TABLE 1

Dosing and adverse effects of commonly prescribed tricyclic antidepressants

	Reuptake mechanism^b	Adverse effects^a					Initial/maximum dosing (for MDD)
	Reuptake mechanism^b	Sedation	Hypotension	Seizures	Weight gain	Cardiac	Initial/maximum dosing (for MDD)
Tertiary amine tricyclic antidepressants (TCAs)
Amitriptyline	5-HT > NE	+++	+++	++	++	+++	25–75 mg/200 mg daily
Clomipramine	5-HT > NE	++	++	+++	+	++	25 mg/250 mg daily
Doxepin	5-HT = NE	++++	+	++	++	+	50–75 mg/300 mg nightly
Imipramine	5-HT = NE	++	+++	++	++	+++	50–100 mg/200 mg daily
Secondary amine TCAs
Despiramine	NE > 5-HT	+	+	+	+	++	100–200 mg/300 mg daily
Maprotiline	NE > 5-HT	++	+	+	++	+	25–50 mg/225 mg nightly
Nortriptyline	NE > 5-HT	+	+	+	+	++	25–50 mg/150 mg daily

↵a Plus sign indicates potential severity of adverse effects.
↵b Tertiary amine TCAs tend to preferentially inhibit serotonin reuptake, resulting in greater synaptic serotonin levels, whereas secondary amine TCAs tend to preferentially inhibit norepinephrine reuptake, resulting in greater synaptic norepinephrine levels.
MDD = major depressive disorder; NE = norepinephrine; 5-HT = serotonin