QUESTION:
Dear Dr. Heller,
I am not biologically unhappy but was given a low dose (10mg) of Pamelor for chronic neck pain and it seemed to help quite a bit. The problem is the side effects. The most bothersome are loss of libido and constipation - (I also worry about bladder problems and if higher BP and palpitations are related). So I started on desipramine, but side effects appear to be the same. I know there are a lot of similar drugs. Do you have any suggestions? One friend is helped by "Remeron" for back pain - can you tell me about it?
Thanks.
ANSWER:
Usually the tricyclic antidepressants (a.k.a. "TCA's") like Pamelor and
desipramine do not cause a loss of libido. Constipation can definitely occur. Bladder
problems usually occur in men with an enlarged prostate. Elevations in blood pressure and
palpitations are uncommon. There are many medications in the TCA class, and you may need
to try several to find one that works for your pain without causing those side effects.
Alternatives include epilepsy medications (such as Neurontin) and Ultram.
Remeron is an antidepressant that blocks the serotonin #2 receptor. It is particularly
useful for insomnia and post traumatic stress disorder. It also helps stop the temporary
side effects some individuals get from BuSpar and SSRI's.
