Tricyclic antidepressants for postpartum depression

Examples

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Brand Name	Generic Name
Tofranil PM	imipramine

Brand Name	Generic Name
Pamelor	nortriptyline

How It Works

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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

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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 (Adapin, Sinequan) 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 been successful. But if you have done well with a tricyclic in the past, talk to your doctor about using it for postpartum depression.

How Well It Works

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Tricyclics are as effective as newer antidepressant medicines at relieving symptoms of depression, but the side effects can be worse.

Side Effects

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Side effects of tricyclic antidepressants tend to improve as you continue to take the medicine. Potential side effects include:

• Stomach upset and other problems, such as constipation.
• Fatigue, drowsiness.
• Excitability, anxiety.
• Insomnia, nightmares.
• Dry mouth, blurred vision.
• Lowered blood pressure.
• Changes in appetite or weight.
• Excessive sweating.
• Inability to urinate (urinary retention).
• 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.

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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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 dangerous.

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.

References

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Citations

1. Weissman AM, et al. (2004). Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. American Journal of Psychiatry, 161: 1066–1078.

2. Brockingham I (2004). Postpartum psychiatric disorders. Lancet, 363(9405): 303–310.

Credits

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Author	Jeannette Curtis
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Lisa S. Weinstock, MD - Psychiatry
Last Updated	June 24, 2008