What common side effects should a 35-year-old patient with depression be educated about when starting Tricyclic Antidepressants (TCAs)?

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From the Guidelines

When starting a tricyclic antidepressant (TCA), it is crucial to educate the patient about common side effects, including anticholinergic effects such as dry mouth, orthostatic hypotension, constipation, and urinary retention, as these are frequently reported and can be mitigated with proper dosing and titration 1. These side effects are a result of the medication's mechanism of action and can be managed by starting with low dosages administered at bedtime and slowly titrating to higher dosages. Some key points to discuss with the patient include:

  • Anticholinergic adverse effects, such as dry mouth, orthostatic hypotension, constipation, and urinary retention, which can be reduced by using a secondary amine TCA like nortriptyline or desipramine 1
  • The importance of reporting any concerning symptoms, particularly cardiac issues or suicidal thoughts
  • The potential for side effects to diminish over time as the body adjusts to the medication
  • The need to not stop the medication abruptly It is essential to weigh the potential benefits of TCAs in treating depression against the potential risks and side effects, and to closely monitor the patient's response to the medication 1.

From the FDA Drug Label

Geriatric patients are particularly sensitive to the anticholinergic side effects of tricyclic antidepressants including amitriptyline hydrochloride Peripheral anticholinergic effects include tachycardia, urinary retention, constipation, dry mouth, blurred vision, and exacerbation of narrow-angle glaucoma. Central nervous system anticholinergic effects include cognitive impairment, psychomotor slowing, confusion, sedation, and delirium.

The patient should be educated about the following common side effects of TCA:

  • Anticholinergic side effects:
    • Peripheral effects:
      • Tachycardia
      • Urinary retention
      • Constipation
      • Dry mouth
      • Blurred vision
      • Exacerbation of narrow-angle glaucoma
    • Central nervous system effects:
      • Cognitive impairment
      • Psychomotor slowing
      • Confusion
      • Sedation
      • Delirium 2

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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