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    Tricyclic Antidepressants for Neck Pain

    Examples

    Generic Name Brand Name
    amitriptyline
    doxepin Silenor, Zonalon
    imipramine Tofranil

    How It Works

    Low doses of tricyclic antidepressant medicines relieve pain and cause drowsiness. Higher doses increase the levels of certain brain chemicals that improve your mood.

    Why It Is Used

    Low doses of tricyclic antidepressants are used to relieve long-lasting (chronic) neck pain. They also cause drowsiness, which may improve sleep and relieve fatigue. In higher doses, antidepressants can help to relieve symptoms of depression. Chronic pain can lead to depression.

    How Well It Works

    Using tricyclic antidepressants to relieve neck pain is not well studied.1 Although researchers are exploring whether and how well tricyclic antidepressants do affect chronic pain, it is known that they can improve sleep. This may in turn improve your ability to cope with pain.

    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.

    Call911or other emergency services right away if you have:

    Call your doctor right away if you have:

    Common side effects of this medicine include:

    The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. Talk to your doctor about these possible side effects and the warning signs of suicide.

    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 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.

    Be sure to tell your doctor about all the medicines you are currently taking. TCAs can interact poorly with certain heart medicines-digoxin (for example, Lanoxin)-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, 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 PDF document?) to help you understand this medication.

    Citations

    1. Binder A (2008). Neck pain, search date May 2007. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

    ByHealthwise Staff
    Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine
    Specialist Medical ReviewerRobert B. Keller, MD - Orthopedics

    Current as ofNovember 14, 2014

    WebMD Medical Reference from Healthwise

    Last Updated: November 14, 2014
    This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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