Tricyclics and tetracyclics

These drugs have been used since the 1950s for the treatment of depression. Like many of the antidepressant drugs, they work on the neurotransmitter norepinephrine. But they are especially powerful and affect other neurotransmitters as well, so those who take them must be monitored very carefully by blood tests.

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Unlike the SSRIs, it is possible to overdose on these medicines and die. Indeed, one of the reasons that they are not prescribed as frequently today as they were earlier is that in some patients these drugs can cause a rapid heartbeat and cardiac conduction abnormalities. Still, for people for whom neither the SSRIs nor the MAOIs are effective, the tricyclics and tetracyclics are the treatment of choice.

This section includes more information on side effects.