What should I know about tricyclic antidepressants?

Tricyclic antidepressants, or TCAs, are used to prevent migraines. They can decrease the frequency, severity, and duration of a migraine. The amount prescribed varies from person to person.

TCAs are commonly taken once a day at bedtime. Your doctor will start you off with a low dose and increase the dose slowly every 1 to 2 weeks. Typically, people respond within 10 days. But the best results may not occur until after you've taken the medication for 4 to 8 weeks.

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How do tricyclic antidepressants work?

TCAs work by increasing the chemicals norepinephrine and serotonin in the brain. When these levels are low, there is a greater chance of migraines. So when the level is raised, there is less chance.

What are the possible side effects from using tricyclic antidepressants and what should I do about them?

Common side effects from TCAs include:

  • agitation
  • anxiety
  • blurred vision
  • constipation
  • difficulty urinating
  • dizziness when standing, called orthostatic hypotension
  • drowsiness
  • dry mouth
  • dry skin
  • fast heart rate
  • fatigue
  • increased appetite
  • muscle twitches
  • nervousness
  • sedation, feeling medicated or sleepy
  • sexual dysfunction
  • sweating
  • weight gain

If you experience any of the following symptoms, you must seek immediate medical attention.

  • altered liver function
  • asthma - worsening of symptoms
  • glaucoma - worsening
  • irregular heartbeat, called cardiac arrhythmia
  • loss of consciousness
  • overdose - potentially fatal
  • rashes or other allergic reactions
  • seizures

On the next page, learn about possible drug interactions with TCAs.

Drug Interactions

What are the possible drug interactions with tricyclic antidepressants?

To help you avoid unnecessary side effects, use caution when taking these medications with other drugs. Tell your doctor about all other drugs you are taking. It's even a good idea to let your doctor see your other prescription containers.

Below is a partial list of drugs that can cause unwanted effects if taken with tricyclic antidepressants. Your doctor can help you know whether or not you can safely take tricyclic antidepressants with the other medications you take.

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Other Antidepressants

  • Prozac (fluoxetine HCl)
  • Luvox (fluvoxamine maleate)
  • Paxil (paroxetine HCl)
  • Zoloft (sertraline HCl)
  • monoamine oxidase inhibitors

Heart Medications Used for Rhythm Abnormalities

  • Tambocor (flecainide acetate)
  • Rythmol (propafenone HCl)

Sedating Medications Such as Barbiturates

  • Luminal Sodium (phenobarbital)
  • Seconal Sodium (secobarbital sodium)
  • Amytal (amobarbital sodium)

Anticholinergic Medications

  • Bentyl (dicyclomine HCl)
  • Ditropan (oxybutynin)

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