Side effects of tricyclic antidepressants

Side effects of tricyclic antidepressants may include:

  • Blurred vision
  • Drowsiness
  • Dry mouth
  • Nausea
  • Lightheadedness on standing up due to a drop in blood pressure (orthostatic hypotension)
  • Weight gain
  • Difficulty thinking clearly
  • Constipation
  • 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 XR), 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 and anxiety 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), may help relieve certain types of pain, but there's a lack of evidence that they help alleviate nerve pain. 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.

Sept. 13, 2016