TCA

Tricyclic Antidepressants

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Primary Products

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DrugSURE® Integrated Test Cups

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DrugSURE® Dip Tests

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OralTox® Oral Fluid Tests

ng/ml

Cut-Off Levels

Rapid Urine Test: 1000 ng/mL

WOD

Window of Detection Times

Urine Specimen: 1 – 3 Days

What is [text]?

Tricyclic antidepressants (TCAs) are a class of medications originally developed in the 1950s to treat major depressive disorder, anxiety disorders, and certain chronic pain conditions. They work by increasing levels of serotonin and norepinephrine in the brain while also affecting several other neurotransmitter systems, which gives them both therapeutic benefits and a higher side-effect profile compared to newer antidepressants. Common TCAs include amitriptyline, nortriptyline, imipramine, desipramine, and clomipramine. These medications are usually dispensed as tablets or capsules, varying in color and dosage depending on formulation.

In healthcare settings, TCAs remain valuable for conditions such as neuropathic pain, migraine prevention, fibromyalgia, obsessive-compulsive disorder (clomipramine), and treatment-resistant depression. Because they affect multiple receptor systems—including cholinergic, adrenergic, and histaminergic pathways—TCAs can produce sedation, anticholinergic effects, and cardiovascular changes. Recreational misuse is rare but possible; when misused, individuals may attempt to achieve sedative or euphoric effects, though doing so poses significant toxicity risk. Overdose is particularly dangerous due to the drug’s effect on cardiac conduction and the central nervous system.

For toxicology screening programs, TCAs are often included in point-of-care testing panels because of their narrow therapeutic window and risk of accidental or intentional overdose. Detection helps medical providers monitor adherence, assess toxicity, and identify potential misuse or dangerous drug interactions.

Effects:

Reduced symptoms of depression and anxiety
Pain modulation and relief in neuropathic pain conditions
Sedation, which can aid sleep in some patients
Migraine and tension-headache prevention
Dry mouth, blurred vision, constipation (anticholinergic effects)
Drowsiness, dizziness, or cognitive slowing
Increased heart rate and blood-pressure fluctuations
Risk of cardiac arrhythmias, especially in overdose
Seizures, confusion, or delirium at toxic levels
High overdose lethality due to cardiac and CNS toxicity

Commons Slang Terms:

(Note: TCAs are not widely abused recreationally, so slang is limited.)

“Trikes”
“Antis”
“Tricycs”
“Old-school antidepressants” (clinical slang)
“Downers” (sometimes used broadly, not TCA-specific)

Legal Status:

Tricyclic antidepressants are prescription-only medications in the United States and are not controlled substances under the Controlled Substances Act. However, because TCAs have a high toxicity risk, narrow therapeutic range, and significant potential for overdose, they are frequently included in clinical point-of-care toxicology panels, especially in emergency, psychiatric, and inpatient medical settings. Their detection can help clinicians determine whether symptoms—such as arrhythmias, confusion, or seizures—are related to TCA exposure.

For workplace and government-run testing programs, TCAs are not typically screened unless the setting involves clinical risk management or monitoring of medication compliance. In medical environments, however, rapid TCA screening can guide immediate treatment decisions, particularly in suspected overdose or polypharmacy cases. Because TCAs are legally prescribed medications, any positive result must be interpreted alongside patient history, prescription records, and confirmatory testing when necessary.