Antidepressants, Tricyclic Health Article

Special conditions

People with certain medical conditions or who are taking certain other medicines can have problems if they take tricyclic antidepressants. Before taking these drugs, be sure to let the physician know about any of these conditions:

ALLERGIES. Anyone who has had unusual reactions to tricyclic antidepressants or to carbamazepine (Tegretol), maprotiline (Ludiomil), or trazodone (Desyrel) in the past should let his or her physician know before taking tricyclic antidepressants. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

PREGNANCY. Problems have been reported in babies whose mothers took tricyclic antidepressants just before delivery. Women who are pregnant or who may become pregnant should check with their physicians about the safety of using tricyclic antidepressants.

BREASTFEEDING. Tricyclic antidepressants pass into breast milk and may cause drowsiness in nursing babies whose mothers take the drugs. Women who are breastfeeding should check with their physicians before using tricyclic antidepressants.

DIABETES. Tricyclic antidepressants may affect blood sugar levels. Diabetic patients who notice changes in blood or urine test results while taking this medicine should check with their physicians.

OTHER MEDICAL CONDITIONS. Before using tricyclic antidepressants, people with any of these medical problems should make sure their physicians are aware of their conditions:

• current or past alcohol or drug abuse
• bipolar disorder (manic-depressive illness)
• schizophrenia
• seizures (convulsions)
• heart disease
• high blood pressure
• kidney disease
• liver disease
• overactive thyroid
• stomach or intestinal problems
• enlarged prostate
• problems urinating
• glaucoma
• asthma

USE OF CERTAIN MEDICINES. Taking tricyclic anti-depressants with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Side effects

The most common side effects are dizziness, drowsiness, dry mouth, unpleasant taste, headache, nausea, mild tiredness or weakness, increased appetite or craving for sweets, and weight gain. These problems usually go away as the body adjusts to the drug and do not require medical treatment. Less common side effects, such as diarrhea, vomiting, sleep problems, sweating, and heartburn also may occur and do not need medical attention unless they do not go away or they interfere with normal activities.

More serious side effects are not common, but may occur. If any of the following side effects occur, check with the physician who prescribed the medicine as soon as possible:

• blurred vision
• eye pain
• confusion
• hallucinations
• fainting
• loss of balance
• swallowing problems
• difficulty speaking
• mask-like face
• shakiness or trembling
• nervousness or restlessness
• movement problems, such as shuffling walk, stiff arms and legs, or slow movement
• decreased sexual ability
• fast or irregular heartbeat
• constipation
• problems urinating

Some side effects may continue after treatment with tricyclic antidepressants has ended. Check with a physician if these symptoms occur:

• headache
• nausea, vomiting, or diarrhea
• sleep problems, including vivid dreams
• unusual excitement, restlessness, or irritability

Interactions

Life-threatening reactions, such as extrememly high blood pressure, may occur when tricyclic antidepressants are taken with other antidepressants called monoamine oxidase (MAO) inhibitors (such as Nardil and Parnate). Do not take tricyclic antidepressants within 2 weeks of taking a MAO inhibitor. However, a patient can take an MAO inhibitor immediately after tricyclic antidepressant therapy is stopped by the physician.

Tricyclic antidepressants may interact with many other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Anyone who takes tricyclic antidepressants should let the physician know all other medicines he or she is taking. Among the drugs that may interact with tricyclic antidepressants are:

• Central nervous system (CNS) depressants such as medicine for allergies, colds, hay fever, and asthma; sedatives; tranquilizers; prescription pain medicine; muscle relaxants; medicine for seizures; sleep aids; barbiturates; and anesthetics.
• Diet pills
• amphetamines
• blood thinning drugs
• medicine for overactive thyroid
• cimetidine (Tagamet)
• other antidepressant drugs, including MAO inhibitors (such as Nardil and Parnate) and antidepressants that raise serotonin levels (such as Prozac and Zoloft)
• blood pressure medicines such as clonidine (Catapres) and guanethidine monosulfate (Ismelin)
• disulfiram (Antabuse), used to treat alcohol abuse
• major tranquilizers such as thioridazine (Mellaril) and chlorpromazine (Thorazine)
• antianxiety drugs such as chlordiazepoxide (Librium) and alprazolam (Xanax)
• antiseizure medicines such as carbamazaepine (Tegretol) and phenytoin (Dilantin)

The list above does not include every drug that may interact with tricyclic antidepressants. Be sure to check with a physician or pharmacist before combining tricyclic antidepressants with any other prescription or non-prescription (over-the-counter) medicine.

Nancy Ross-Flanigan