In purely clinical situations, they are clearly only an adjunct to good psychiatric assessment. They can be of value in the primary care setting if used as one component of a screening process. Rating scales are, of course, very useful in clinical research settings. No, I do not. Selective serotonin reuptake inhibitors, bupropion, and other agents that do not block cholinergic receptors are far better options than are tricyclic agents.
Tricyclic antidepressants are anticholinergic poisons in elderly and demented patients.
A potential side effect of SSRIs is weight loss. Use of activating antidepressants, such as an SSRI, might account for only a small proportion of those cases. If no other cause was identified, I might reduce the dose of the SSRI and re-evaluate the patient before switching to another antidepressant class. In a treatment algorithm for depression in the elderly I helped develop, tricyclic antidepressants are used only for specific problems. For example, a patient with enuresis or chronic pain and depression might benefit from a tricyclic antidepressant.