Tricyclics

This is an older group of drugs, which has been in use since 1957. These drugs affect predominantly noradrenaline. Some of the drugs in this class include Tryptanol, Elavil (Amitriptyline); Tofranil, Ethipramine (Imipramine); Anafranil (Clomipramine); Emdalen (Lofepramine); Aventyl (Nortriptyline) and others. Tricyclics are also used for the treatment of anxiety disorders, sleep disorders, pain relief, migraine prophylaxis and bedwetting (imipramine).

Some patients, particularly the elderly, find the side effects of these drugs more difficult to tolerate. Tricyclics are not safe in overdose, and in the event of more tablets being taken than prescribed, medical advice should be sought urgently. Despite the side-effect profile, tricyclics are extremely effective antidepressants. Common side-effects include:

• dry mouth;
  
• dizziness (due to decreased blood pressure - alleviated by standing up slowly);
  
• constipation;
  
• blurred vision (usually transient);
  
• drowsiness (less of a problem with imipramine and lofepramine);
  
• weight gain.
  

These side effects are often transient and of nuisance value only. They may be managed by altering diet, water intake and rising slowly from a lying or sitting position.