedComm (2020). 2022;3(3):e156. Published 2022 Jul 21. doi:10.1002/mco2.156U.S. Food and Drug Administration.Anafranil® (Clomipramine Hydrochloride Capsules) prescribing information.Obata H.Analgesic mechanisms of antidepressants for neuropathic pain.Int J Mol Sci. 2017;18(11):2483. Published 2017 Nov 21. doi:10.3390/ijms18112483Rihmer Z, Dome P, Katona C.Serotonin and depression - a riposte to Moncrieff et al. (2022).Neuropsychopharmacol Hung. 2022;24(3):120-125.Wang SM, Han C, Bahk WM, et al.Addressing the side effects of contemporary antidepressant drugs: A comprehensive review.Chonnam Med J. 2018;54(2):101-112. doi:10.4068/cmj.2018.54.2.101López-Muñoz F, Alamo C.Monoaminergic neurotransmission: the history of the discovery of antidepressants from 1950s until today.Curr Pharm Des. 2009;15(14):1563-1586. doi:10.2174/138161209788168001Vos CF, Aarnoutse RE, Op de Coul MJM, et al.Tricyclic antidepressants for major depressive disorder: a comprehensive evaluation of current practice in the Netherlands.BMC Psychiatry. 2021;21(1):481. Published 2021 Oct 1. doi:10.1186/s12888-021-03490-xBandelow B, Michaelis S, Wedekind D.Treatment of anxiety disorders.Dialogues Clin Neurosci. 2017;19(2):93-107. doi:10.31887/DCNS.2017.19.2/bbandelowStrawn JR, Geracioti L, Rajdev N, et al.Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review.Expert Opin Pharmacother. 2018;19(10):1057-1070. doi:10.1080/14656566.2018.1491966Finnerup NB, Attal N, Haroutounian S, et al.Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis.Lancet Neurol. 2015;14(2):162-173. doi:10.1016/S1474-4422(14)70251-0Pittenger C, Bloch MH.Pharmacological treatment of obsessive-compulsive disorder.Psychiatr Clin North Am. 2014;37(3):375-391. doi:10.1016/j.psc.2014.05.006Ferreira GE, Abdel-Shaheed C, Underwood M, et al.Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews.BMJ.2023;380:e072415 doi:10.1136/bmj-2022-072415Kelly K, Posternak M, Alpert JE.Toward achieving optimal response: understanding and managing antidepressant side effects.Dialogues Clin Neurosci. 2008;10(4):409-418. doi:10.31887/DCNS.2008.10.4/kkellyIpek E, Oktay AA, Krim SR.Hypertensive crisis: an update on clinical approach and management.Curr Opin Cardiol. 2017;32(4):397-406. doi:10.1097/HCO.0000000000000398National Library of Medicine. StatPearls.Tricyclic Antidepressants.Foong AL, Grindrod KA, Patel T, et al.Demystifying serotonin syndrome (orserotonin toxicity).Can Fam Physician. 2018;64(10):720-727.U.S. Food and Drug Administration.Amitriptyline Hydrochloride Tablets prescribing information.
Delcourte S, Etievant A, Haddjeri N.Role of central serotonin and noradrenaline interactions in the antidepressants' action: Electrophysiological and neurochemical evidence.Prog Brain Res. 2021;259:7-81. doi:10.1016/bs.pbr.2021.01.002
Centers for Disease Control and Prevention.Mental Health Conditions: Depression and Anxiety.
Otte C, Gold SM, Penninx BW, et al.Major depressive disorder.Nat Rev Dis Primers. 2016;2:16065. Published 2016 Sep 15. doi:10.1038/nrdp.2016.65
Jørgensen CK, Juul S, Siddiqui F, et al.Tricyclic antidepressants versus ‘active placebo’, placebo or no intervention for adults with major depressive disorder: a protocol for a systematic review with meta-analysis and Trial Sequential Analysis.Syst Rev. 2021;10(1):227. Published 2021 Aug 13. doi:10.1186/s13643-021-01789-0
Ter Hark SE, Vos CF, Aarnoutse RE, et al.Biomarkers as predictors of treatment response to tricyclic antidepressants in major depressive disorder: A systematic review.J Psychiatr Res. 2022;150:202-213. doi:10.1016/j.jpsychires.2022.03.057
Schneider J, Patterson M, Jimenez XF.Beyond depression: Other uses for tricyclic antidepressants.Cleve Clin J Med. 2019;86(12):807-814. doi:10.3949/ccjm.86a.19005
Tian H, Hu Z, Xu J, et al.The molecular pathophysiology of depression and the new therapeutics.MedComm (2020). 2022;3(3):e156. Published 2022 Jul 21. doi:10.1002/mco2.156
U.S. Food and Drug Administration.Anafranil® (Clomipramine Hydrochloride Capsules) prescribing information.
Obata H.Analgesic mechanisms of antidepressants for neuropathic pain.Int J Mol Sci. 2017;18(11):2483. Published 2017 Nov 21. doi:10.3390/ijms18112483
Rihmer Z, Dome P, Katona C.Serotonin and depression - a riposte to Moncrieff et al. (2022).Neuropsychopharmacol Hung. 2022;24(3):120-125.
Wang SM, Han C, Bahk WM, et al.Addressing the side effects of contemporary antidepressant drugs: A comprehensive review.Chonnam Med J. 2018;54(2):101-112. doi:10.4068/cmj.2018.54.2.101
López-Muñoz F, Alamo C.Monoaminergic neurotransmission: the history of the discovery of antidepressants from 1950s until today.Curr Pharm Des. 2009;15(14):1563-1586. doi:10.2174/138161209788168001
Vos CF, Aarnoutse RE, Op de Coul MJM, et al.Tricyclic antidepressants for major depressive disorder: a comprehensive evaluation of current practice in the Netherlands.BMC Psychiatry. 2021;21(1):481. Published 2021 Oct 1. doi:10.1186/s12888-021-03490-x
Bandelow B, Michaelis S, Wedekind D.Treatment of anxiety disorders.Dialogues Clin Neurosci. 2017;19(2):93-107. doi:10.31887/DCNS.2017.19.2/bbandelow
Strawn JR, Geracioti L, Rajdev N, et al.Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review.Expert Opin Pharmacother. 2018;19(10):1057-1070. doi:10.1080/14656566.2018.1491966
Finnerup NB, Attal N, Haroutounian S, et al.Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis.Lancet Neurol. 2015;14(2):162-173. doi:10.1016/S1474-4422(14)70251-0
Pittenger C, Bloch MH.Pharmacological treatment of obsessive-compulsive disorder.Psychiatr Clin North Am. 2014;37(3):375-391. doi:10.1016/j.psc.2014.05.006
Ferreira GE, Abdel-Shaheed C, Underwood M, et al.Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews.BMJ.2023;380:e072415 doi:10.1136/bmj-2022-072415
Kelly K, Posternak M, Alpert JE.Toward achieving optimal response: understanding and managing antidepressant side effects.Dialogues Clin Neurosci. 2008;10(4):409-418. doi:10.31887/DCNS.2008.10.4/kkelly
Ipek E, Oktay AA, Krim SR.Hypertensive crisis: an update on clinical approach and management.Curr Opin Cardiol. 2017;32(4):397-406. doi:10.1097/HCO.0000000000000398
National Library of Medicine. StatPearls.Tricyclic Antidepressants.
Foong AL, Grindrod KA, Patel T, et al.Demystifying serotonin syndrome (orserotonin toxicity).Can Fam Physician. 2018;64(10):720-727.
U.S. Food and Drug Administration.Amitriptyline Hydrochloride Tablets prescribing information.
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