Tricyclic antidepressants have multiple mechanisms of action and have been most thoroughly studied in the treatment of neuropathic pain. They function by decreasing depression and, thereby decreasing the amplification of pain. They also decrease the inhibitory neurotrans-mitters norepinephrine and serotonin, thereby amplifying the impact of the body's own mechanisms to inhibit pain transmission.
The anticholinergic effects of tricyclic antidepressant can cause problems in patients with glaucoma, cardiac conduction abnormalities, or prostatic hypertrophy; thus, these pharmaceuticals must be used cautiously in elderly patients or in patients with these comorbid diseases.
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