Trimipramine (Surmontil) is the least prescribed of the TCAs available in the US. You’ll probably never see it in the wild.
Trimipramine’s mechanism differs from other TCAs. It is not a significant 5-HT or NE reuptake inhibitor. It is mainly an antihistamine and 5-HT2A receptor antagonist. It is also one of two antidepressants (amoxapine) that block D2 dopamine receptors This gives it antipsychotic properties and the potential to cause extrapyramidal symptoms (EPS) and elevate prolactin. Trimipramine has a receptor binding profile similar to the antipsychotic clozapine (Clozaril).
Trimipramine can be highly sedating, which is an H1 antihistaminic effect.
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