New York State Medical Treatment Guidelines for Tricyclic Antidepressants (TCAs) in workers compensation patients

The guidelines from the New York State Workers Compensation Board provide general principles for the use of Tricyclic Antidepressants (TCAs). These directives aim to assist healthcare professionals in determining appropriate strategies for prescribing these medications, characterized by their tricyclic chemical structure, as part of a comprehensive treatment plan.

Healthcare practitioners specializing in Tricyclic Antidepressants can rely on the guidance from the Workers Compensation Board to make well-informed decisions about the most suitable approaches for utilizing these medications in the care of their patients.

It is crucial to emphasize that these guidelines are not intended to replace clinical judgment or professional expertise. The ultimate decision regarding the use of Tricyclic Antidepressants should involve collaboration between the patient and their healthcare provider.

Tricyclic Antidepressants (TCAs)

Amitriptyline is not advised for the treatment of patients with PTSD. Similarly, Desipramine is also not recommended in this context. There is supporting evidence against the use of Desipramine.

However, Imipramine is recommended as a second-line treatment for patients with PTSD. It may be considered after initial PTSD psychotherapies and/or other pharmacotherapies have been tried and found to be ineffective or not tolerated.

Nortriptyline is not recommended for the treatment of patients with PTSD.

On the other hand, Mirtazapine is a recommended second-line option for treating patients with PTSD. Indications – PTSD sufficient to require medications. Generally, sertraline, venlafaxine and paroxetine would all be preferable initial medication recommendations.

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