Tricyclic Antidepressant (ATC) Screening

Screening for tricyclic antidepressants (TCAs) is an essential tool for evaluating the use and effectiveness of these medications in treating depression. This test measures ATC levels in blood or urine, ensuring appropriate dosing while minimizing the risks of side effects and overdosing.

What is a tricyclic antidepressant (TCA) screening?

This test checks whether tricyclic antidepressants (TCAs) can be found in your blood or urine. It can also measure the amount of ATC in your blood or urine. TCAs are a type of antidepressant. Antidepressants are prescription medications that treat depression, a serious mood disorder. Depression can affect how you think, feel, and behave.

There are several types of antidepressants. Each of them works in a slightly different way. TCAs were one of the first types of antidepressants developed. They may be effective, but they tend to cause more side effects than newer types of antidepressants. Most new antidepressants fall into one of these three groups:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin and noradrenaline reuptake inhibitors (SNRIs)
  • Atypical antidepressants, which are newer antidepressants that do not fit into the other groups.

Health professionals often use newer antidepressants rather than TCAs because they are safer and have fewer side effects. But TCAs may be a good option for treating depression when other antidepressants don't work.

Health professionals sometimes use TCAs to treat other health conditions, such as anxiety, chronic pain, migraines, and insomnia.

Some commonly prescribed TCAs include:

  • Doxepin
  • Nortriptyline
  • amitriptyline
  • Imipramine
  • Desipramine

TCAs should be dosed carefully. Finding a dose that works without being dangerous can be difficult. In fact, TCAs are the cause of numerous prescription drug overdose deaths in the United States.

Other names: ATC test, ATC test, tricyclic screening

What's the point?

A TCA test is used to:

  • Help your provider prescribe the right dose of TCA.
  • Determine if you are abusing TCAs (taking them without a prescription or taking more than the prescribed dose). The test may be included as part of a drug test (toxicology), which checks for the presence of multiple prescription medications and illegal drugs.
  • Diagnosing TCA overdose. Timely treatment of an overdose can save lives.

Why do I need a TCA display?

You may need this test if you have been prescribed a TCA to ensure that you are getting a dose that is safe and effective. You may also need this test if you have symptoms of an TCA overdose. These include:

  • Dry mouth
  • Blurred vision
  • Constipation
  • Difficulty urinating
  • Sleepiness
  • Dizziness
  • Crises
  • Confusion
  • Tremors

If you think you have taken too much TCA, or if you have symptoms of an TCA overdose, call 911 or go to the nearest emergency center.

What happens during a TCA screening?

A TCA screening can be done through a blood test or a urine test.

During a TCA blood test, a health professional will take a blood sample from a vein in your arm using a small needle. After the needle is inserted, a small amount of blood will be collected in a test tube or vial. You may feel a slight prick when the needle goes in or out. This usually takes less than five minutes.

For a TCA urine test, you will need to provide a urine sample in a sterile cup. Your supplier will give you more information on how to collect your sample.

Do I need to do anything to prepare for the exam?

You do not need special preparations for a TCA screening.

Are there any risks associated with the test?

There is very little risk in taking a blood test. You may feel a slight pain or bruise where the needle was inserted, but most symptoms go away quickly.

There is no risk in doing a urine test.

What do the results mean?

Your blood test results will show the levels of TCA in your bloodstream. Depending on the TCA you are taking and the levels, your provider may adjust your dosage.

There are two types of urine test results. A type will show if TCA was found but not in what quantity. The other type shows TCA levels.

If blood or urine test results show that you have dangerously high TCA levels, you will be treated immediately.

If you have questions about your results, talk to your provider.

Learn more about lab tests, reference ranges, and understanding results.

Is there anything else I need to know about a TCA display?

Tricyclic antidepressants (TCAs) are most commonly prescribed by a mental health professional, a specialist in the diagnosis and treatment of mental health conditions, such as depression. There are many different types of mental health professionals out there. Some types, usually doctors, are authorized to prescribe medications, including TCAs. Other mental health professionals work with providers who can write prescriptions. The most common types of mental health professionals include:

  • Psychiatrists are doctors who specialize in mental health disorders. Psychiatrists can prescribe medication.
  • Psychologists are professionals trained in psychology. Psychologists may use one-on-one counseling sessions and/or group therapy sessions. They often have doctoral degrees but don't have medical degrees. They cannot prescribe medication unless they have a special license. Some psychologists work with providers who can prescribe medication.
  • Psychiatric or mental health nurses are nurses with special training in mental health disorders. Nurses who may have a master's or doctoral degree in mental health nursing include: advanced nurse practitioners (APRNs), certified nurse practitioners (CNPs), and specialized clinical nurses (CNSs). In some states, some nurses may prescribe medication.
  • Certified clinical social workers have at least a master's degree in social work with special training in mental health. They can't prescribe medication but can work with providers who can. Providers who are licensed clinical social workers usually have LCSW or LICSW after their name.
  • Certified professional counsellors (LPC) may also be referred to as clinicians or therapists. States have various names for these licenses, such as LMFT (licensed marriage and family therapist). These professionals generally have a master's degree in a field related to mental health. They cannot prescribe medication but can work with providers who can.

