choosing a tricyclic antidepressant

Last reviewed 01/2018

Tricyclic antidepressants may be divided into:

• sedating
• non-sedating

When there is a risk of the patient taking an overdose it is usually preferable to choose an SSRI, if a tricyclic is essential then lofepramine may be the safest drug.

Tricyclic antidepressants (with the exception of lofepramine) are more dangerous in overdose than other equally effective drugs recommended for routine use in primary care (1).

Tricyclic antidepressants (with the exception of lofepramine) should not be prescribed for patients with a:

• high risk of serious cardiac arrhythmias
• recent myocardial infarction

Dosulepin should not be initiated routinely because evidence supporting its tolerability relative to other antidepressants is outweighed by the increased cardiac risk and toxicity in overdose (1). NICE advise that dosulepin should not be prescribed (2).

Reference:

1. NICE (April 2007). Management of depression in primary and secondary care
2. NICE (October 2009). Depression updated guideline.