Why are Tricyclic Antidepressants not considered a first-line treatment?

Tricyclic Antidepressants (TCAs) are not considered first-line treatments primarily because of their high incidence of adverse effects. While they can be effective in managing depression, their side effect profile includes anticholinergic effects, sedation, weight gain, cardiovascular issues, and potential for overdose. These side effects can lead to significant discomfort for patients and can complicate treatment adherence.

Considering the alternatives, low efficacy is not typically a concern with TCAs; they have been shown to be effective for many patients. Limited availability is not a major issue as TCAs are generally accessible in healthcare settings. Poor patient compliance can be influenced by the side effects but is not a standalone reason for TCAs being relegated to a non-first-line status; rather, it is a consequence of the adverse effects which many patients experience. Therefore, the high incidence of adverse effects remains the foremost reason to limit their use as a first-line treatment option.