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Tricyclic Antidepressants for Teenagers: What You Need to Know

Author:
Emma Loker
Emma Loker
B.S.
Editor:
Aja Chavez
Aja Chavez
AMFT, APCC
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There’s a lot to consider when treating teen depression. As a parent, you’re likely overwhelmed by the span of depression-related content online. In truth, teen depression can be tricky to manage. What can start out as a lack of interest in usual hobbies or a sadness that seems to hang over your child can spiral into something worse if left unattended. 

Some teens find value in and improve with talking therapy, but there are instances where antidepressants might be needed to help them push through the fog and come out smiling on the other side. 

Teens are commonly prescribed SSRIs (selective serotonin reuptake inhibitors), but if these don’t work, SNRIs (serotonin-norepinephrine reuptake inhibitors) or tricyclic antidepressants (TCAs) may be considered. Regardless of the treatment plan chosen, all teens under Mission Prep’s care are closely monitored and cared for, for the duration of their treatment.

We give both parents and teens the necessary guidance to support informed treatment decisions. Our mental health team devotes time to understanding teenagers’ experiences before creating personalized treatment plans that might integrate different therapies alongside medication.

This article also works as a helpful guide for understanding if tricyclic antidepressants are right for your child’s care, as it discusses:

  • What tricyclic antidepressants are and when they’re suitable for treating teen depression
  • The mental health conditions for which tricyclic antidepressants are used to treat
  • How tricyclic antidepressants compare to other antidepressants
  • What to know before starting tricyclic antidepressants
  • Common side effects of TCAs in teens
  • What the long-term effects of tricyclics are in teens
  • Where to find professional support when considering antidepressants
Tricyclic Antidepressants for Teenagers

What Are Tricyclic Antidepressants (TCAs), and When Are They Used for Teen Depression?

Tricyclic antidepressants for teenagers have been part of psychiatric care for a long time. They were introduced in the 1950s and became one of the first medication classes used to treat major depression.¹ Over the years, they’ve been prescribed for both adults and adolescents, though not always as a first choice.

TCAs aren’t usually the first treatment offered to teens because newer medications are often better tolerated. But when other options don’t work, or when depression shows up alongside chronic pain, poor sleep, or physical symptoms, a tricyclic may be worth considering.

How TCAs for Depression in Adolescents Work

In the brain, nerve cells use chemical messengers to communicate. Some of the most important ones for mood are serotonin and norepinephrine. Yet, in people with depression, these messengers don’t always work the way they should.² 

TCAs change how the brain handles these messengers. They make it harder for the brain to clear serotonin and norepinephrine too quickly. As a result, the signals last longer. They also act on histamine, acetylcholine, and alpha receptors – each tied to processes like sleep, attention, or blood pressure. Although, this wide reach can cause side effects such as tiredness, dry mouth, dizziness, or difficulty concentrating.

Although TCAs are mainly used to treat depression, their effects go beyond mood. These medications influence several different systems at once. This is part of what makes them helpful – and also part of what makes them complex. For instance, the tricyclic Nortriptyline has been proven to be effective in treating adolescent ADHD.³

However, studies show that the brain doesn’t stop developing and maturing until a teen reaches their mid-to-late 20s.⁴ For this reason, extra care is taken when TCAs are used. Doses are usually started low and adjusted gradually. For instance, a clinical team will monitor sleep, appetite, focus, and other changes closely in the first few weeks.

How TCAs Differ from Newer Antidepressants: TCAs vs SSRI Antidepressants for Teens

Newer antidepressants – such as SSRIs and SNRIs – are more commonly used for treating teen mental health conditions. This is because they tend to affect only one or two systems, meaning fewer side effects and a generally smoother experience for most patients.

Tricyclics act across a wider range of chemical receptors. This may help when symptoms include physical discomfort or severe fatigue. But this same broad effect also raises the chances of unwanted side effects. For this reason, TCA overdose risk in teens is higher than with SSRIs or SNRIs.

Even so, there are cases where a TCA is the best option available. It all depends on the teen’s overall picture—their symptoms, history, and response to previous medications, as well as their level of support. When used carefully and supported well, TCAs can be a valuable part of treatment.

