Examples
Tricyclic antidepressants
|
| amitriptyline | |
| desipramine | Norpramin |
| doxepin | Silenor |
| imipramine | Tofranil |
| nortriptyline | Pamelor |
Tetracyclic antidepressants
How It Works
Low doses of tricyclic or tetracyclic
antidepressant medicine increase the level of certain brain chemicals, which
may affect how the brain perceives pain. They may also help you sleep.
Why It Is Used
Low doses of antidepressants are
often used to treat people who have chronic pain.
Higher doses of
antidepressants are used to relieve
depression.
When these drugs are not used
- Some of these medicines are not given to
older adults, because the medicines cause too many severe side
effects.
- Cyclic antidepressants usually are not given to people
who have certain heart problems, such as irregular heartbeats or low blood
pressure.
How Well It Works
Research has shown that cyclic
antidepressants reduce chronic
low back pain for some people.footnote 1 They are not recommended for sudden and severe (acute) low
back pain. Other antidepressants called selective serotonin reuptake inhibitors
(SSRIs) do not appear to help people who have low back pain.footnote 2
Side Effects
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Call 911 or other emergency services right away if you have:
- Trouble breathing.
- Swelling of your face, lips, tongue, or throat.
Call your doctor right away if you have:
- Hives.
- Thoughts of suicide.
- Agitation and restlessness.
- Seizures.
- Fast heartbeat.
- Nausea and vomiting.
Common side effects of this medicine include:
- Dry mouth.
- Dizziness.
- Drowsiness.
- Headache.
- Weight gain.
- Constipation.
FDA advisory. The U.S. Food and
Drug Administration (FDA) has issued an
advisory on antidepressant medicines and the risk of
suicide. The FDA does not recommend that people stop using these medicines.
Instead, a person taking antidepressants should be watched for
warning signs of suicide. This is especially important
at the beginning of treatment or when the doses are changed.
See
Drug Reference for a full list of side effects. (Drug Reference is not
available in all systems.)
What To Think About
Never suddenly stop taking antidepressants. The use of any
antidepressant should be tapered off slowly and only under the supervision of a
doctor. Abruptly stopping antidepressant medicines can cause negative side
effects or a relapse of your condition.
Antidepressants are started at low doses, and the dose is increased gradually to reduce the severity of side effects. You may need regular blood tests to check the amount of the medicine in your blood. Too much of this type of medicine in the bloodstream can be dangerous.
You may start to feel better in 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines or if you do not notice any improvement by 3 weeks, talk to your doctor.
People who have seizures (epilepsy), difficulty urinating (urinary retention), glaucoma (an eye disease), or heart conditions may notice that antidepressants make these symptoms worse.
Be sure to tell your
doctor about all the medicines you are currently taking. Antidepressants can interact
poorly with certain heart medicines-digoxin (for example, Lanoxin)-and/or
with other medicines, such as those used to treat seizures-phenytoin
(Dilantin).
Taking medicine
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
If you are pregnant, breastfeeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breastfeeding, or planning to get pregnant.
Checkups
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
References
Citations
- Chou R, Huffman LH (2007). Medications for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine, 147(7): 505-514.
- Chou R, et al. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7): 478-491.
Credits
ByHealthwise Staff
Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Current as ofMarch 21, 2017
Chou R, Huffman LH (2007). Medications for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine, 147(7): 505-514.
Chou R, et al. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7): 478-491.