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
When these drugs are not used
- Some of these medicines are not given to
older adults, because the medicines cause too many severe side
- Cyclic antidepressants usually are not given to people
with certain heart problems, such as irregular heartbeats or low blood
How Well It Works
Research has shown that cyclic
antidepressants reduce chronic
low back pain for some people.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 with low back pain.2
Side effects may vary among these
medicines, and most of them decrease as the person continues to take the
medicine. Cyclic antidepressants tend to have more common and more serious side
effects than other, newer types of antidepressant medicines, such as serotonin
reuptake inhibitors (SSRIs). Side effects include:
- Stomach upset and other digestive problems,
such as constipation.
- Dry mouth.
- Lowered blood pressure.
- Tremors and sweating.
- Inability to urinate
- Sexual side effects.
- Confusion or
delirium in older adults.
- Fatigue and drowsiness.
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.
Drug Reference for a full list of side effects. (Drug Reference is not
available in all systems.)
What To Think About
These medicines need to be started
at low doses, and the dose should be increased gradually to reduce the severity
of side effects. Your doctor may recommend occasional 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.
Do not suddenly stop taking these medicines without talking to your doctor. These
medicines are often gradually tapered off, under supervision by your
You may start to feel better within 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. Desipramine and
nortriptyline have the fewest side effects and may be given to older adults for
this reason. But antidepressants may not be the preferred choice for older
adults, due to severe side effects.
(TCAs) and tetracyclic medicines are used by carefully selected people who are
closely monitored while they are taking the medicine. These antidepressants are
not generally used along with:
- Certain heart medicines, such as digoxin
- Certain medicines used to treat seizures, such as
Cyclic antidepressants are not recommended for people who
have certain heart conditions.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
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):
Staiger TO, et al. (2003). Systematic review of
antidepressants in the treatment of chronic low back pain. Spine, 28(22): 2540-2545.