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Abdominal or stomach pain agitation blacktarry stools bleeding gums blood in urine or stools blurred vision burningcrawlingitchingnumbnesspricklingpins and needlesor tingling feelings change in consciousness changes in patterns and rhythms of speech chest pain or discomfort chills cold sweats coma confusion confusion about identityplaceand time continuing ringingbuzzingor other unexplained noise in ears convulsions coolpale skin cough or hoarseness dark urine decrease in frequency of urination decrease in urine volume decreased urine output difficulty in breathing difficulty in passing urinedribblingdifficulty in speaking disturbance of accommodation disturbed concentration dizzinessfaintnessor lightheadedness when getting up from a lying or sitting position suddenly double vision drooling dry mouth excitement fainting false beliefs that cannot be changed by facts fastslowor irregular heartbeat fear or nervousness fever with or without chills flusheddry skin fruit-like breath odor general feeling of tiredness or weakness headache hearing loss high fever high or low blood pressure hostility inability to move armslegsor facial muscles inability to speak increased hunger increased need to urinate increased ocular pressure increased sweating increased thirst increased urination irritability lack of coordination lethargy light-colored stools lip smacking or puckering loss of appetite loss of balance control loss of bladder control loss of consciousness lower back or side pain mental depression or anxiety muscle spasm or jerking of all extremities muscle tightness muscle tremblingjerkingor stiffness muscle twitching nausea and vomiting nightmares or unusually vivid dreams overactive reflexes painful or difficult urination passing urine more often pinpoint red spots on skin poor coordination pounding in the ears puffing of cheeks rapid or worm-like movements of tongue rapid weight gain restlessness seeinghearingor feeling things that are not there seizures severe muscle stiffness shakiness and unsteady walk shivering shortness of breath shuffling walk sleeplessness slow speech slurred speech sore throat soresulcersor white spots on lips or in mouth stiffness of limbs stupor sudden loss of consciousness sweating swelling of faceanklesor hands swelling or puffiness of face swollen glands talking or acting with excitement you cannot control trouble in speaking trouble sleeping troubled breathing twisting movements of body pain or discomfort in armsjawbackor neck unable to sleep uncontrolled chewing movements uncontrolled movementsespecially of armsfaceneckbackand legs unexplained weight loss unpleasant breath odor unsteadinesstremblingor other problems with muscle control or coordination unusual bleeding or bruising unusual tiredness or weakness unusually pale skin upper right abdominal pain vomiting of blood weakness in armshandslegsor feet weight gain or loss yellow eyes and skin.

The pooled analyses of placebo-controlled trials in children and adolescents with MDDobsessive compulsive disorderOCDor other psychiatric disorders included a total of 24 short-term trials of 9 antidepressant drugs in over 4400 patientsThe pooled analyses of placebo-controlled trials in adults with MDD or other psychiatric disorders included a total of 295 short-term trialsmedian duration of 2 monthsof 11 antidepressant drugs in over 77,000 patientsThere was considerable variation in risk of suicidality among drugsbut a tendency toward an increase in the younger patients for almost all drugs studiedThere were differences in absolute risk of suicidality across the different indicationswith the highest incidence in MDDThe risk differencesdrug vs placebohoweverwere relatively stable within age strata and across indicationsThese risk differencesdrug-placebo difference in the number of cases of suicidality per 1000 patients treatedare provided in Table 1.

Tell your doctor if you are allergic to itor to other tricyclic antidepressantssuch as nortriptylineor if you have any other allergiestell your doctor your medical historyespecially if you experiencebleeding problemsurinating problemsbreathing problemsliver problemsfamily history of suicideoveractive thyroidhyperthyroidismpersonal or family history of glaucomaangle-closure typerecent heart attackpersonalfamily history of mental/mood conditionssuch as bipolar disorderpsychosisseizuresor conditions that may increase your risk of seizures For an overdoseseek medical attention immediatelyFor non emergenciescontact your local or regional poison control center at 1-800-222-1222.

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