Tricyclic Antidepressants Pharmacology

SimpleNursing Editorial Team Feb 26, 2018
nurse giving tricyclic antidepressants to an reclining old man

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  1. What are NSAID Drugs? Pathophysiology
  2. TCA Pathophysiology
  3. TCA Side Effects
  4. TCA Patient Education

Tricyclic antidepressants (TCA) are one of the most significant lectures that you will encounter in your psychiatric nursing course. TCAs are just one of the leading antidepressants that will be discussed elaborately by Mike here at

What are Tricyclic Antidepressants?

Your first-generation anti-depressant is your tricyclic antidepressant (TCA). You can easily remember TCAs as a Transportation Security Administration (TSA) – slow, drawn out, and the security process lags. Compared to TCAs, the therapeutic process is prolonged, taking a few weeks to a month. So, that’s the first thing to keep in mind:

TCA = TSA = slow therapeutic range

Types of Tricyclic Antidepressants

  1. Amitriptyline (Elavil)
  2. Imipramine (Tofranil)
  3. Doxepin (Sinequan)

We’ve underlined Imipramine (Tofranil) to emphasize that this drug is the most common TCA you will encounter on your tests and in the clinical setting.

Test tip: Write this down on a notecard with your dopamine, serotonin, and norepinephrine pathophysiology. 

Tricyclic Antidepressants Pathophysiology

There’s a block in the reuptake of your norepinephrine and serotonin. This means we are slowing down communication between neurons, thereby prolonging the neurotransmitters. 

Think of it as one side of a phone call being delayed or put on hold by the other line to slow down the transmission of messages. So technically, we are blocking the re-uptake transmitters.

Norepinephrine (Levophed) is the catecholamine that helps increase the heart rate and blood pressure.

When TCAs are given, you are slowing down norepinephrine communication, basically telling the body not to activate the heart severely and not squeeze those vessels that cause increased blood pressure.

Tricyclic Antidepressants Side Effects

The main side effects of TCAs are:

  • Heart dysrhythmias
  • Hypotension
  • Anti-cholinergic effects like dryness
  • Confusion
  • Memory loss
  • Sedation

In cases of TCA toxicity, your patient will be experiencing toxicity level signs and symptoms known as EPSE or extra-pyramidal side effects. The EPSE of TCA are:

  • Tardive dyskinesia
  • Akinesia
  • Akathisia
  • Pseudoparkinsonism

Tricyclic Antidepressants Patient Education

It’s imperative to lay out all the facts on patients taking TCAs and to their caregiver or support system as well. So what are the things that you need to educate and emphasize?

  1. TCA = slow acting (six to eight weeks for maximum therapeutic levels)
  2. Suicide ideations = essentially important to monitor because it usually happens in the first month of patients taking anti-depressants

Suicide ideations are not just for your TCAs but all other antidepressant medications as well.

Tricyclic Antidepressant Nursing Considerations

Remember: Monitor for suicide ideations.

  1. patients will have dry mouths and eyes, and their appetite is affected. Furthermore, patients will have low blood pressure.
  2. patients will have orthostatic changes – sitting up and then immediately passing out.
  3. No cardiac medications and no myocardial infarction or heart attack patients due to the involvement of norepinephrine.
  4. Wean off.

Tricyclic Antidepressant NCLEX Question

Q: If your patients are feeling better and want to go home, what will you watch out for?

A: Suicide ideations.

If your answer is discharge planning, that would be a big no-no.

Suicide ideations are the best answer because when major depressive patients feel better, technically they are still depressed, but with more energy.

During major depression, patients do not feel like doing anything but sitting like a lump on a log – they just don’t have the power to engage in any activity. However, after taking TCAs, depressed patients have enough energy to carry out thoughts of killing themselves.

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