Family doctor

These are the more traditional antidepressants which have been used since the early 1960s, and are still very commonly prescribed today. They are very effective in treating depression, and are not addictive. There are a number of these medicines, most of which are listed below:

• Amitriptyline (Tryptanol, Amitrip)
• Clomipramine (Anafranil, Clopress)
• Desipramine (Pertofran)
• Dothiepin (Prothiaden, Dopress)
• Doxepin (Anten)
• Imipramine (Impramin Dumex)
• Maprotiline (Ludiomil) - really a tetracyclic, but similar to tricyclics
• Nortriptyline (Allegron, Norpress)
• Trimipramine (Surmontil, Tripress)
• Amoxapine (Asendin)

There are some differences between these listed antidepressants so people can find one works better for them than another, or that they have less side effects with one than another.

USE: Depression, bedwetting (occasionally), some chronic pain disorders, fibromyalgia and sleep disturbance

The listed medicines are not approved for all of these conditions.

Cautions:

Do not use:

• While using or for 2 weeks after using a Monoamine Oxidase Inhibitor (MAOI) - an uncommon type of antidepressant.
• If you've had a recent heart attack.

Be careful using these medicines in people with:

• Heart problems
• Epilepsy or lowered seizure threshold (e.g. brain damage)
• Glaucoma
• History of urinary retention
• High thyroid
• Liver problems
• Kidney problems

Side effects:

For many people side effects can happen at the start of treatment with these medicines and then as the body gets used to the medicine they are usually less of a problem or can go away completely. For this reason, it is very common to start treatment at a low dose and gradually build up, especially in older people who may be more sensitive to these side effects. Side effects can happen before you notice any improvement in your depression (or other condition you are taking it for).

The most common side effects can include:

• Dry mouth
• Dry eyes
• Constipation
• Urinary retention
• Blurred vision
• Drowsiness, dizziness
• Orthostatic hypotension (low blood pressure if you stand up suddenly)
• Anxiety
• Nausea
• Weight gain or weight loss
• Feeling of warmth in the body, perspiration or flushing
• Headache
• Allergy is very uncommon, and may have the symptoms of skin rash, itching, oedema (increased fluid in part of the body which can make it look swollen, including the face). If these symptoms occur with this or any medicine, talk to a doctor immediately.

If you have any other effects which you think may be from this medicine, please talk to your doctor or pharmacist.

Interactions:

When being prescribed other medicines or when buying medicines from the pharmacy or supermarket always check with a doctor or pharmacist if that medicine you are about to get can be used safely with the medicines you are taking already. The tricyclic antidepressant group of medicines can be affected by many other medicines or remedies, both prescription and non-prescription.

Interactions include:

• Cimetidine (Tagamet)
• Other antidepressants, including fluoxetine (Prozac)
• MAOI medicines e.g. tranylcypromine (Parnate) - these medicines MUST NOT be taken together as they are a dangerous combination.
• Alcohol (tricyclics can exaggerate the effect alcohol has)
• Other medicines which can also cause drowsiness
• Other medicines which can cause dry mouth or blurred eyes (anticholinergics) e.g. atropine, antihistamines, anti-parkinson medicines, phenothiazines, thioridazine
• Pseudoephedrine (a common ingredient of cold and flu remedies)
• Reserpine
• Carbamazepine (Tegretol)
• Some diabetic medicines

Patient information:

• Follow the instructions on the label of the medicine or as directed by your doctor.
• Do not give your medicine to anyone else, or use anyone else's medicines.
• These medicines take around 2 to 3 weeks for any benefit to be noticed and about 6 weeks to get to the best effect - be patient.
• Side effects are quite common at the beginning of treatment but many are minor and will disappear or diminish as your body becomes used to the medicine. Talk to your doctor or pharmacist if you think you have side effects.
• Sometimes the doctor will start you on a low dose then gradually increase the dose to allow your body to get used to the medicine.
• These medicines are not addictive.
• It is recommended that when deciding to stop taking this medicine that you talk it over with your doctor first. In general it is recommended when stopping the medicine to gradually reduce the dose then stop, rather than stopping abruptly. Your doctor or pharmacist can advise you on this.
• If you do not think you are getting any benefit from this medicine talk to your doctor as you may need a change in dose or to change to another one that will work better for you - remember that you need to take the medicine at least 6 weeks first.
• There are a number of medicines which can interfere with this medicine so always ask you doctor or pharmacist before taking other medicines with this one, even if the medicine is a simple cold remedy from the cupboard at home.
• If you are planning to get pregnant talk to your doctor first about whether or not you should continue taking this medicine. Your doctor can advise you on taking this medicine during breastfeeding also.
• It is wise to avoid alcohol when using these medicines.
• Tricyclic antidepressants can cause drowsiness or make you less alert, especially at the start of treatment. If affected do not drive a vehicle or operate machinery.
• If you have an allergic reaction (see adverse effects) talk to a doctor immediately.
• These medicines may dry the eyes so if you wear contact lenses, let your optometrist know you are taking this medicine.
• As these medicines can cause dry mouth ensure good dental hygiene and regular dental checks.

The information above relates to a group of medicines and not to any one individual medicine and is intended to give a general overview. Interactions, cautions for use, uses and side effects may vary for individual medicines from the information given above. Your doctor or pharmacist will have access to more information about each of the individual medicines.