Trimipramine (Surmontil): How This TCA Works, Dosing, and When Telehealth Is Enough

Last updated: August 23, 2026

Trimipramine is a tricyclic antidepressant used for depression. Capsules come as generic trimipramine maleate in 25 mg, 50 mg, and 100 mg strengths (as the base). The historic brand is Surmontil. Trimipramine is not a controlled substance. It is not approved for children.

This guide covers what trimipramine treats, how outpatient dosing usually starts, common and serious side effects, overdose risk, and which parts of care a telehealth visit can handle. It is educational, not a diagnosis or a promise that any plan will pay for a specific medicine.

See if you may qualify for online depression care →

What is trimipramine?

According to MedlinePlus (revised March 15, 2026), trimipramine treats depression. It is a tricyclic antidepressant. It increases certain natural substances in the brain that help maintain mental balance. The brand name is Surmontil.

The DailyMed trimipramine capsule label (Breckenridge; label updated March 17, 2026; revised November 2025) describes capsules equivalent to 25 mg, 50 mg, or 100 mg of trimipramine as the base. Chemical name: 5-(3-dimethylamino-2-methylpropyl)-10,11-dihydro-5H-dibenz (b,f) azepine acid maleate (racemic form). Molecular weight 410.5. It does not act by monoamine oxidase inhibition. The label describes an antidepressant with an anxiety-reducing sedative component. DEA schedule: none (human prescription drug).

StatPearls on tricyclic antidepressants lists trimipramine with other TCAs such as amitriptyline, imipramine, doxepin, and clomipramine. StatPearls on antidepressants places it with older agents, separate from SSRIs, SNRIs, and MAOIs. LiverTox covers trimipramine as a TCA used for depression.

What does trimipramine treat?

DailyMed indications: relief of symptoms of depression. Endogenous depression is more likely to respond than other depressive states. In studies with neurotic outpatients, the drug appeared equivalent to amitriptyline in less-depressed patients and somewhat less effective than amitriptyline in more severely depressed patients. In hospitalized depressed patients, trimipramine and imipramine were equally effective.

Trimipramine capsules are not approved for bipolar depression. Before any antidepressant, the prescriber should screen for bipolar risk, including family history of suicide, bipolar disorder, and depression, because an antidepressant alone can flip some people into mania or a mixed episode.

Providers sometimes use TCAs off-label. Off-label use needs a clear clinical reason and a discussion of alternatives that may have a better safety profile. MedlinePlus notes the medicine may be prescribed for other uses; ask the prescriber.

How do you take trimipramine?

MedlinePlus: capsules one to three times a day, at about the same times. The prescriber starts low and raises the dose gradually. Benefit may take up to 4 weeks. Do not stop without talking to the prescriber.

DailyMed dosing:

• Start low and raise gradually. Lower doses for older adults, adolescents, and outpatients versus hospitalized patients.
• Most antidepressants have a lag of 10 days to 4 weeks. Raising the dose faster does not shorten that lag; it raises side-effect risk.
• Outpatients: start 75 mg/day in divided doses, increase to 150 mg/day. Doses over 200 mg/day are not recommended. Maintenance 50 to 150 mg/day. The total daily dose may be given at bedtime.
• Hospitalized patients: start 100 mg/day in divided doses; may rise in a few days to 200 mg/day. If no improvement in 2 to 3 weeks, the maximum recommended dose is 250 to 300 mg/day.
• Adolescent and geriatric patients: start 50 mg/day, with gradual increases up to 100 mg/day.
• After remission, stay on the lowest dose that holds the response, preferably as a single bedtime dose, for about three months to reduce relapse risk.

Missed dose (MedlinePlus): take it when you remember unless the next dose is near. Do not double up.

Browse conditions and next steps →

What side effects should you watch for?

MedlinePlus lists common effects that may persist: nausea, vomiting, diarrhea, stomach pain, drowsiness, weakness, excitement or anxiety, confusion, dizziness, headache, nightmares, dry mouth, appetite or weight change, constipation, trouble urinating or frequent urination, sexual changes, sweating, ringing in the ears, and pain, burning, or tingling in the hands or feet.

