NEUROPATHIC PAIN-TCA & SSRI

SUMMARY

1. Uses: antidepressants, sedation, chronic pain. Potent serotonergic, noradrenergic, and anti-histaminergic effects.
2. Analgesic effects within 1 week, followed by antidepressant effects in 2 weeks.
3. Recommended use of SSRI in the morning & sedating TCAs at night.

SIDE EFFECTS
4. Noradrenergic side effects can be assoc. with autonomic (orthostatic hypotension, dizziness, urinary retention), cardiac (tachycardia), and ocular (blurred vision) disturbances.
5. Serotonergic effects can include increased gastric distress, agitation, and headaches.
6. Antihistamine-mediated effects can include decreased gastric acid secretion and sedation.
7. Serotonin syndrome: toxic levels of serotonin in blood & CSF leading to delirium, autonomic & neurologic dysfunction with concomitant use of TCA, SSRI & tramadol.

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.