Desipramine is a tricyclic antidepressant, affecting the production and uptake of neurotransmitters like serotonin, norepinephrine, and dopamine. The medication is primarily used to treat depression, but it can also be prescribed off label to treat withdrawal symptoms associated with detoxing from stimulant drugs like cocaine.
In the United States, the brand name for desipramine is Norpramin. This medication is currently manufactured by Sanofi-Aventis. The medication was originally approved in 1964 by the Food and Drug Administration (FDA).
Depending on the condition being treated, a person with a prescription for desipramine may take the medications once per day or more. Since desipramine can take 2-3 weeks to become fully effective, this medication should be taken regularly, not “as needed.” To treat depression, a physician or therapist may prescribe the lowest possible dose of desipramine and increase the dose over time to ensure effectiveness; however, to treat withdrawal symptoms in people who are overcoming cocaine or amphetamine addiction, the physician may prescribe a larger dose to help the person get relief more quickly. The therapist or doctor will then gradually reduce the dose through a tapering schedule as withdrawal symptoms ease.
Desipramine comes in tablets with dosages of 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, or 150 mg. The prescribing physician will typically start their patient at 50 mg taken once per day and gradually increase the dose to 150-200 mg.
How Desipramine Treats Cocaine Addiction
Antidepressants are designed to moderate neurotransmitters to reduce depression and to elevate mood. When a person wants to end their dependence on “uppers” like cocaine, Adderall, or amphetamines, tricyclic antidepressants like desipramine may be of some clinical use in alleviating withdrawal symptoms during detox.
One of the major symptoms of withdrawal during stimulant detox is depression. Depression-like symptoms during cocaine withdrawal include slowed activity, reduced physical and mental energy, unpleasant dreams, changes in appetite, and a general feeling of discomfort. Some people may also experience anhedonia, or the inability to feel pleasure. Although the experience is very individual, antidepressants like desipramine may be able to reduce symptoms.
There is also some evidence that desipramine specifically alleviates cravings and compulsions associated with cocaine abuse. Although this mechanism is not well understood, tricyclic antidepressants may be able to reduce behaviors associated with addiction to stimulants, specifically cocaine. This can help maintain abstinence during rehabilitation.
Desipramine Side Effects
Because desipramine is a potent antidepressant, there can be some side effects associated with taking it. Common side effects include:
- Tingling or weakness, especially in extremities
- Difficulty falling asleep or staying asleep
- Changes in vision
- Ringing in the ears (tinnitus)
- Decreased sex drive
One of the most serious side effects associated with antidepressants, including desipramine, is an increased risk of suicidal ideation or action. Although antidepressants should treat symptoms of depression, such as feeling worthless, alone, remorseful, or unhappy, some people who take these medications can experience increased thoughts about suicide. People who are younger than 24 are especially vulnerable to this condition. It is important to speak with a doctor if suicidal thoughts begin or continue while on this medication.
Serious side effects include changes in mood or behavior, such as:
- Panic attacks
- Difficulty sleeping
- Mood swings
- Hostility or aggressiveness
- Continued or worsening depression
More on Detox
- The Distinction of Going Cold Turkey over Tapering off Drugs
- At-Home vs. Medical Detox
- How to Cope with Withdrawals
- 7 Steps to Weaning Yourself off Drugs
It is possible to overdose on desipramine. Symptoms include:
- Irregular heartbeat
- Stiff muscles
- Nausea and vomiting
- Reduced body temperature
- Agitation, irritability, or behavior changes
- Widened pupils
Emergency medical attention is the only way to help a person overdosing on any drug, illicit or prescription. Call 911 immediately.
Interactions with Desipramine
Because tricyclic antidepressants like desipramine affect all neurotransmitters, they can have potent interactions with other medications. It is particularly important to avoid taking desipramine in combination with other antidepressants, especially MAO inhibitors. If a person receives a prescription for desipramine and has used an MAO inhibitor in the past 14 days, they could experience serious consequences, including serotonin syndrome.
Other prescription medications, over-the-counter drugs, and dietary supplements can interact with desipramine.
- John’s wort
- Medications to treat mood disorders
- Migraine headache prescription medications
- Narcotic painkillers
Additionally, consuming alcohol while taking desipramine can be dangerous. Tricyclic antidepressants interact strongly with alcohol and can increase the effects of intoxicating CNS depressants, which can make them more dangerous.
People who have some health conditions may not be able to take desipramine safely. Some of these conditions include:
- Cardiovascular conditions, including heart attack or stroke
- Family history of heart arrhythmias
- Bipolar disorder
- Liver disease
- Thyroid condition
- Difficulty urinating
Recovering from Cocaine Addiction
People who struggle with cocaine addiction should get help immediately. Addiction to cocaine can cause many serious side effects, including overdose, cardiovascular damage, neurological damage, seizures, strokes, heart attacks, abdominal pain, malnutrition through appetite loss, hallucinations, delusions, and psychosis.
It is important to work with a medical professional to detox safely from cocaine and other stimulants, and this process may involve a prescription for a tricyclic antidepressant like desipramine. Once the person has successfully detoxed, they should continue into a comprehensive rehabilitation program. While certain medications can aid in addiction recovery, therapy is the backbone of recovery.