Teen Treatment With Tricyclic Antidepressants: What Conditions Do Tricyclics Work for?

As previously mentioned, tricyclic antidepressants aren’t commonly prescribed for teens at the start of treatment. In most cases, providers begin with newer antidepressants that tend to cause fewer side effects. But when those medications don’t bring enough relief – or when symptoms show up in more complicated ways – a TCA might be considered.

For instance, some teens experience more than a low mood. They may struggle with disrupted sleep, body aches, or persistent anxiety that hasn’t improved with first-line options. Others try several antidepressants with little effect. In these situations, the care team may consider older medications.

TCAs affect more than one system in the brain, which can be useful when the clinical picture is more layered. This is part of why they’re sometimes prescribed, but also why they’re used carefully, and never without a clear reason.

Let’s consider some of the common conditions that a provider may consider using tricyclics to treat.

Tricyclic Antidepressants for Depression in Adolescents

For teens with depression, providers usually start with newer treatment options that have a better track record for tolerability. That said, tricyclics are still used – just under specific conditions.

For example, tricyclics might be considered after other antidepressants have already been tried. In some cases, they’re introduced when symptoms have lasted a long time or don’t seem to shift. Some teens also experience depression in ways that go beyond mood, like trouble sleeping, constant fatigue, or physical pain that doesn’t respond to standard care.

In these situations, a broader-acting medication like a TCA may offer something that newer medications don’t. The benefits vary, and the decision to prescribe one usually follows a longer process of evaluation.

However, there is evidence that tricyclics work for teen depression. One study on tricyclic drugs for depression in adolescents and children published in the National Library of Medicine found that they may lead to a reduction in the symptoms of depression in adolescents (but not children).⁵

Tricyclic Antidepressants and Anxiety in Teens

Tricyclic medications aren’t typically used to treat anxiety on their own, but there are cases where tricyclic antidepressants and teen anxiety treatment overlap. Some teens experience anxiety that comes alongside depression, or symptoms that don’t fully improve with standard treatments. In those situations, a TCA might become part of the plan.

Certain tricyclics affect brain systems tied to both mood and stress response. This broader effect may help reduce symptoms like constant worry, restlessness, or sleep issues. It’s not the same as what you’d expect from a medication designed specifically for anxiety, but for the right teen, it can still make a difference.

Providers weigh this option carefully. The goal isn’t to treat anxiety directly. It’s to find something that eases the overall load when other medications haven’t helped enough.

Using TCAs in Treating Adolescent Mood Disorders

Most teens with mood disorders don’t need tricyclics. Other medications tend to be a better starting point, especially when the diagnosis is clear and the symptoms are more straightforward. But when treatment becomes more complex (or when the response to medication has been inconsistent), these older drugs sometimes return to the discussion.

In some cases, a teen may have overlapping symptoms that don’t fit neatly into one category. Depression with anxiety. Mood instability with physical pain. When a newer antidepressant doesn’t address those layers, a TCA might be considered as part of a more personalized plan.

Tricyclics are usually brought into the treatment plan after other options have been exhausted. And it always involves close monitoring, since TCAs affect several systems in the brain, not just mood regulation.

TCAs in Teenage Bipolar Disorder (Non-First-Line)

Tricyclics aren’t usually used to treat bipolar disorder in teens. In fact, they’re often avoided early on because using tricyclic antidepressants for teenage bipolar disorder can increase the risk of triggering a manic episode.

That said, they may be considered in rare cases – usually when depressive symptoms haven’t responded to other treatments and a mood stabilizer is already in place. Even then, the decision is made with caution and only under close supervision.

TCAs vs SSRIs: Which Antidepressant Is Better for Teens?

For most teens, SSRIs are the starting point. They tend to be easier to tolerate and carry less risk if too much is taken. This is part of why they’re prescribed more often.

Tricyclics come up later in the treatment plan – usually when other options haven’t worked. They affect more systems in the brain, which can help with multiple symptoms. But this also means more side effects, and they require closer monitoring.

But which TCA is best for an adolescent? It’s not about which one is “better.” Everyone can respond to the same medication differently. It’s about what fits the teen’s needs and how their body responds.

