| Antidepressants treat pain, and the emotional conditions for
which they are more commonly prescribed, by adjusting level of neurotransmitters
in the brain. They can increase the availability of our body's signals
for well-being and relaxation, which can improve pain control in
individuals with chronic pain conditions that aren't fully responding
to the usual analgesics.
These medications are usually prescribed in far lower doses for
pain control than would be effective to treat emotional imbalances.
Because of the dosages involved, it's far safer for a physician
to suggest a combination treatment with two different antidepressants
taken at different times of day to target different aspects of a
chronic pain condition. It is not uncommon for a low-dose SSRI to
be prescribed for morning use, and a low-dose tricyclic or benzodiazepine
for evening use to counteract the insomnia.
Chronic pain conditions treated by low-dose antidepressants include:
- Chronic pain reduction - all
- Insomnia - Benzodiazepines and tricyclics can be used to treat
this condition which often accompanies and worsens chronic pain
conditions.
- Irritable bowel - SSRIs help regulate serotonin, which also
plays a role in proper digestion, and can relieve this uncomfortable
companion of some chronic pain syndromes.
- Menstrual pain and discomfort - SSRIs
- Vascular headache reduction - Tricyclics may be prescribed in
low doses to reduce the frequency of migraine attacks, as well
as the likelihood of rebound headaches from the frequent use of
pain relievers. It may take a period of consistent use before
the full benefits are realized.
Antidepressants are usually prescribed for a duration of a few
months, though you will not usually be able to evaluate their effectiveness
until you have been taking them for several weeks. These medications,
particularly tricyclics and SSRIs, depend on having a steady dose
build up in the body over a period of time. You will need to take
your medication daily in order to experience the full benefits of
treatment. Benzodiazepines may occasionally be prescribed on an
as needed basis, but you should follow your doctor's guidelines.
While antidepressants pose some risk of physical dependence, they
are not generally considered a drug of abuse. Individuals with chronic
pain may be significantly helped by these medications, which may
reduce the need for pain relievers. Antidepressants generally have
a more favorable profile for long-term side effects than frequent,
ongoing analgesic use.
Antidepressants are available only by prescription.
General Side Effects
The most common side effects with antidepressants are blurry vision,
constipation, difficulty urinating, dry mouth, fatigue (your doctor
may suggest evening or bedtime dosages), headache (SSRIs), insomnia
(SSRIs), nausea (SSRIs), sensitivity to sunlight (Tricyclics: Wear
sunglasses, protective clothing, and sunblock. Do not use sunlamps
or tanning beds.), and temperature sensitivity (avoid saunas, jacuzzis,
and exposure to extreme cold). Weight fluctuations (Tricyclics:
typically weight gain; SSRIs: typically weight loss) and sexual
side effects such as decreased libido are also reported with these
medications. Do not take antidepressants before driving or performing
other potentially hazardous tasks until you are familiar with your
reactions to them.
Other side effects may vary widely, and cross a wide spectrum of
symptoms, though these medications are generally considered to be
very safe when used as directed. Individuals who have had allergic
reactions to one of these medications will have to try a different
medication on the advice of their doctor, as a serious reaction
could occur with any dose. An allergy to one medication of a type
is not necessarily an indication of allergy to all antidepressants
in that class, though your doctor will suggest proceeding with caution.
Consult the warnings and instructions for your individual treatment
for a more complete list of possible side effects.
Cautions: All antidepressants may not be right for everyone.
Some individuals may want to check with a doctor for safe use guidelines
with a particular condition, or may decide that another treatment
would be more appropriate. Be sure to give your prescribing physician
a complete medical history, being especially sure to mention any
of the following conditions.
- Alcohol or Drug Addiction: There is a slightly increased
risk of chemical dependence with these medications, particularly
for addiction prone individuals. If an addiction is untreated,
combining alcohol or drugs with antidepressants poses a greatly
increased risk for organ damage and dangerous or fatal overdose.
- Allergies: An allergy to an antidepressant in the past
might indicate that you should not use that medication, or related
medications. However, because there are different types of antidepressants,
your doctor may try a different medication. Skin reactions are
the most likely symptom of medication allergy, and indicate that
you should contact your doctor as soon as possible. Mention any
other food or drug allergies you may have experienced, to be sure
that your doctor can prescribe an appropriate medication.
- Bipolar Disorder: Antidepressants may convert depression
to mania.
- Brain Disease or Congenital Brain Disorder: Antidepressants
were not designed to treat these conditions, and may worsen some
of them. There is an increased risk of seizure with SSRI use.
