Tofranil (and the updated version, Tofranil-PM) was OK for me. I got dry mouth, losing pounds was impossible,despite dieting, and I was groggy for a while, but...for me, Tofranil is like taking Cymbalta or Effexor, with less apathy and you take it all at bedtime, so its an effective sedative for a little while.

Long term, I think TCA drugs can be a kinda tricksy. Some TCA drugs they can do blood level tests for, which might be a good idea if you're on multiple psych drugs, especially 2+ antidepressant drugs. Some doctors have issues about heart probs over the long haul (like my current doctor, who now has me on low dose lamictal+wellbutrin, instead of the Tofranil).

There are plenty of TCA drugs out there, that's for certain. Amoxapine might be good for you. Its one drug that partly metabolizes into loxapine, which is an older (and often surprisingly tolerable) antipsychotic. The antidepressant part lifts mood and energy levels, while the loxapine part helps with agitation, psychosis, (hypo)mania, severe anxiety, etc. According to what little I've read about it (I looked it up because my last doctor brought it up once), --if-- it helps, it often helps quickly. Also, higher doses have been used successfully in Schizophrenia, where there are often problems with depression, anxiety, etc.

OK. Other than that...I got nothin', lol. Oh, except that if Elavil proves too much to handle, some people do well adding Remeron to ongoing antidepressant treatment. Lower doses are densely sedating and can contribute to weight gain. Higher doses are less sedating and I think the weight gain becomes less of an issue, too.

I hope you can find a combination that gets the job done. Good luck.