Desipramine: Uses, Side Effects, Dosage, & More

What Is Desipramine?

Desipramine is a tricyclic antidepressant (TCA), a medication class that works to increase levels of brain chemicals that play a role in regulating mood, such as norepinephrine and serotonin. Desipramine is FDA-approved for the treatment of depression. FDA approval means that after rigorous testing, the FDA determined that the benefits of desipramine outweigh the risks, and desipramine is proven to be safe and effective for its intended population of patients with depression.^1,2,3

How Does Desipramine Work?

Desipramine works to improve symptoms of major depression by blocking the neurons in our brains from consuming and storing chemicals such as norepinephrine and serotonin that regulate mood, energy, and emotions. This allows our brain to restore its normal chemical levels, so the chemicals can remain active in our brains. Over time, this can help boost mood, increase energy, and improve well-being to reduce overall depression symptoms.^1,2

Is Desipramine an SSRI?

Desipramine is classified as a tricyclic antidepressant (TCA), so it is not a selective serotonin reuptake inhibitor (SSRI) like many antidepressants that are tried first line before other treatments. SSRIs work in a similar way as TCAs. Still, SSRIs are selective to influence only one chemical in the brain, serotonin, while TCAs, such as desipramine, influence multiple chemicals in the brain, such as serotonin and norepinephrine. ²

Can Desipramine Be Used for Anxiety?

Anxiety is not listed as an FDA-approved or off-label indication for desipramine, so it should not be used to treat anxiety. Desipramine has not undergone sufficient testing with quality research designs to establish its safety and effectiveness, so it is not a suitable drug of choice for anxiety treatment^1,2,4

What Is Desipramine Used to Treat?

Depression is the only FDA-approved indication of desipramine. FDA approval means that after rigorous testing, the FDA determined that the benefits of desipramine outweigh the risks, and desipramine is proven to be safe and effective for its intended population of patients with depression.^1,3

Desipramine has multiple off-label indications. An off-label indication of a medication is not FDA-approved. Still, prescribers can decide to use a medication for off-label use because they believe that it may offer benefits to a patient based on their professional judgment. The off-label indications for desipramine include bulimia nervosa, irritable bowel syndrome, neuropathic pain, overactive bladder, postherpetic neuralgia, and Attention Deficit and Hyperactivity Disorder (ADHD). Desipramine may be used for the treatment of patients with any of the off-label indications listed if deemed appropriate by your prescriber or pharmacist.²

Common Side Effects of Desipramine

Common side effects of desipramine include dizziness, dry mouth, and excessive sleepiness. The most common reason for discontinuation of desipramine was due to dizziness when standing up. While some individuals might not require medical attention for these effects, close monitoring of the symptoms is crucial to address any severe or chronic symptoms promptly. It is recommended to maintain open communication with a healthcare professional, such as your prescriber and pharmacist, to ensure proper management and support during desipramine treatment.^1,2

Common side effects of desipramine include:¹

• Dizziness
• Sedation (excessive sleepiness)
• Dry mouth
• Constipation
• Changes in mental status (blurred vision, confusion)
• Heart abnormalities

*All medications, including desipramine, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.

Serious Side Effects of Desipramine

Previous research has shown that desipramine has the potential to cause serious side effects, some of which have caused multiple patients to drop out of research studies. If patients experience any of the following serious effects, they should seek urgent medical care immediately; potential serious side effects of desipramine include changes in heart function, seizures, hallucinations, glaucoma (increased pressure in the eye), and liver failure. Desipramine is a medication that affects the brain, so the side effects may affect any part of the body.^1,2,4

Serious side effects of desipramine include:¹

• Changes in heart function (rapid heartbeat, abnormal heart rhythm)
• Increased risk of suicide
• Increased risk of bone fracture
• Glaucoma (increased pressure in the eye)
• Seizures
• Hallucinations
• Sudden liver failure

*All medications, including desipramine, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.

Desipramine Warnings & Precautions

Desipramine has an FDA box warning (the most serious warning) of increased risk of worsening depression and the emergence of suicidal ideation and behavior (suicidality). All patients being treated with desipramine should be monitored by healthcare professionals and their caregivers for worsening of depression, suicidality, or any unusual changes in behavior, especially at the beginning of treatment and following any desipramine dose changes.^1,2

Desipramine also has a warning of causing glaucoma (increased pressure in the eye) and serotonin syndrome. Serotonin syndrome is most likely to occur in patients taking desipramine if being taken at the same time as another medication that increases serotonin levels in the brain. Serotonin syndrome can cause mental status changes, such as agitation, hallucinations, delirium, upset stomach, or seizures. Patients should seek medical attention immediately if experiencing symptoms of serotonin syndrome while taking desipramine.¹

Avoid taking desipramine if you:¹

• Are diagnosed with heart disease: Desipramine has been shown to increase the risk of abnormal heart rhythm, rapid heartbeat, stroke, and heart attack in these patients.
• Are diagnosed with thyroid disease or or taking medications for thyroid disease: Desipramine has been shown to increase the risk of changes in heart function for these patients.
• Have a family history of sudden death, abnormal heart rhythm, or abnormal heart conduction: Desipramine may cause heart abnormalities, and patients with a family history of these symptoms may have an increased risk of serious changes in heart function.
• Have a history of urinary retention or glaucoma: Desipramine can block the function of chemicals within the body that are essential to normal function, and the blockade of these chemicals can lead to worsening of glaucoma and urinary retention.
• Have a history of seizures: Desipramine has been shown to cause an increased risk of seizures, especially in patients who are predisposed.

