Tricyclic antidepressants (TCAs) for the treatment of chronic pelvic pain

Examples

Generic Name	Brand Name
amitriptyline	Amitril, Elavil
doxepin	Sinequan
imipramine	Tofranil
trazodone	Desyrel

How It Works

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

Why It Is Used

Tricyclic antidepressants are used to help improve coping skills and pain tolerance and to restore normal sleep patterns in women with chronic pelvic pain.²

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 medication because of side effects, and others report no improvement.³

Side Effects

Side effects vary among the different medications in this class. They may include:

• Drowsiness.
• Dry mouth.
• Constipation.
• Confusion.
• Agitation or nightmares.
• Lightheadedness when changing position (orthostatic hypotension).

Tricyclic antidepressants may make problems worse if you have any of the following:

• Epilepsy
• Difficulty urinating (urinary retention)
• Glaucoma
• Heart problems, such as coronary artery disease or heart failure

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

Studies suggest that using a tricyclic antidepressant with a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine, may be more successful than using just one medication to break the cycle of pain, sleep problems, and depression caused by chronic female pelvic pain.¹

These medications may take 2 to 3 weeks to start working. They usually work quickly to improve sleep but may take several weeks to improve pain. Treatment with antidepressants does not always relieve symptoms caused by chronic pelvic pain. Even when the treatment does work, you may find the side effects of these medications unacceptable.

Using an antidepressant medication to treat chronic pelvic pain does not mean that the condition is "all in your head." The dose of a tricyclic antidepressant used to treat chronic pelvic pain is usually much less than that needed to treat depression.

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Author:	Kathe Gallagher, MSW	Last Updated: January 30, 2007
Medical Review:	Renée M. Crichlow, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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