Which of the following is true about the use of tricyclic antidepressants?

Tricyclic antidepressants (TCAs) are predominantly considered second-line or later treatments when addressing mood disorders, particularly when selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have proven ineffective or have unacceptable side effects for the patient. This is due to their side effect profile and safety considerations during pregnancy and lactation.

The use of TCAs is often characterized by caution as they can sometimes lead to more severe side effects than SSRIs, making clinicians more inclined to try SSRIs or SNRIs first. Therefore, when the first-line options do not provide adequate relief, TCAs can be introduced as an alternative.

In the context of managing anxiety, while TCAs may have anxiolytic properties, they are not the first-choice treatment. They can be utilized but are generally approached with more caution due to potential complications or side effects related to anxiety disorders. This reinforces the rationale behind the notion that they are only used after SSRIs and SNRIs have failed, adhering to a hierarchy in treatment options based on efficacy and safety.