Tricyclic antidepressants for premenstrual syndrome (PMS)

Examples

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Brand Name	Chemical Name
Elavil	amitriptyline hydrochloride

Brand Name	Chemical Name
Anafranil	clomipramine hydrochloride

Brand Name	Chemical Name
Pertofrane	desipramine hydrochloride

Brand Name	Chemical Name
Sinequan	doxepin hydrochloride

Brand Name	Chemical Name
Tofranil	imipramine hydrochloride

Brand Name	Chemical Name
Pamelor	nortriptyline hydrochloride

Brand Name	Chemical Name
Vivactil	protriptyline hydrochloride

Brand Name	Chemical Name
Surmontil	trimipramine maleate

Tricyclic antidepressants (TCAs) are taken orally every day throughout the menstrual cycle for premenstrual syndrome (PMS) symptoms. Generally, a low dose is given at first, and the dosage is increased slowly until the medication takes effect. This helps minimize side effects.

How It Works

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TCAs improve your mood by increasing the levels of certain chemicals in the brain (neurotransmitters).

In low doses, these medications may cause drowsiness and sleep. This can be helpful when sleep disorders are a symptom of PMS.

Why It Is Used

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TCAs may be used if PMS is causing:

• Severe depression.
• Sleep disturbances.

How Well It Works

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Some women with severe premenstrual depression benefit from TCAs. TCAs have not been studied as much as selective serotonin reuptake inhibitors (SSRIs) for their specific effects on PMS mood symptoms.

Side Effects

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The side effects of TCAs may include:

• Constipation.
• Dry mouth.
• Blurred vision.
• Drowsiness.
• Lowered blood pressure.
• Weight gain.
• Tremors, sweating.
• Urinary retention.
• Loss of sexual desire or ability.

Side effects decrease as you continue treatment.

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

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Tricyclic antidepressants are taken every day throughout the menstrual cycle. By comparison, an SSRI antidepressant can be taken for only the premenstrual part of each cycle to treat PMS-related symptoms.¹

TCAs take 4 to 6 weeks to effectively relieve PMS symptoms.

When considering TCA treatment, compare the possible benefits against the costs of treatment and possible side effects. You can discuss these with your health professional.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Freeman EW, et al. (2004). Continuous or intermittent dosing with sertraline for patients with severe premenstrual syndrome or premenstrual dysphoric disorder. American Journal of Psychiatry, 161(2): 343–351.

Credits

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Author	Kathe Gallagher, MSW
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Primary Medical Reviewer	Renée M. Crichlow, MD - Family Medicine
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
Last Updated	July 7, 2006