Other Side Effects

Increased sweating can occur with the tricyclic compounds and occasionally can be marked. The mechanism for this symptom is unclear but may be associated with noradrenergic effects. Another side effect for which the mechanism is unclear is carbohydrate craving. This effect, when coupled with antihistaminic effects, can lead to significant weight gain. One report of outpatients treated with amitriptyline found an average gain of 7 kg during a 6-month period (Berken et al. 1984). Weight gain appears to be greater with the tertiary compounds (Fernstrom et al. 1986) and is less common with nortriptyline, desipramine, and protriptyline. Sexual dysfunction has been described with the tricyclics but generally is less common with this group than during treatment with the SSRIs. This side effect appears to be associated with the more serotonergic compounds and does occur with clomipramine. Tricyclic antidepressants can cause allergic skin rashes, which are sometimes associated with photosensitivity reactions. Various blood dyscrasias also have been reported; fortunately, these are very rare.

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