Am Fam Physician. 2004 Oct 1;70(7):1270.
Optimal Dosage of Tricyclic Antidepressants
What is the optimal dosage of tricyclic antidepressants in the acute phase of treatment of major depression in adults?
Although the quality of the data limits the strength of the recommendation, current evidence shows that 75 to 100 mg per day of a tricyclic antidepressant is more effective than placebo. Higher dosages are not more effective and are associated with more dropouts because of side effects.
Although tricyclic antidepressants have been proved effective in the treatment of depression, there is little evidence for the optimal dosage. Despite the lack of evidence, the American Psychiatric Association recommends dosages of 100 to 300 mg per day.1
Furukawa and colleagues examined 41 trials of tricyclic antidepressants; 35 studies with 2,013 patients compared low dosages of tricyclics (75 to 100 mg per day) with placebo, and six studies with 551 participants compared low dosages of tricyclics with standard dosages (more than 100 mg per day). Most studies used amitriptyline and imipramine.
At four weeks, six to eight weeks, and three to 12 months, patients were more likely to respond to dosages of 75 to 100 mg per day than to placebo. These findings were similar for primary care patients. Standard dosages of tricyclics had a higher dropout rate because of side effects and were not more effective than low dosages.
The quality of the studies was limited by poor reporting and nonstandard diagnostic criteria, and there was significant heterogeneity between studies. Therefore, a definitive answer on the optimal dosage remains unknown. However, current evidence supports the use of low-dosage tricyclic antidepressants.
Furukawa T, et al. Low dosage tricyclic antidepressants for depression. Cochrane Database Syst Rev. 2003; 3: CD003197.
1. Practice guideline for the treatment of patients with major depressive disorder (revision). American Psychiatric Association. Am J Psychiatry. 2000;157(4 suppl)1–45.
Copyright © 2004 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions
More in AFP
MOST RECENT ISSUE
Aug 15, 2016
Access the latest issue of American Family Physician