Treatment - Antidepressants

Reviewed by: HU Medical Review Board | Last reviewed: November 2022

Antidepressants are drugs mostly used to control moods. However, some antidepressants may also be used to relieve the itchiness of chronic hives.1

The antidepressants that come in skin cream form are the ones prescribed to reduce itchiness and other symptoms. Antidepressants in pill form alter your brain chemicals (neurotransmitters). This can relieve depression, which is common among people with chronic hives.1-3

Antidepressants used for itchiness

There are many types of antidepressants. One type is called tricyclic antidepressants (TCAs). TCAs block both H1 and H2 histamine receptors. This can help relieve itchiness from chronic hives. Some TCAs block histamine from attaching to a protein called the H1 receptor. This can relieve itchiness and hives.1-3

The strongest histamine blocker TCA is doxepin (Zonalon). The exact reason doxepin may work to reduce itchiness in chronic hives is not known. But, blocking histamine relieves itchiness. Also, antidepressants can reduce inflammation, which may also be why this drug works for some people who have chronic hives. If other antihistamines do not help control your symptoms of chronic hives, your doctor may prescribe doxepin.2

There are other types of skin cream TCAs. These are usually not prescribed for chronic hives. They include:2

  • Imipramine (Tofranil®)
  • Nortriptyline (Pamelor™)
  • Desipramine (Norpramin®)

Antidepressants for mood

Symptoms of chronic hives can impact your quality of life. The symptoms often lead to stress, sleep problems, and social stigma. Together, this can cause mental health issues and mood disorders, such as depression.4

Talk to your doctor about possible treatments for depression. They may prescribe an oral antidepressant (pill) to improve your mood. Some studies have shown that oral antidepressants also control other symptoms of chronic hives.5

There are many types of antidepressants. The right one for you depends on your specific situation, such as your symptoms, other medical conditions, and what has worked before.6

Examples of antidepressants that are not tricyclics include:6

  • Selective serotonin reuptake inhibitors (SSRIs) – fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs) – duloxetine (Cymbalta®), venlafaxine (Effexor XR®)
  • Atypical antidepressants – mirtazapine (Remeron®), vortioxetine (Trintellix®)
  • Monoamine oxidase inhibitors (MAOIs) – tranylcypromine (Parnate®), phenelzine (Nardil®)

What are the possible side effects of antidepressants?

Antidepressants are a large group of drugs, so side effects can vary depending on the specific drug you are taking. However, there are a few common side effects, including:6

  • Dry mouth
  • Weight gain
  • Changes in sexual desire

TCAs are older drugs that tend to cause more side effects than newer antidepressants. These side effects include:2

  • Drowsiness
  • Dizziness
  • Blurry vision
  • Constipation
  • Dry mouth
  • Difficulty urinating
  • Weight changes

Because of these side effects, doctors often suggest using these drugs as a cream instead of an oral medicine. This may help reduce the chances of side effects. However, allergic reactions and other side effects are still possible.1

If oral antidepressants are needed to treat depression, your doctor will usually suggest SSRIs first. These tend to have a lower risk of side effects than other types of antidepressants. However, side effects are still possible. Talk to your doctor if you notice any changes in symptoms.6

These are not all the possible side effects of antidepressants. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking an antidepressant.

Things to know about antidepressants

Take antidepressants exactly as your doctor prescribes. If your symptoms do not improve, talk to your doctor before changing your medicine. Do not stop taking them without talking to your doctor first.6

Talk to your doctor about your full health history. Certain drugs and medical conditions increase the risk of side effects. Tell your doctor:6

  • If you are pregnant or planning to become pregnant
  • If you have any other health conditions, especially heart or liver problems

Before beginning treatment for chronic hives, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

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