Desipramine Dosages for FDA-Approved Treatment

Desipramine is an FDA-approved oral tablet used for the treatment of depression for adolescents and adults ranging from age 12 and older. The typical dose for an adult is between 100 to 200 mg per day. A prescriber will typically start a patient at 25-50 mg per day, then increase the dose over time to between 100-200 mg per day as tolerated.

Patients with more severe illness may have doses adjusted up to 300 mg daily, but this dosage should only be initiated in the hospital setting with continuous monitoring. Doses above 300 mg per day are not recommended. The typical adolescent (age 12 to 19) and geriatric dose (above age 65) is 25-100 mg daily. The dose may be adjusted up to 150 mg per day for severely ill adolescent and geriatric patients, but doses above 150 mg per day are not recommended. Desipramine is not recommended for children under 12 due to its increased risk for suicidal behavior.^1,2

Desipramine may also be used for the off-label treatment of bulimia nervosa, irritable bowel syndrome, neuropathic pain, overactive bladder, postherpetic neuralgia, or ADHD. Off-label indications for desipramine use similar dosing as the FDA-approved indication of depression. If patients experience any symptoms of dizziness or drowsiness, especially when standing up, or when taking desipramine for any indication, prescribers should be alerted in order to make dosage changes.^1,5

Desipramine Forms & Strengths

Desipramine is only available as an oral tablet, however, it comes in a variety of dosage strengths. The dosage strengths range from 10 mg to 150 mg oral tablets. There are no extended or delayed-release formulations on the market. Desipramine can be taken as a single daily dose or in divided doses throughout the day. Prescribers may use higher dosage strength for patients with more severe illness. In contrast, lower dosage strengths may be utilized for patients who cannot tolerate the side effects well or geriatric or adolescent patients.¹

The onset of effects of desipramine will vary between patients, and it is important to note that a higher dosage strength does not imply more extensive effects or a quicker onset of action. Patients should communicate closely with their healthcare provider to find the most suitable dosage for the patient’s specific needs.¹

Desipramine is available in the following forms and strengths:¹

• 10 milligram (mg) oral tablet
• 25 milligram (mg) oral tablet
• 50 milligram (mg) oral tablet
• 75 milligram (mg) oral tablet
• 100 milligram (mg) oral tablet
• 150 milligram (mg) oral tablet

How Quickly Does Desipramine Take Effect?

Patients may begin to experience the initial effects of desipramine as early as two to five days after starting treatment. However, it could require as long as two to three weeks to observe the full effects of desipramine.¹

How Should I Take Desipramine?

Patients should take desipramine exactly as directed by their prescriber. Desipramine is an oral tablet that can be taken once daily or multiple times throughout the day as a divided dose. Desipramine can cause drowsiness, so it is sometimes recommended to take it in the evening. When taking desipramine, swallow the tablet whole. Desipramine can be taken with or without food. If patients are experiencing an upset stomach while taking desipramine, they may take it with food to reduce symptoms.^1,2,6

What Happens If I Miss a Dose of Desipramine?

If a patient misses a dose of desipramine, they should take the dose as soon as they remember unless it’s close to the time of their next scheduled dose. If the latter is the case, they should skip the missed dose and resume their regular dosing schedule. Do not double up on doses or take extra doses to catch up on missed doses. Abruptly stopping desipramine may result in antidepressant withdrawal symptoms or other side effects, so patients should not change their dosing schedule or stop taking desipramine without talking to their prescriber first.⁶

Can You Overdose on Desipramine?

Yes, you can overdose on desipramine. It is important to take desipramine exactly as prescribed in order to avoid symptoms of an overdose. Patients have the potential to overdose on desipramine if not taken as prescribed or taken with another substance that may interact with desipramine, such as alcohol. Signs and symptoms of an overdose of desipramine will present quickly after the medication is administered. The typical signs and symptoms of a desipramine overdose include changes in heart rhythm, drowsiness, seizures, or loss of consciousness. Any side effect described previously, such as hallucinations and confusion, could also appear in a patient who overdosed on desipramine.¹

What Should You Do If You Take Too Much Desipramine?

