Critical review of tricyclic antidepressant use in children and adolescents

Objective: To provide a critical review of the role of tricyclic antidepres sant (TCA) medications in children and adolescents. Method: Multiple resour ces including a Medline search (1966-1998) were used. Results: There were f ew double-blind, placebo-controlled studies of TCAs, and even fewer with po sitive results. Also, potentially serious cardiovascular side effects have been described. Conclusion: The future therapeutic role of TCAs for childre n and adolescents needs to be seriously weighed against lethality of overdo se, the unresolved issue of possible sudden unexplained death, and the avai lability of safer and easier to monitor medications. Ongoing future researc h on heart rate variability and epidemiology of psychotropic medication-rel ated deaths will address developmental aspects of TCA use.