Tricyclic antidepressants for neck pain

Examples

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Brand Name	Generic Name
Vanatrip	amitriptyline hydrochloride

Brand Name	Generic Name
Sinequan	doxepin hydrochloride

Brand Name	Generic Name
Tofranil	imipramine hydrochloride

How It Works

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

Why It Is Used

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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

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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

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Side effects vary among the different tricyclic antidepressants. If you have severe side effects from one medicine, try another.

Most side effects decrease over time. They may include:

• Constipation.
• Dry mouth.
• Blurred vision.
• Drowsiness.
• Low blood pressure.
• Weight gain.
• Tremors and sweating.
• Urinary retention.
• Increased appetite.

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.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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You may start to feel better within 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.

These medicines are generally not prescribed for people who have heart problems.

People with chronic pain and depression are often treated with a higher dosage of tricyclic antidepressant than the dose used for chronic pain alone. They may also use another type of antidepressant, a selective serotonin reuptake inhibitor (SSRI). SSRIs include sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil). For more information, see the topic Chronic Pain.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Binder A (2006). Neck pain, search date May 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer	Robert B. Keller, MD - Orthopedics
Last Updated	August 21, 2008