If a patient overdoses on desipramine, they should seek medical care immediately. It is recommended that the physician call the poison control center for the most updated treatment while carefully monitoring the patient’s mental and heart function. Death may occur from an overdose on desipramine, so it is vital that patients seek medical care as soon as possible after an overdose.^1,6

What to Avoid When Taking Desipramine

Desipramine has the potential to interact with different substances, including multiple types of medications. Desipramine has the potential to interact with medications with additive antidepressant and sedative effects. The effects of desipramine may be altered if combined with other substances that either block or utilize the same enzyme within the body as desipramine, so it is important that the patient’s prescriber is aware of the patient’s full medication list. Desipramine may also enhance the effects of alcoholic beverages, so patients should avoid alcohol while on this medication.¹

Desipramine, when combined with specific harmful substances, has the potential to cause serious, life-threatening effects. It is important that individuals prescribed desipramine maintain open communication with their prescriber about all medications, including over-the-counter medications, and any herbal substances they may be taking to ensure a safe and effective treatment.¹

4 substances you should avoid while taking desipramine include:¹

• Other antidepressant medications (MAOIs, SSRIs, SNRIs): Combining desipramine with other antidepressants or drugs that increase levels of certain brain chemicals can lead to excessive levels of chemicals in the brain, which could potentially cause life-threatening events. These medications include monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and selective norepinephrine reuptake inhibitors (SNRIs).
• Drugs that inhibit or interact with CYP2D6: CYP2D6 is an enzyme within the body responsible for metabolizing many drugs and natural substances. Desipramine is a substance metabolized by this enzyme, so when taken with other drugs that require CYP2D6 for their metabolism or drugs that block the effects of CYP2D6 in the body, the effects of desipramine have the potential to be blunted, and treatment outcomes may not be seen.
• Drugs with sedative effects: Other drugs that may cause excessive sleepiness, such as benzodiazepines and tranquilizers, may cause additional drowsiness effects to those of desipramine.
• Alcohol: Desipramine may cause an exaggerated response to alcoholic beverages.

Desipramine Antidepressant Discontinuation

Abrupt discontinuation of desipramine is not recommended. If a patient decides to discontinue desipramine without consulting their prescriber, they may begin to experience withdrawal symptoms, including insomnia, nausea, dizziness, upset stomach, excessive alertness, or sensory disturbances. To avoid these symptoms, patients should work closely with their prescriber to slowly taper off of desipramine over time.²

How to Get a Prescription for Desipramine

Desipramine is a medication that needs to be prescribed by a qualified medical professional such as a primary-care physician or psychiatrist. If a patient believes that they may be eligible for treatment of depression with desipramine, they will need a psychiatric evaluation by a qualified medical professional to determine if desipramine is the right course of treatment for them. Desipramine is not considered a first-line treatment for depression; patients with more severe symptoms may be more likely to be considered for treatment with this medication.²

How Much Does Desipramine Cost?

The cost of desipramine varies from approximately $65 to $200 per 100 tablets depending on the dosage strength and whether the brand or generic of desipramine is used. Generally, higher dosage strength and the brand name drug will be more expensive. Desipramine may offer rebates, coupons, co-pay cards, or free samples for eligible patients as well (most of these discounts are for brand-name versions only). The cost range provided above does not account for insurance coverage.⁷

Questions to Ask Your Healthcare Provider About Desipramine

When other treatments for depression have proven ineffective for patients, they may want to learn more about desipramine from their doctor, psychiatrist, or therapist. Patients should ask their prescriber about the possible benefits, risks, and side effects of desipramine. Patients should also be concerned about whether desipramine will interact with their current medications, past medical history, or other aspects of their typical diet.¹

In the case where a patient may need to change prescribers, online psychiatry services may be a convenient option for patients to ensure consistent mental health services.¹

Questions to ask your care team about desipramine include:¹

• What are the potential common side effects of desipramine that I should be aware of?
• What signs should I look out for that I may need to ask my prescriber or pharmacist about stopping desipramine?
• Do I need to discontinue any of my current medications if I start taking desipramine?
• Are there alternative treatments for my depression that I should consider before starting desipramine?
• If I participate in counseling or therapy at the same time, will that increase the effectiveness of desipramine?
• How long does it typically take for the effects of desipramine to start working?
• How long will it take for me to adjust to taking desipramine?
• How will desipramine impact my overall quality of life and well-being?
• Am I at risk for more serious symptoms if I am already taking other medications?
• What is the best dosage of desipramine to ensure fewer side effects?

In My Experience

In my experience, desipramine can be a viable option for adult patients who have previously used other antidepressant medications without success. However, it’s important to note that desipramine has the potential to cause serious side effects, which is why prescribers tend to recommend other antidepressant medications first. Prior to starting desipramine, patients should talk to their prescriber about the potential benefits and risks of taking desipramine. It is important to communicate with your prescriber regarding your medical history and current medications. Throughout desipramine therapy, it is advisable to adhere to your prescriber’s guidance to ensure optimal safety and effectiveness.¹

For Further Reading

• Treatment Resistant Depression: Signs, Symptoms, & Treatment Options
• Key Signs of High-Functioning Depression & How to Cope with Symptoms
• Desipramine Overdose Information
• Depression Resources
• Depression