What to Know Before Starting a Teen on Tricyclic Antidepressants

Tricyclic antidepressants don’t mix well with everything. Some cold medicines, antihistamines, or anything that affects heart rhythm can cause problems. Alcohol should also be avoided; even small amounts can increase side effects or cause dangerous interactions.

Once a TCA is started, consistency matters. Stopping tricyclic antidepressants safely is important. Stopping abruptly can lead to tricyclic antidepressants withdrawal in adolescents, including symptoms like headaches, irritability, or trouble sleeping. Tapering slowly, with medical supervision, helps avoid this.

Let’s take a closer look at the common side effects of TCAs in teens.

Common Side Effects of TCAs in Teens

Some of the first changes teens might notice after starting tricyclics are physical. Dry mouth, low energy, or feeling lightheaded aren’t unusual in the early weeks. For a few, appetite shifts or constipation might also show up.

There can be cognitive effects as well. A teen might seem less focused or describe their thinking as “slower” than usual. In most cases, these symptoms are mild and fade as the body adjusts. If they linger (or start to affect school, sleep, or motivation), the care team may need to make changes.

Tricyclic Antidepressants and Sleep in Teens

Some tricyclics can make teens feel sleepy, which can be helpful if falling or staying asleep has been a struggle. But the same effect that improves sleep at night can sometimes carry over into the next day.

If a teen starts feeling groggy in the morning or has trouble focusing in class, this might mean the dose is too high or that the timing needs to shift. These adjustments happen often in the first few weeks.

TCAs and Weight Changes in Teens

Some teens gain weight while taking a tricyclic, though it doesn’t happen in every case. The medication may increase appetite or slow metabolism slightly over time.

If weight starts changing quickly or if eating habits shift in a way that raises concern, it’s worth bringing up during a follow-up visit. Small adjustments to the dose or routine can sometimes make a difference. Mission Prep can also discuss healthy lifestyle plans for managing issues such as weight gain if this is a concern. 

Are There Long-Term Effects of CTAs in Teens?

Long-term effects of TCAs in teens are possible. Over time, some teens may feel emotionally “flat” or less mentally sharp while taking a TCA. These effects don’t show up for everyone, but they’re important to watch for, especially if the medication has been in use for several months.

There are also more serious risks to consider. You may come across the question “What are the 3 C’s of tricyclic antidepressants?” In large doses, tricyclics can affect the heart or cause seizures. This is where the “three C’s” come in: coma, convulsions, and cardiotoxicity. These side effects are rare, but they’re part of why TCAs are prescribed carefully and monitored closely.

Tricyclic Antidepressants for Teenagers: What You Need to Know

Get Support at Mission Prep: Teen Mental Health Treatment with TCAs and Beyond

At Mission Prep, we focus on treating the whole issue through therapy, support for families, and thoughtful medication planning when needed.

If a tricyclic antidepressant becomes part of care, we monitor it carefully. Every dose, change, and response is tracked and adjusted with the teen’s full picture in mind. 

If you’re considering your options or wondering what comes next, we’re here to help. Reach out to talk with us directly at (866) 823-5443 today. 

References

  1. StatPearls. (2023). Tricyclic Antidepressants. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557791/
  2. StatPearls. (2023). Major Depressive Disorder. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559078/
  3. Spencer, T. J., Biederman, J., Wilens, T. E., Harding, M., O’Donnell, D., Griffin, S., & Faraone, S. V. (2002). A controlled study of nortriptyline in children and adolescents with attention deficit hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 41(3), 321–329. https://pubmed.ncbi.nlm.nih.gov/11052409/ 
  4. National Institute of Mental Health. (2023, February). The teen brain: 7 things to know (NIH Publication No. 23-MH-8078). U.S. Department of Health and Human Services, National Institutes of Health. Retrieved May 7, 2025, from https://www.nimh.nih.gov/health/publications/the-teen-brain-7-things-to-know
  5. Hazell, P., & Mirzaie, M. (2013). Tricyclic drugs for depression in children and adolescents. Cochrane Database of Systematic Reviews, 2013(6), CD002317. https://pmc.ncbi.nlm.nih.gov/articles/PMC7093893/#:~:text=Subgroup%20analyses%20showed%20the%20effect,drug%20to%20moderate%20favouring%20placebo. 

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