Serious effects that need urgent care:

• New or worse depression, suicidal thinking, agitation, panic, severe restlessness, or mania. Boxed warning: antidepressants raised suicidality versus placebo in short-term studies in people 24 and under. Trimipramine is not approved in pediatrics. DailyMed Table 1: under 18, 14 extra suicidality cases per 1,000 treated; ages 18 to 24, 5 extra; ages 25 to 64, 1 fewer; 65 and older, 6 fewer.
• Jaw, neck, or back spasms; slow or difficult speech; shuffling walk; uncontrolled shaking.
• Fever and sore throat; trouble breathing or swallowing; rash; yellowing of skin or eyes; seizures; hallucinations; chest pain; pounding or irregular heartbeat.
• Eye pain, vision change, colored rings around lights, or redness around the eye (angle-closure glaucoma risk from pupil dilation).
• Serotonin syndrome: agitation, hallucinations, fast heart rate, labile blood pressure, sweating, tremor, rigidity, seizures, nausea, vomiting, or diarrhea, especially with other serotonergic drugs or MAOIs.

Overdose can be fatal. DailyMed: cardiac dysrhythmias, severe hypotension, convulsions, and CNS depression including coma. QRS width of 0.10 seconds or more has been tied to more seizures; 0.16 seconds or more to more ventricular dysrhythmias. Hospital monitoring is required as soon as possible. Poison control: 1-800-222-1222.

MedlinePlus: older adults should not usually take trimipramine because it is not as safe or effective as other options for the same condition. Alcohol adds to drowsiness. The drug can raise sun sensitivity. Recent heart attack is a reason not to take it.

What cannot be combined with trimipramine?

DailyMed contraindications:

• MAOIs intended to treat psychiatric disorders with trimipramine, or within 14 days either way.
• Starting trimipramine while on linezolid or intravenous methylene blue.
• Possible cross-sensitivity with other dibenzazepine TCAs (clomipramine, desipramine, imipramine, and related drugs).
• Acute recovery after a myocardial infarction.

MedlinePlus also flags cimetidine (Tagamet) as an over-the-counter product that may interact. Tell the prescriber about prostate enlargement, trouble urinating, thyroid disease, seizures, and heart, kidney, or liver disease. Tell surgeons and dentists you take trimipramine.

When is telehealth enough?

HHS telehealth guidance notes that providers can prescribe medicines for mental health conditions during a telehealth visit. Trimipramine is not a controlled substance, so federal controlled-substance telehealth rules do not apply the way they do for stimulants or benzodiazepines.

A licensed clinician on Klarity Health (2,000+ providers) can review history, screen for bipolar risk and suicide risk, discuss TCA versus SSRI or SNRI options, and decide whether trimipramine or another medicine fits. In-person care is the safer path after a recent heart attack, when overdose risk is high, when serotonin syndrome or seizures appear, or when ECG or lab follow-up cannot wait.

Many insurance plans may cover online depression visits and medication management. Coverage varies by plan. Verify your benefits before you book.

See if you may qualify for online depression care →

FAQ

Is Surmontil still available?

MedlinePlus lists Surmontil as the brand name. Generic trimipramine maleate capsules remain on the U.S. market per DailyMed (Breckenridge ANDA label, March 2026).

Is trimipramine a sleeping pill?

It is approved for depression, not as a primary insomnia drug. The label notes a sedative component and allows the full daily dose at bedtime for convenience. Do not use leftover capsules as a sleep aid.

How does trimipramine compare with amitriptyline or imipramine?

DailyMed: in less-depressed neurotic outpatients it looked similar to amitriptyline; in more severe outpatient depression it looked somewhat less effective. In hospitalized depression it matched imipramine. Individual response and side-effect burden still drive the choice.

Can I get trimipramine online?

A telehealth visit can evaluate depression and, when clinically appropriate, prescribe a TCA. The clinician may prefer a medicine with a wider safety margin. Klarity does not promise any specific drug.

Disclaimer

This article is for education. It is not medical advice and it is not a coverage determination. Insurance benefits vary by plan. Verify benefits before you book. If you are in crisis, call or text 988, or go to the nearest emergency department.

Explore conditions Klarity treats →