What is a major concern when prescribing Tricyclic Antidepressants (TCAs)?

When considering the prescription of Tricyclic Antidepressants (TCAs), a major concern is indeed the risk of overdose. TCAs are known for having a relatively narrow therapeutic index, which means that the difference between an effective dose and a potentially lethal dose is small. This is particularly significant because TCAs can be quite dangerous in overdose situations, leading to serious cardiac arrhythmias, seizures, and even death.

The concern is heightened in populations such as individuals with suicidal ideation, as they may have easier access to a sufficient quantity of the medication to result in a harmful overdose. The potential for severe cardiovascular effects and central nervous system depression associated with TCA overdose underscores the importance of careful monitoring and consideration of patient history when prescribing these medications.

In contrast, while TCAs can have gastrointestinal side effects, they are not the primary focus of concern when it comes to prescribing these medications. The same holds true for energy levels and sexual side effects, which, while relevant in the context of TCA side effects, do not present the immediate life-threatening risks associated with overdose.