🌼 Tricyclic Antidepressants (TCAs)


What they are:

Tricyclic antidepressants are an older class of antidepressants that affect serotonin and norepinephrine.

They’re not usually first choice for depression in kids anymore, but they still have important roles in migraine prevention, chronic pain, bedwetting, and sometimes ADHD.


Common examples:

• Amitriptyline (Elavil)

• Imipramine (Tofranil)

• Nortriptyline (Pamelor)

• Clomipramine (Anafranil – often for OCD)


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🧠 How They Work


TCAs block the reuptake of serotonin and norepinephrine, increasing their levels in brain circuits involved in mood and pain regulation.

They also affect other receptors (histamine, acetylcholine), which is why they can cause sleepiness, dry mouth, and constipation.


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📊 Use in Children & Teens

• Tofranil (imipramine) has long been used to treat night-time bedwetting (nocturnal enuresis) when other methods fail.

• Low-dose amitriptyline is commonly used for migraine prevention and chronic pain in youth.

• TCAs are sometimes used as second-line options for ADHD or depression when other treatments are not effective or tolerated.


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😊 Potential Benefits Families Notice

• Fewer nighttime accidents (enuresis)

• Reduction in headache frequency/intensity

• Better sleep quality when used at bedtime

• In some cases, improved mood or focus


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⚠️ Side Effects & Safety Concerns


Common side effects:

• Sleepiness or fatigue

• Dry mouth, constipation

• Blurry vision

• Increased appetite or weight gain


More serious concerns:

• Heart rhythm changes (arrhythmias) — TCAs can affect the heart’s electrical system, especially in overdose. Because of this, many doctors order an EKG before and sometimes during treatment.

• Overdose risk: TCAs are dangerous in high doses; medicines must be stored very securely, especially around teens with depression.


Guidelines from child psychiatry organizations generally say:

• TCAs should not be first-line for pediatric depression or ADHD, as safer and better-studied options (like SSRIs and stimulants) exist.

• When used (e.g., for enuresis, migraines, OCD), they require careful dosing and monitoring.


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🌷 How Families Can Support Safe Use

• Give doses exactly as prescribed, usually at bedtime because of sedation.

• Watch for signs of dizziness, fainting, chest pain, or rapid heartbeat and contact a doctor urgently if they appear.

• Keep all pills locked away — never let kids manage TCAs on their own, especially if there is any history of self-harm.


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References (TCAs):

• Caldwell, P. H. Y., et al. (2016). Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database of Systematic Reviews.

• Otasowie, J., et al. (2014). Tricyclic antidepressants for ADHD in children and adolescents. Cochrane Database of Systematic Reviews.

• AACAP. (2007). Practice parameter for the assessment and treatment of children and adolescents with depressive disorders (notes on TCA use).