Tricyclic Anti-Depressants for Back Pain Relief

If you don't know by now, pain and depression are closely related. According to an article published in U.S. Pharmacist in 2009, the symptoms of these two conditions overlap. The article reports on data from the National Health and Nutrition Examination Survey III  finding that up to 10% of the population experiences depression, of which 90% report having pain.

Pills on a white table
Jamie Grill / Tetra images / Getty Images

The article goes on to say that the biological basis for depression is also a potential player in what underlies chronic pain. For this reason, antidepressants may make an effective type of medication for chronic neck or back pain.

In fact, antidepressants have been proven effective for various types of chronic pain, including nerve pain, pain associated with depression, and fibromyalgia, according to the article. The authors say that different classes of antidepressant are effective for different types of pain. 

Types of tricyclic antidepressants prescribed for nerve pain include amitriptyline, nortriptyline, desipramine, as well as novel antidepressants bupropion, venlafaxine, and duloxetine (brand name Cymbalta.) 

What Are Tricyclic Antidepressants?

Tricyclic antidepressants are a class of medications approved by the FDA for treating depression. Although the FDA doesn't approve of them as pain treatment, healthcare providers sometimes prescribe them for this use anyway. (This is called off-label prescribing.) When antidepressants are taken for nerve pain, they are sometimes used as an adjuvant, i.e., a helpful add-on to the main medication protocol 

If you are taking a tricyclic antidepressant for pain, your dose will likely be lower than if you are taking it for depression.

Side Effects

The targets of tricyclic antidepressants are not limited to depression and pain. These drugs affect a number of body systems. Because of this, a range of side effects can occur. The side effects may be manageable (dry mouth, constipation, drowsiness) or very serious (rapid heartbeat, aggravation of glaucoma, increased risk of seizures, to name a few).

It is important that you have an honest discussion with your healthcare provider about any other conditions you may have so that she can accurately determine if this type of pain medication is a good fit for you.

As mentioned above, some of the novel antidepressants are effective for managing neuropathic back pain. The good news is that they may also incur fewer side effects than tricyclic antidepressants.

Certain anti-seizure medications are used as adjuvant pain medications used to treat chronic back pain are those in the anticonvulsant class. Anti-seizure medications for chronic back pain work about as well as antidepressants but come with different safety and side effect warnings.

This type of drug may make a better choice for seniors and the elderly because the safety concerns are fewer than for antidepressants.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

By Anne Asher, CPT
Anne Asher, ACE-certified personal trainer, health coach, and orthopedic exercise specialist, is a back and neck pain expert.