Side effects of tricyclic antidepressants
Side effects of tricyclic antidepressants may include:
- Blurred vision
- Dry mouth
- Lightheadedness on standing up due to a drop in blood pressure
- Weight gain
- Difficulty thinking clearly
- Difficulty urinating
- Heart rhythm problems
To reduce or prevent side effects, your doctor will likely start you at a low dose and slowly increase the amount. Most people are able to take tricyclic antidepressants, particularly in low doses, with only mild side effects. The doses that are effective for pain are generally lower than the doses used for depression.
Other antidepressants that may help
Other classes of antidepressants have become more popular because they have fewer side effects. These drugs may also be used to help relieve chronic pain:
Serotonin and norepinephrine reuptake inhibitors (SNRIs). Some SNRIs, such as venlafaxine (Effexor), duloxetine (Cymbalta) and milnacipran (Savella), may help relieve chronic pain. People with chronic pain often develop depression along with their chronic pain. Venlafaxine and duloxetine offer the advantage of being effective for depression at the same dosages useful for treating pain.
Venlafaxine can cause drowsiness, insomnia or elevated blood pressure, and may worsen heart problems. Duloxetine can cause side effects, such as drowsiness, insomnia, nausea, dry mouth, dizziness, constipation or excessive sweating.
Milnacipran is used to relieve fibromyalgia pain and can cause side effects, such as nausea and drowsiness. However, it has shown only limited effectiveness in relieving other types of pain.
Selective serotonin reuptake inhibitors (SSRIs). SSRIs, which include drugs such as paroxetine (Paxil) and fluoxetine (Sarafem, Prozac), are useful for treating depression associated with pain conditions, but don't appear to help relieve pain on their own. However, fluoxetine may boost the painkilling effects of some tricyclic antidepressants.
SSRIs generally don't work as well as tricyclic antidepressants for pain, but they often produce fewer side effects. Fluoxetine can cause certain side effects, such as insomnia and dizziness.
It's important to note that antidepressant medications are associated with a slightly increased risk of suicidal thoughts or actions. Talk to a doctor or counselor promptly if you feel depressed or suicidal.
Aug. 22, 2013
- Bajwa ZH, et al. Overview of the treatment of chronic pain. http://www.uptodate.com/home/. Accessed June 12, 2013.
- Daroff RB, et al. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4377-0434-1..00051-7--s0085&isbn=978-1-4377-0434-1&sid=1449455838&uniqId=413635127-3#4-u1.0-B978-1-4377-0434-1..00051-7--s0085. Accessed June 13, 2013.
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- Watson JC (expert opinion). Mayo Clinic, Rochester, Minn. June 27, 2013.
- FDA proposes new warnings about suicidal thinking, behavior in young adults who take antidepressant medications. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2007/ucm108905.htm. Accessed June 27, 2013.