It is worthwhile, therefore, starting at a lower dose and only increasing the dose if necessary depending on side effects and response to treatment. The most common side effects with tricyclic antidepressants are anticholinergic - blurred vision, constipation, mild urinary retention and dry mouth. Also commonly seen are insomnia, light-headedness, drowsiness, increased perspiration and mild tremors. Desipramine has been shown to lower the seizure threshold. In addition, it may precipitate a hypomanic or manic episode in individuals vulnerable to bipolar mood disorders.
Cardiovascular effects are less common but more serious.
These include hypotension and cardiac arrhythmias. Four cases of sudden death have been reported in children receiving tricyclic antidepressants. Desipramine should be used with caution in individuals with a history of cardiovascular disease, thyroid disease, urinary retention, glaucoma, seizure disorder or a history of tricyclic sensitivity. Desipramine has some advantages over methylphenidate. It is possible to combine a low dose of desipramine at bedtime with methylphenidate in the morning.