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January 23, 1987

Nocturnal Ulcer Pain Relief From Tricyclic Antidepressants

JAMA. 1987;257(4):485. doi:10.1001/jama.1987.03390040101018

To the Editor.—  In the Oct 10, 1986, issue of JAMA, there was the following question1: "A 43-year-old woman with well-documented peptic ulcer disease complained of frequent and annoying nocturnal awakening due to pain, despite the use of ranitidine, sucralfate, and antacids. The nocturnal pain disappeared completely when she was given a nighttime dose of amitriptyline hydrochloride; however, she suffered from jitteriness, constipation, and... weight gain while taking the tricyclic agent." Suggestions were sought as to how to proceed with the therapy.The answer mentioned possible explanations of the effects of tricyclic antidepressants, which include sedative effects and an acid antisecretory effect due to anticholinergic properties. However, the property of tricyclic antidepressants as histamine2-receptor blockers was not mentioned. Tricyclic antidepressants are both histamine1-and histamine2-receptor blocking agents.2-4Controlled clinical trials using 50 mg/d of trimipramine (as the maleate salt) showed it to be superior to a placebo