Tricyclic antidepressants for postpartum depression

Examples

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Brand Name	Chemical Name
Tofranil PM	imipramine

Brand Name	Chemical 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. However, if you have done well with a tricyclic in the past, talk to your health professional about using it for postpartum depression.

How Well It Works

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Tricyclics relieve depression in around 60% of people with depression.³

Side Effects

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Side effects of tricyclic antidepressants tend to lessen as you continue to take the medication. 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—report to your health professional).

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 medication in your blood. Too much of this type of medication in the bloodstream can be dangerous.

Do not suddenly stop taking these medications. These medications must be gradually tapered off with supervision from your health professional.

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.

3. Butler R, et al. (2006). Depression in adults, search date September 2004. Online version of Clinical Evidence (15): 1–38.

Credits

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Author	Kathe Gallagher, MSW
Editor	Kathleen M. Ariss, MS
Editor	Renée Spengler, RN, BSN
Associate Editor	Pat Truman
Primary Medical Reviewer	Joy Melnikow, MD, MPH - Family Medicine
Specialist Medical Reviewer	Lisa S. Weinstock, MD - Psychiatry
Last Updated	June 30, 2006