- Breathing problems: If you have asthma, hay fever, allergies,
or chronic sinus conditions, be aware that some of the medications
used for these conditions may increase the risk of serious heart
complications when combined with antidepressant treatment. If
you have asthma, these drugs may make this condition worse.
- Difficulty urinating: Consult with your doctor, some
antidepressants may not be right for you.
- Enlarged prostate: Some antidepressants may worsen this
condition.
- Diabetes or Hypoglycemia: Some antidepressants may cause
fluctuations in blood sugar levels. Also, there are rare reports
of some antidepressants increasing numbness, tingling, or pain
in the extremities. Consult your doctor about minimizing these
effects.
- Heart problems: Do not take Elavil if you have had a
recent heart attack. Many heart medications may interact negatively
with Elavil, and certain medicine combinations may increase the
likelihood of dangerous heart-related side effects. Inform your
doctor of any history of spontaneous rapid heartbeat, irregular
heartbeat, or heart-related chest pain.
- Dependence: Physical dependence and withdrawal are possible
risks for some of these drugs. Even though these medications can
cause withdrawal symptoms when use is stopped, they have a low
rate of actual addiction. Addiction should be distinguished from
physical dependence, as it is a psychological need to seek out
a drug even when there is no compelling health need, to the point
of decreasing the quality of life. Addiction is typically rare
with these treatments, and withdrawal symptoms are usually mild
if you follow your doctor's advice.
- Diabetes: Some antidepressants may alter blood sugar.
- Glaucoma: Certain antidepressants may not be safe for
glaucoma. You will want to speak with your doctor about treatment
options.
- Intestinal blockage: Inform your doctor of any history
of this disorder. Tricyclic antidepressants have, in rare cases,
caused this condition.
- Irritable bowel or bladder: Constipation or difficulty
urinating may result from tricyclic antidepressant treatment,
consult your doctor about minimizing these possible side effects.
- Kidney Disease: These medications may stress damaged
kidneys. Ask your doctor if this treatment is right for you, or
if there are dosing guidelines that would make it safe. Drink
6-8 glasses of water daily to reduce strain on the kidneys.
- Liver Disease: Antidepressants may stress damaged livers.
Speak to your doctor about appropriate dosage guidelines, or other
available treatments. Do not combine alcohol use with your treatment.
- Medical Emergencies: Inform medical personnel if you
have taken these medications recently, as they may interfere with
diagnosis of certain conditions or interact with some treatments.
- Mental Depression: Therapy with central nervous system
depressants may exaggerate this condition.
- Mental Illness: Certain antidepressants may exaggerate
symptoms of depression in the mentally ill.
- Overdose: This may be indicated by extreme agitation,
coma, dizziness, stupor, shock, or difficulty breathing. If you
suspect an overdose of these medications, seek emergency medical
treatment immediately. To avoid, keep medication out of reach
of children, follow maximum dosing instructions, and do not mix
with alcohol or other drugs which may cause drowsiness.
- Parkinson's Disease: SSRIs may worsen this condition.
- Porphyria: Certain muscle relaxants are considered unsafe
for porphyria. Check with your doctor regarding a muscle relaxant
that will be safe for your condition.
- Pregnancy: These medications have not been demonstrated
to cause serious problems in pregnant or nursing women, though
they have not been adequately studied for safety. Speak with your
physician about the risks of treatment.
- Schizophrenia: These medications are not approved for
treating schizophrenia, and may increase paranoia.
- Seizures: Some of these medications may increase the
risk of seizure. Discuss this with your prescribing physician
if you have a history of seizure or are taking medication that
makes seizure more likely.
- Sexual Side Effects: These treatments may reduce the
libido.
- Surgery: Inform your doctor or dentist beforehand that
you use these medications, and follow any instructions they may
give you.
- Withdrawal: Long-term and frequent use of these medications
may result in withdrawal symptoms if treatment is stopped abruptly.
The severity of symptoms is usually dependent on dosage and length
of use, and may be alleviated by following the advice of your
doctor. Abruptly stopping treatment is not recommended for any
antidepressant.
Interactions
Antidepressants may interact with other medications you may be
taking. The following drugs are especially likely to interact with
these treatments, but you should check the labels of each individual
medication for a more complete list of interactions. If medications
increase each other's effects, or lead to undesirable drug buildups
in the body, your doctor may recommend adjusting the dosages of
one of the medications if it seems appropriate to use both treatments.
Medications which increase central nervous system depression should
not generally be taken with antidepressants, or within the time
frame that they are active in the body. If your doctor prescribes
other medications that have CNS depressant effects, be sure to work
out a medication schedule that won't leave you oversedated or increase
your risk for overdose.
