Jesse Spencer on Side effects of TCAs include significant anticholinergic effects (e.g., dry mouth, blurred vision, constipation, urinary retention), drowsiness or insomnia, confusion, anxiety, nausea, weight gain, and impotence. They can also cause cardiovascular complications (particularly disturbances in heart rhythm). The tricyclics represented the mainstay of antidepressant treatment from the introduction of imipramine in 1957 until fluoxetine (Prozac) the first ssRI was introduced in 1987. Although they are effective as antidepressants, their adverse side effects and more significantly their lethality in overdose have led to a profound decline in their use. They remain, however, the standard against which other antidepressants are com- pared; no other class of antidepressants has demonstrated more clinical efficacy. Jesse Spencer 2016.