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Tricyclic Antidepressants (TCAs) for the Treatment of Chronic Pelvic Pain


Examples

Generic NameBrand Name
amitriptylineSilenor, Tofranil
doxepinSilenor, Tofranil
imipramineSilenor, Tofranil
trazodoneSilenor, Tofranil

How It Works

Tricyclic antidepressants can improve chronic pain symptoms. But it is not known exactly how they do so. They may improve pain tolerance, and they may reduce symptoms of depression.1

Why It Is Used

Tricyclic antidepressants are used to help improve coping skills and pain tolerance in women who have chronic pelvic pain.1

In low doses, tricyclic antidepressants can help relieve pain. In higher doses, they have antidepressant effects.

How Well It Works

When using tricyclic antidepressants for chronic pelvic pain (with no diagnosable cause), some women report that their pain is less intense and doesn't last as long. Some women discontinue the medicine because of side effects, and others report no improvement.2

Side Effects

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:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Callor other emergency services right away if you have:

  • Trouble breathing.
  • Hives.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor right away if you have:

  • Thoughts of suicide.
  • Agitation and restlessness.
  • Seizures.
  • Fast heartbeat.
  • Nausea and vomiting.

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.

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

What To Think About

Never suddenly stop taking TCAs. 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.

TCAs 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 tricyclic antidepressants make these symptoms worse.

Be sure to tell your doctor about all the medicines you are currently taking. TCAs can interact poorly with certain heart medicines—digoxin (for example, Lanoxin)—and/or with other medicines, such as those used to treat seizures—phenytoin (Dilantin).

Taking medicine

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.

Advice for women

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.

Checkups

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)Click here to view a form.(What is a PDF document?) to help you understand this medication.

References

Citations

  1. American College of Obstetricians and Gynecologists (2004, reaffirmed 2008). Chronic pelvic pain. ACOG Practice Bulletin No. 51. Obstetrics and Gynecology, 103(3): 589–605.

  2. Howard FM (2003). Chronic pelvic pain. Obstetrics and Gynecology, 101(3): 594–611.

Credits

ByHealthwise Staff
Primary Medical ReviewerSarah Marshall, MD - Family Medicine
Specialist Medical ReviewerKirtly Jones, MD, MD - Obstetrics and Gynecology
Last RevisedJanuary 11, 2011

eMedicineHealth Medical Reference from Healthwise

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