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Home > Health & Fitness > Healthwise > Tricyclic and Tetracyclic Antidepressants for Low Back Pain
Low doses of tricyclic or tetracyclic
antidepressant medicine increase the level of certain brain chemicals, which
may affect how the brain perceives pain. They may also help you sleep.
Low doses of antidepressants are
often used to treat people who have chronic pain.
Higher doses of
antidepressants are used to relieve
Research has shown that cyclic
antidepressants reduce chronic
low back pain for some people.1 They are not recommended for sudden and severe (acute) low
back pain. Other antidepressants called selective serotonin reuptake inhibitors
(SSRIs) do not appear to help people who have low back pain.2
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
Call 911 or other emergency services right away if you have:
Call your doctor right away if you have:
Common side effects of this medicine include:
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.
Drug Reference for a full list of side effects. (Drug Reference is not
available in all systems.)
Never suddenly stop taking antidepressants. The use of any
antidepressant should be tapered off slowly and only under the supervision of a
doctor. Abruptly stopping antidepressant medicines can cause negative side
effects or a relapse of your condition.
Antidepressants 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.
You may start to feel better in 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.
People who have seizures (epilepsy), difficulty urinating (urinary retention), glaucoma (an eye disease), or heart conditions may notice that antidepressants make these symptoms worse.
Be sure to tell your
doctor about all the medicines you are currently taking. Antidepressants can interact
poorly with certain heart medicines—digoxin (for example, Lanoxin)—and/or
with other medicines, such as those used to treat seizures—phenytoin
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
Complete the new medication information form (PDF)new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Chou R, Huffman LH (2007). Medications for acute and
chronic low back pain: A review of the evidence for an American Pain
Society/American College of Physicians clinical practice guideline.
Annals of Internal Medicine, 147(7):
Chou R, et al. (2007). Diagnosis and treatment of low
back pain: A joint clinical practice guideline from the American College of
Physicians and the American Pain Society. Annals of Internal Medicine, 147(7): 478–491.
May 14, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Robert B. Keller, MD - Orthopedics
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