If you are suffering from depression, it is important to get treatment. Talk to your primary doctor if you need help finding a mental health provider who can treat your depression.

References

  1. American Psychiatric Nurses Association [Internet]. Falls Church (VA): American Psychiatric Nurses Association; Psychiatric Mental Health Nurses; [accessed April 26, 2024]; [approximately 3 screens]. Available at: https://www.apna.org/i4a/pages/index.cfm?pageid=3292
  2. American Psychiatric Association [Internet]. Washington D.C.: American Psychiatric Association; c2024. What is depression? ; [accessed April 26, 2024]; [approximately 6 screens]. Available at: https://www.psychiatry.org/patients-families/depression/what-is-depression
  3. Cleveland Clinic: Health Library: Diagnostics & Testing [Internet]. Cleveland (OH): Cleveland Clinic; c2024. Blood tests; [revised December 6, 2022; accessed April 26, 2024]; [approximately 16 screens]. Available at: https://my.clevelandclinic.org/health/diagnostics/24508-blood-tests
  4. Cleveland Clinic: Health Library: Diagnostics & Testing [Internet]. Cleveland (OH): Cleveland Clinic; c2024. Tricyclic antidepressants; [revised December 6, 2022; accessed April 26, 2024]; [approximately 16 screens]. Available at: https://my.clevelandclinic.org/health/treatments/25146-tricyclic-antidepressants
  5. Familydoctor.org [Internet]. Leawood (KS): American Academy of Family Physicians; c2024. Types of antidepressants; [updated July 24, 2023; accessed April 26, 2024]; [approximately 10 screens]. Available at: https://familydoctor.org/types-of-antidepressants
  6. Johns Hopkins Medicine [Internet]. Baltimore: The Johns Hopkins University; c2024. Health: Why aren't my anti-depressants working? ; [accessed April 26, 2024]; [approximately 3 screens]. Available at: https://www.hopkinsmedicine.org/health/wellness-and-prevention/why-arent-my-antidepressants-working
  7. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998-2024. Antidepressants: Choosing the one that's right for you; [accessed April 26, 2024]; [approximately 4 screens]. Available at: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046273
  8. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998-2024. Mental Health Providers: Tips for Finding One; [accessed April 26, 2024]; [approximately 3 screens]. Available at: https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health-providers/art-20045530
  9. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c1998-2024. Tricyclic and tetracyclic antidepressants; [accessed April 26, 2024]; [approximately 4 screens]. Available at: https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983
  10. Moraczewski J, Awosika AO, Aedma K. Tricyclic antidepressants. [Updated on August 17, 2023; accessed on April 26, 2024]. [about 12 screens]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; January 2024-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557791/
  11. National Institute of Mental Health [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Depression; [revised March 2024; accessed April 26, 2024]; [approximately 10 screens]. Available at: https://www.nimh.nih.gov/health/topics/depression
  12. Nemours KidsHealth [Internet]. Jacksonville (FL): The Nemours Foundation; c1995-2023. Get a blood test; [revised September 2021; accessed April 26, 2024]; [approximately 4 screens]. Available at: https://kidshealth.org/en/parents/blood-tests.html
  13. Preskorn SH. Tricyclic antidepressants: the reasons and methods of therapeutic drug monitoring. J Clin Psychiatry [Internet]. July 1989 [accessed April 26, 2024]; 50 Support:34-42; discussion 43-6. Available at: https://pubmed.ncbi.nlm.nih.gov/2661550
  14. Request a Test [Internet]. Brecksville (OH): Request A Test; c2020. TCA tricyclic antidepressant test; [accessed April 26, 2024]; [about 1 screen]. Available at: https://requestatest.com/Tricyclic-TCA-Antidepressants-Screen-test
  15. Testing.com [Internet]. Seattle (WA).: OneCare Media; c2024. Urinalysis (UA test); [modified September 28, 2022; accessed April 26, 2024]; [approximately 11 screens]. Available at: https://www.testing.com/tests/urinalysis/