Tricyclic antidepressants (TCAs) are the vintage powerhouse team of psychiatry—time-tested, multifaceted, and still relevant in select clinical situations. Though largely replaced by newer agents due to side effect profiles, TCAs like amitriptyline, nortriptyline, and imipramine remain useful for treatment-resistant depression, chronic pain, insomnia, and certain anxiety disorders.
This section supports psychiatric NPs in using TCAs safely and effectively by detailing baseline and ongoing ECG monitoring, blood level checks, anticholinergic side effect management, and overdose precautions. Despite their age, TCAs pack a punch in the right patient. With careful dosing and monitoring, they remain a reliable option in the psychiatric toolbox—delivering strength, depth, and durability when modern options fall short.