Tricyclic antidepressants for premenstrual syndrome (PMS)


Generic Name Brand Name
clomipramine Anafranil
desipramine Norpramin
doxepin Sinequan
imipramine Tofranil
nortriptyline Aventyl, Pamelor
protriptyline Vivactil
trimipramine Surmontil

Tricyclic antidepressants (TCAs) are taken orally every day throughout the menstrual cycle for premenstrual syndrome (PMS) symptoms. Generally, a low dose is given at first, and the dosage is increased slowly until the medication takes effect. This helps minimize side effects.

How It Works

TCAs improve your mood by increasing the levels of certain chemicals in the brain (neurotransmitters).

In low doses, these medications may cause drowsiness and sleep. This can be helpful when sleep disorders are a symptom of PMS.

Why It Is Used

TCAs may be used if PMS is causing:

  • Severe depression.
  • Sleep disturbances.

How Well It Works

Some women with severe premenstrual depression benefit from TCAs. TCAs have not been studied as much as selective serotonin reuptake inhibitors (SSRIs) for their specific effects on PMS mood symptoms.

Side Effects

The side effects of TCAs may include:

  • Constipation.
  • Dry mouth.
  • Blurred vision.
  • Drowsiness.
  • Lowered blood pressure.
  • Weight gain.
  • Tremors, sweating.
  • Urinary retention.
  • Loss of sexual desire or ability.

Side effects decrease as you continue treatment.

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Tricyclic antidepressants are taken every day throughout the menstrual cycle. By comparison, an SSRI antidepressant can be taken for only the premenstrual part of each cycle to treat PMS-related symptoms.1

TCAs take 4 to 6 weeks to effectively relieve PMS symptoms.

When considering TCA treatment, compare the possible benefits against the costs of treatment and possible side effects. You can discuss these with your health professional.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.



  1. Freeman EW, et al. (2004). Continuous or intermittent dosing with sertraline for patients with severe premenstrual syndrome or premenstrual dysphoric disorder. American Journal of Psychiatry, 161(2): 343–351.

Last Updated: June 19, 2008

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