Medications that alter serotonin levels should not be combined
with SSRIs, as a dangerous condition known as serotonin syndrome
can develop. Symptoms may include agitation, clumsiness, confusion,
diarrhea, fever, restlessness, shivering, sweating, trembling or
shaking, twitching, or uncontrollable excitement. If you experience
more than one of these conditions together, seek medical treatment
immediately.
Check with a doctor about the safety of your treatment in the combination
of any of the following:
- 5-HTP or Tryptophan - Should not be used within 5 weeks of stopping
treatment with an SSRI, increases risk of serotonin syndrome.
- Alcohol - Antidepressants and alcohol can accelerate central
nervous system depression, and may cause unexpected blackouts.
Avoid mixing the two, as this could result in liver damage, or
a dangerous and potentially fatal overdose.
- Amphetamines may increase the risk of heart problems.
- Antibiotics - Some types of antibiotics can cause undesirable
buildups of medication in the body when used with antidepressants.
Also, certain antidepressants may increase sensitivity to sunlight,
which can also be a side effect of antibiotic use. If this combination
is used, wear sunscreen and protective clothing to avoid serious
sun damage.
- Anticoagulants like Coumadin
(warfarin)
- Antihistamines like Tavist or Benadryl may cause oversedation
or increase the risk of other side effects.
- Antiseizure treatments - Some medications used to treat depression
and chronic pain may increase the risk of seizure, especially
in combination with seizure treatments. Oversedation may result
from combining other antidepressants with seizure medication.
Speak with your doctor about dosage adjustments and arranging
a medication schedule, or finding a more compatible treatment.
May increase risk of serotonin syndrome, speak to your doctor
about dosage adjustments.
- Appetite suppressants - May increase risk of heart complications,
check individual medications for interaction risks.
- Benzodiazepines (a class of antidepressants, antianxiety treatments,
anti-panic agents, and muscle relaxants) such as Ativan (lorazepam),
Valium (diazepam), Halcion (triazolam), Restoril (temazepam),
Librium(chlordiazepoxide), Xanax (alprazolam), Tranxene-SD (clorazepate),
Paxipam (halazepam), ProSom (estazolam), Klonopin (clonazepam),
and others, should not be used in combination with other antidepressants
except under the advice and supervision of a doctor.
- BuSpar (buspirone)
- Can result in oversedation. Should not be used within 5 weeks
of stopping treatment with an SSRI, increases risk of serotonin
syndrome.
- Central Nervous System Depressants - Any prescription medication,
over the counter medication, or herbal supplement that may cause
drowsiness. These medications should be used with caution while
taking antidepressants as you may become oversedated. Consult
your doctor or pharmacist to be sure that your treatment is as
safe as possible.
- Cough medicine - If you cough medicine contains dextromethorphan,
you should not use it within 5 weeks of stopping an SSRI as it
increases the risk of developing serotonin syndrome.
- Ephedrine, pseudoephedrine - may increase the risk of heart
complications, found in certain sinus and cold preparations. Avoid
supplements containing the herb Ephedra.
- Epinephrine (adrenaline) may increase the risk of heart complications.
- Herbs - The following herbs should not be combined with antidepressant
treatments: Ginseng, Indian Snakeroot, Kava kava, St. John's Wort,
Valerian, and Yohimbe
- Manarex (moclobemide) - Potential of serious interactions with
SSRIs.
- Lithium - Should not be used within
5 weeks of stopping treatment with an SSRI, increases risk of
serotonin syndrome.
- MAO inhibitors - Antidepressants of any other type should not
be mixed with MAO (monoamine oxidase) inhibitors, a class of antidepressants
and antisenility drugs, such as Eldepryl (selegiline), Furoxone
(furazolidone), Nardil (phenelzine), Marplan (isocarboxazid),
or Parnate (tranylcypromine). Never use any antidepressants within
2-6 weeks of stopping an MAO inhibitor, depending on the medication.
A drug interaction in this case could be serious or even fatal.
Patients over 65 should allow a longer wait period between using
antidepressants and an MAO, as medications may stay in their system
longer than in other patients.
- Muscle relaxants - Combining Flexeril
(cyclobenzaprine), Norflex
(orphenadrine), Skelaxin
(metaxalone), Soma (carisoprodol),
or Robaxin (methocarbamol),
Maolate (chlorphenesin), or Paraflex (chlorzoxazone), with an
antidepressant may overly depress the central nervous system.
