: This study aims to monitor medication compliance and adverse drug reactions (ADRs) to tricyclic antidepressants (TCAs) in depressed patients. Additionally, it seeks to identify the most frequently used TCA drugs and assess the age and gender distribution of the patient population. Methods: The study was conducted in the psychiatric department of tertiary care hospitals in AP, India, with approval from the administrative and institutional ethics committees. Seventy patients from the psychiatric department participated after understanding the study's purpose and providing informed consent. Information was collected via pre-approved forms, and medication adherence was measured using the Medication Adherence Rating Scale (MARS). Data analysis was performed using IBM SPSS version 26. Results: Seventy patients using TCAs reported adverse drug reactions. Imipramine was the most frequently prescribed antidepressant in this study. The reported ADRs included blurred vision, insomnia, and hesitancy when urinating. Using a pre-made WHO form, 70 patients were examined for ADRs. Probable causality accounted for 43% of the ADRs, 54% of which could have been avoided. Sixty-four percent of the ADRs were of mild severity. Socioeconomic barriers were the only significant factor affecting non-adherence, which was not as prominent. Conclusion: This study provides a representative profile of the typical ADRs observed in the psychiatric department. Clinical pharmacists play a crucial role in improving patient medication adherence by raising awareness about illnesses and treatments and offering patient counselling services.