Tricyclic antidepressants (TCAs) are commonly used in pain management. Use of TCAs may cause drowsiness in patients. For this reason, patients are often urged to take these medications just before going to bed. To minimize potential side effects, most physicians will start their patients on a low dose of the medication and gradually increase the amount. Other side effects associated with TCAs include:

• Dry mouth
• Constipation
• Weight gain
• Urination difficulties
• Changes in blood pressure
• Dizziness, lightheadedness and fainting
• Blurred vision

Because of the potential side effects associated with the TCAs, their use is generally not recommended in patients age 50 or older.

The analgesic benefits of TCAs can be experienced at lower doses than are needed for treating depression. This helps to minimize side effects for many patients. However, many patients require doses equivalent to those used for depression in order to obtain pain relief.

Selective serotonin and norepinephrine reuptake inhibitors (SSNRIs) are also frequently prescribed to treat pain. Among the possible side effects are nausea, dry mouth, loss of appetite, fatigue, sleep problems, sweating and tremors.

Patients who discontinue use of antidepressants must do so slowly and under a physician’s close supervision. Tapering off too quickly can cause withdrawal symptoms, including insomnia, restlessness and vivid dreams.