- Narcotic pain medication like Codeine, Demerol
(meperidine), Buprenex (buprenorphine), Darvon (propoxyphene),
Dilaudid (hydromorphone), MS Contin or Kadian (morphine), nalbuphine,
OxyContin (oxycodone),
Percocet (oxycodone
and acetaminophen), Stadol (butorphanol), Talwin compound
(pentazocine), or Vicodin
(hydrocodone and acetaminophen), Vicoprofen
(hydrocodone and ibuprofen) may increase the central nervous
system depressant effects of some antidepressants. Demerol may
increase the risk of serotonin syndrom in combination with SSRIs.
- Oral contraceptives - These hormone treatments may interact
with benzodiazepines, causing the medication to buildup in the
body. Dosage adjustments may be necessary, so be sure to speak
with your doctor about an appropriate combination treatment.
- Orap (pimozide) may increase the risk of side effects.
- Parkinsonism medication like Cogentin or Larodopa
- Phenergan (promethazine) may increase the risk of side effects.
- Placidyl (ethchlorvynol)
- Protease inhibitors such as Agenerase (amprenavir), Norvir (ritonavir),
and perhaps others, may lead to toxic levels of some antidepressants
in the body.
- Quinidex (quinidine)
- Rifamate (isoniazid), Rifater (rifampin), or Mycobutin (rifabutin)
- Sedatives like Fioricet
(butalbital, acetaminophen, and caffeine), Fiorinal
(butalbital, aspirin, and caffeine), Phenobarbitol, Seconal, or
other barbiturates may cause oversedation in combination with
antidepressants.
- Selective serotonin reuptake inhibitors (SSRIs) like Celexa
(citalopram), Paxil (paroxetine), Prozac (fluoxetine), Luvox (fluvoxamine),
or Zoloft (sertraline) should not be mixed with each other, and
should only be used concurrently with other antidepressants at
the advice of a doctor.
- Sleep medication like Ambien
(zolpidem), Sonata
(zaleplon), or over the counter sleeping pills may cause oversedation
when combined with antidepressants.
- Street Drugs - Do not mix antidepressants with street drugs,
particularly hallucinogens. You may put yourself at risk for dangerous
or fatal overdoses. Do not use street drugs within 2-5 weeks of
stopping an antidepressant, or about the same amount of time encouraged
as a waiting period between the prescription antidepressant use
and the use of an MAO inhibitor.
- Tagamet (cimetidine)
- May increase risk of serious side effects.
- Tambocor (flecainide)
- Temaril (trimeprazine) may increase the risk of side effects.
- Tenex (guanfacine) - may decrease effectiveness of some antidepressants.
- Thyroid hormones such as Synthroid.
- Tikosyn (dofetilide) - possible heart rhythm problems, do not
mix with some antidepressants.
- Tranquilizers like Haldol (haloperidol), Mellaril (thioridazine),
or Thorazine (chlorpromazine) could cause oversedation when mixed
with antidepressants.
- Tricyclic antidepressants such as Elavil (amitriptyline), Asendin
(amoxapine), Anafranil (clomipramine), Pertofrane or Norpramin
(desipramine), Sinequan (doxepin), Tofranil (imipramine), Aventyl
or Pamelor (nortriptyline), Vivactil (protriptyline), and Surmontil
(trimipramine), should not generally be combined with other antidepressants
unless your doctor suggests it.
- Triptans - The migraine medications Amerge
(naratriptan), Imitrex
(sumatriptan), Maxalt (rizatriptan), and Zomig (zolmitriptan)
should not be used within 5 weeks of stopping treatment with an
SSRI, as this increases risk of serotonin syndrome.
- Ultram (tramadol) - This
pain reliever may oversedate you if taken in combination with
some antidepressants. Should not be used within 5 weeks of stopping
treatment with an SSRI, increases risk of serotonin syndrome.
- Vitamin C - Large doses increase the risk of weight gain when
taken with tricyclic antidepressant use.
- Wellbutrin/Zyban (bupropion)
- Antidepressant treatments should not generally be mixed with
each other, unless a psychiatrist determines that you have a condition
that resists treatment with a single medication.
For maximum safety and effectiveness, follow your
doctor's guidelines when using antidepressants, and always check
the individual instructions for each medication you may take. These
drugs may have somewhat different side effect and interaction profiles,
and should be investigated independently if you are taking them
concurrently with other medications or suspect that they may be
causing certain symptoms.
References:
This document is provided for information only; it is not intended
to diagnose symptoms, prescribe treatment, or to substitute for
consultation with a physician. While we have made every effort to
ensure that this information is accurate and extensive, only your
doctor can tell you if a medication, or drug combination, is safe
for you. Information intended for US residents only. |
