Tricyclic Antidepressants – Test Prep and Practice Pearls
Real Life Pharmacology - Pharmacology Education for Health Care Professionals
Eric Christianson, PharmD; Pharmacology Expert and Clinical Pharmacist
4.9 • 773 Ratings
🗓️ 21 May 2026
⏱️ 17 minutes
🧾️ Download transcript
Summary
Welcome to today’s episode on the tricyclic antidepressants, commonly known as TCAs — one of the foundational medication classes in psychopharmacology. Although newer antidepressants like SSRIs often dominate modern prescribing, TCAs remain highly relevant in clinical practice because of their effectiveness in treatment-resistant depression, chronic pain syndromes, migraine prevention, insomnia, and certain anxiety disorders. In this episode, we’ll break down the pharmacology behind these medications, discuss how tertiary amines differ from secondary amines, review major adverse effects and drug interactions, and highlight the key clinical pearls that healthcare professionals and students need to know. Whether you’re a medical, pharmacy, nursing, or PA student preparing for exams, or a practicing clinician looking for a practical refresher, this episode will give you a solid framework for understanding this classic but still clinically important medication class.
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Transcript
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| 0:00.0 | Hey, all welcome back to the Real Life Pharmacology podcast. I'm your host, pharmacist, Eric Christensen. |
| 0:05.7 | Thank you so much for listening today. Go check out Real Life Pharmacology.com. We've got the free 31-page |
| 0:12.8 | PDF, top 200 drugs, great study guide, great refresher. If you're on practice or if you're a student |
| 0:18.7 | preparing for board exams and |
| 0:20.9 | pharmacology exams. Simply an email, we'll get you access to that. And then we've also got |
| 0:25.4 | updates when we've got new free stuff available as well as some of our paid content as well. |
| 0:31.7 | So again, no brainer to go get that. Simply an email will get you access to that top 200 study guide. |
| 0:39.9 | All right. So we are going to cover tricyclic antidepressants today. I'm going to cover some of the |
| 0:46.0 | most important things you see in practice as well as things that show up on board exams. So |
| 0:52.7 | tricyclic antidepressants, as it sounds, |
| 0:56.1 | they are kind of classically used as an antidepressant. |
| 1:00.4 | They were the mainstay of therapy prior to the advent of SSRIs. |
| 1:07.2 | So at this point, it is an older class of antidepressant medications. |
| 1:13.4 | They are still used clinically. |
| 1:16.4 | But I will say, you know, it's most often when we've got a compelling indication or we've |
| 1:22.6 | got a patient that's refractory to other antidepressants. |
| 1:27.9 | So in addition to depression, certainly can be used for neuropathic pain, as well as migraine |
| 1:36.9 | prevention. |
| 1:38.1 | Those are the two major indications I see it used for. |
| 1:42.0 | Occasionally you see some insomnia use. |
| 1:44.6 | Usually that's lower dose oxopin. |
| 1:46.3 | I'll talk about that coming up. |
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