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Cyclic Antidepressants

Potential Side Effects with Cyclic Antidepressants

Common Side Effects

  • Tremor
  • Unpleasant taste
  • Dry mouth
  • Nausea
  • Fatigue
  • Weakness
  • Anxiety
  • Diarrhea
  • Headache
  • Sensitivity to sunlight
  • Constipation
  • Indigestion
  • Insomnia
  • Sedation
  • Nervousness
  • Excessive sweating

Infrequent Adverse Effects

  • Shakiness
  • Vomiting
  • Eye pain
  • Slow pulse
  • Jaundice
  • Joint pain
  • Fever
  • Chills
  • Visual changes
  • Muscle aches
  • Nasal congestion
  • Difficult and/or frequent urination
  • Dizziness
  • Abnormal dreams
  • Diminished sex drive
  • Inflamed tongue
  • Hair loss
  • Abdominal pain
  • Rash
  • Palpitations
  • Hiccups
  • Back pain
  • Irregular heartbeat
  • Fainting

Rare Adverse Effects

  • Itchy skin
  • Swollen testicles
  • Swollen breasts
  • Involuntary movements of jaw, lips, and tongue
  • Sore throat
  • Nightmares
  • Confusion

Side Effects More Common To People Over Age 60

  • Seizures
  • Headache
  • Fainting
  • Urination problems
  • Dizziness
  • Shaking
  • Insomnia
  • Hallucinations

Contact Lenses. You may experience problems with your contact lenses if you take cyclics. Because these drugs can cause dry eyes, your lenses may get gummed up with deposits of thick secretions, making them feel gritty, itchy, or painful. If this happens, your doctor may be able to prescribe a different antidepressant, reduce your dose, or prescribe artificial tears.

Dizziness. Some tricyclics, especially amitriptyline, might make you dizzy when you stand up (this is called "orthostatic hypotension"). If you notice this, try standing up more slowly. In the morning, dangle your feet over the side of the bed for a few minutes before slowly standing up. If you have a serious problem with dizziness, your doctor may be able to adjust your dose or switch you to another cyclic. The tricyclics least likely to cause this problem are amoxapine and nortriptyline (Pamelor).

Drowsiness. Sedation is a common side effect of many tricyclics and tetracyclics; three of the most sedating are doxepin, amitriptyline, and trimipramine.

"I found the sleepiness to be fairly pleasant," Sally, 52, reports. "I was sleepy all the time, but it was a blissful sort of sleepiness. And since I'd been having trouble sleeping before I started taking imipramine, I didn't mind it so much."

If you think that "drugged" feeling is unpleasant, you can try taking cyclics right before bedtime or ask your doctor about lowering your dosage. Or you may have more luck with one of the nonsedating tricyclics: amoxapine, desipramine, nortriptyline, or protriptyline. These are a good choice if you experience lethargy and tiredness in addition to your depression. On the other hand, they may interfere with sleep, especially if you take your medication late in the day.

Neuroleptic Malignant Syndrome. If you use amoxapine too long, you run the small risk of developing a group of symptoms called "neuroleptic malignant syndrome," including fever, fast or irregular heartbeat, sweating, weakness, muscle stiffness, seizures, or loss of bladder control.

Sexual Problems. Most antidepressants affect sexual functioning in one way or another, and cyclics aren't any different. You may experience either an increase or a decrease in sexual interest. Men may experience problems with erection or ejaculation or suffer from impotence. Cyclics may trigger swollen testicles or breast enlargement in men and women. If you experience significant problems with sexual functioning, your doctor may choose to switch you to a different antidepressant that doesn't cause these problems, such as Wellbutrin (bupropion).

Sun Sensitivity. If you take a cyclic antidepressant and you go out into the sun even briefly, you may end up with a rash, red or discolored skin, or a dreadful sunburn. Before going out into the sun, study the accompanying list of "Sunlight Precautions When Taking Cyclic Antidepressants" (see box). If you do get a severe reaction from the sun, consult your doctor.

WebMD Medical Reference from "Making the Antidepressant Decision"

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