Tricyclic Antidepressants for Chronic Pain

Never suddenly stop taking TCAs. 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.

TCAs 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 tricyclic antidepressants make these symptoms worse. These medicines can also affect blood sugar levels in people with diabetes. If you notice that the results of your blood sugar tests are different than you expect, or if you have any questions, talk to your doctor.

Be sure to tell your doctor about all the medicines you are currently taking. TCAs can interact poorly with certain heart medicines—for example, digoxin (such as Lanoxin)—and/or with other medicines, such as those used to treat seizures—for example phenytoin (Dilantin).

Dry mouth is common with these medicines. To help with dry mouth, you can chew sugarless gum, suck on sugarless candy, or melt ice in your mouth. If you continue to have problems with dry mouth after a couple of weeks, call your doctor. Dry mouth can lead to tooth decay and gum disease.

These medicines can make your skin more sensitive to the sun.

• Stay out of the sun, if possible.
• Wear long pants, long-sleeved shirts, and hats, if possible.
• Use sunscreen with an SPF that your doctor recommends.

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 Reference Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breast-feeding, 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, breast-feeding, 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 Reference PDF Opens New Window document?) to help you understand this medication.

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