It is difficult in the public medical sector to devote much time to psychotherapy in primary care or psychiatric outpatient settings, and yet it still is the basic treatment, particularly for milder depressions. Practically speaking this may involve day treatment center, senior citizen centers, volunteer work, or gradual return to regular work. The commonest mistake in using antidepressants is insufficient dose and duration. They can be given in once a day doses and I usually give at bedtime because of their sedating qualities. In outpatients, I make dose adjustments once a week, increasing the dose if there are no side effects and no therapeutic response, up to therapeutic dose.
Desipramine is the metabolite of imipramine, and nortriptyline is the metabolite of amitriptyline.
The only real advantage of Elavil is cost. Despite these side effects they can be highly effective drugs. TCA's are helpful adjuncts in pain treatment and for that indication they can be effective in small doses. I find these drugs to be more alike than they are different. For Prozac, start qod or even just twice a week.