Safety issues

Some tricyclic antidepressants are more likely to cause side effects that affect safety. These side effects include:

• Disorientation or confusion, especially in older people when the dose is too high.
• Heartbeat that is too fast or not regular.
• Seizures that happen more often in people who have seizures.

Before you take a tricyclic antidepressant, talk with your healthcare professional about:

• Antidepressants and pregnancy. Talk to your healthcare professional about the risks and benefits of using specific antidepressants. Some antidepressants may harm your baby if you take them during pregnancy or while you're breastfeeding. If you're taking an antidepressant and you're considering getting pregnant, talk with your healthcare professional about the possible risks. Don't stop taking your medicine without talking to your healthcare professional first. Stopping an antidepressant might put you at risk of withdrawal-like symptoms or returning depression.
• Interactions with other medicines and supplements. When taking an antidepressant, tell your healthcare professional about any other prescription or nonprescription medicines, herbs or other supplements you're taking. Some antidepressants can cause dangerous reactions when combined with some medicines or herbal supplements.

• Serotonin syndrome. Rarely, an antidepressant can cause high levels of serotonin to build up in your body. Serotonin syndrome most often happens when two medicines that both raise the level of serotonin are taken together. These include other antidepressants, some pain or headache medicines, and the herbal supplement St. John's wort.

  Symptoms of serotonin syndrome include anxiety, nervousness, high fever, sweating, confusion, tremors, restlessness, lack of coordination, major changes in blood pressure and a fast heartbeat. Get medical care right away if you have any of these symptoms.

• Safety and blood tests. Your healthcare professional may recommend blood tests to measure the medicine levels to decide on the most effective dose. Some side effects and benefits of tricyclic antidepressants depend on the dose. Overdose of tricyclic antidepressants can be dangerous.
• Long-term health conditions. Tricyclic antidepressants can cause problems in people with certain health conditions. For example, if you have narrow-angle glaucoma, an enlarged prostate, heart problems, diabetes or a history of seizures, talk with your healthcare professional to decide if a tricyclic antidepressant is a safe choice for you.