Tricyclic Antidepressants for Postpartum Depression
How It Works
Tricyclic antidepressants balance certain
brain chemicals (neurotransmitters) that are linked to
depression. When these brain chemicals are in proper
balance, the symptoms of depression may be relieved.
Why It Is Used
Tricyclics are an older class of
antidepressant that has been well studied for
postpartum depression treatment. Nortriptyline and
imipramine are passed on to breast-feeding infants at very low levels.
Nortriptyline has been studied the most for breast-feeding mothers.1
Doxepin (Sinequan, Zonalon) is not considered safe while breast-feeding.2
Tricyclics may cause bothersome side effects.
This is why tricyclics are usually tried only when treatment with a selective
serotonin reuptake inhibitor (SSRI) hasn't worked well. But if you have
done well with a tricyclic in the past, talk to your doctor about using it for
How Well It Works
Tricyclics are as effective as newer
antidepressant medicines at relieving symptoms of depression. But the side
effects can be worse.
Side effects of tricyclic antidepressants
tend to improve as you continue to take the medicine. Potential side effects
- Stomach upset and other problems, such as
- Fatigue, drowsiness.
- Insomnia, nightmares.
- Dry mouth, blurred
- Lowered blood pressure.
- Changes in appetite or
- Excessive sweating.
- Inability to urinate
- Loss of sexual desire or ability.
- Tremors, shuffling walk, slurred speech (uncommon, so report this
to your doctor).
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
Tricyclics 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
Do not suddenly stop taking these medicines. These medicines must be gradually tapered off with
supervision from your doctor.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Weissman AM, et al. (2004). Pooled analysis of
antidepressant levels in lactating mothers, breast milk, and nursing infants.
American Journal of Psychiatry, 161:
Brockingham I (2004). Postpartum psychiatric
disorders. Lancet, 363(9405): 303-310.