Anticholinergic side effects of tricyclic antidepressants

hi all,

I have TN2 and like most people with TN2 i decided to take a tricyclic antidepressant (TCA) which was nortriptyline in my case. However, after some research on the internet it seems that the anticholinergic side effects of TCAs are quite a serious problem and they can cause cognitive decline and dementia.

Here is just a definition of what is anticholinergic:

Here is the paper that discussed the study that looks at the long term effects of TCAs in terms of their anticholinergic side effects:

This is not a minor study and there is consensus in the medical community about these anticholinergic agents.

Keep in mind however that while this study cant prove causation (only correlation) this is still quite alarming. While the study looked only at older people i think it still gives me pause about TCAs.

Of course the pain of TN is much more problematic than a increase chance of dementia in old age. However, some conclusions can be made that is very relevant to us:

If there is a choice, nortriptyline should be chosen over amitriptyline because of a lesser anticholinergic effect.

Also if possible, maybe cymbalta is another option? it has a much less anticholinergic effect.

Of course this is just my opinion and i like to hear your thoughts on this. Are there any other helpful medications for TN2 that have less anticholinergic side effects?



Yes I have heard this and am not surprised as even a young person on them can experience cognitive problems.Guess it’s go with the pain or take a TCA and hope you don’t develop dementia if you are older.Its an individual choice really but will be very interested in replies.Red what’s your opinion?

As a 25 year old who has tried literally every other kind of medication for my ATN I am sticking to them, future consequences be damned. I want to have a life now, and I am still struggling with that while on the TCAs. Honestly, I don't want to live super long, so I would rather get the most out of my life now and worry about the future as it comes. Maybe that is a foolish "young" way of thinking, but I have 2 Digestive Chronic Illnesses, chronic Sinusitis, related to my allergies and asthma, kidney stones, gall stones, Depression and anxiety AND the ATN makes 7 Chronic, illnesses 4 of them are also acute. I don't want to live in this body longer than I have to. If my brain goes, so be it, my time will be up, and it will have been well spent. I would rather live only 5 more years, but be able to do things and know people and actually live life than suffer 60 more years isolated, and dysfunctional, in retched, constant pain.

hi itwouldntbemakebelieve ,

I spoke to a friend of mine who is a doctor today and he explained to me that the anticholinergic effects are more of an issue for the geriatric population because their liver functions are compromised and maybe they cant clear the medication fast enough from their system.

So i think you are fine and so am i (i am 35 years old).

Your post made me very sad, i also suffer from multiple conditions and sometimes it gets too much.

I hope you live a full and long life, youre so young that they might find some cure with stem cells or gene therapy or ... and cure all your conditions.


I've been taking nortriptyline (10 mg, for the record, tried 25 but the side effects were not good for what extremely small improvement I got from the increased dose) for chronic migraines and assorted mental health issues for... at least five years. Granted, I was maybe 25 when I started it, but so far, I'm not seeing any huge issues. I concur on the idea that being elderly and renal-impaired might cause a greater build-up of it, which would increase the risk. For me personally, I'd rather increase the possibility of something maybe happening way down the line if I see a benefit now as far as my quality of life goes. But that's just me.


None of these medications are very nice to our bodies in the long run. I was on Amitriptyline for a year and am now of Nortriptyline. What truly affects my mental state the most is the pain. I call it "pain brain". I cannot focus on any one thing and walk around in a grumpy, edgy fog. So, for me these medications have improved my mental state overall.

I have noticed on higher doses of both of those meds that they do affect my mood and actually give me more anxiety.

TN is a beast. Unfortunately we have to find a balance between function and pain control. And I know that there is a fair amount that I am willing to trade for pain control.