While studying about tricyclic antidepressants (TCAs), I came across some interesting information regarding the many different off-label uses of TCAs in medicine. Amitriptyline (Elavil) and doxepin are often prescribed off -label as studies have shown that these medications are effective in preventing migraines (Moraczewski et al., 2023). As this is a TCA, it does produce anticholinergic effects which can lead to symptoms such as dry mouth, constipation, urinary retention, and tachycardia (Rosenthal & Burchun, 2021). TCAs have been shown to be effective in treating the symptoms associated
with fibromyalgia, and neuropathic pain by modulating neurotransmitters in the central nervous system (Moraczewski et al., 2023). Additionally,
Amitriptyline
(Elavil) has been shown to be the only medication
effective in treating depression in patients with Parkinson’s disease. Although effective for Parkinson’s disease, TCAs have an anticholinergic effect which can make dementia worse, and an antiadrenergic effect which can contribute more to orthostatic hypotension (Rosenthal & Burchun, 2021). Additionally, there is no contraindication with starting a TCA after an SSRI as a contraindication exists with starting an MAOI right after an SSRI. A TCA will not raise concern for serotonin syndrome the way that MOAIs and SSRIs when combined do (Rosenthal & Burchun, 2021).
References
Moraczewski, J., Awosika, A. O., & Aedma, K. K. (2023). Tricyclic Antidepressants. In StatPearls [Internet].
Treasure Island, FL: StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557791/
Rosenthal, L., & Burchum, J. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
