ABSTRACT
Tricyclic antidepressants (TCAs) were among the first antidepressant medications developed, though they are now rarely used as first-line treatments. Early in their use in the 1960s and 1970s it was observed that they seemed to decrease incontinence episodes in adults and children with enuresis. Since that time, tricyclic antidepressants, particularly imipramine, have been used generally as a second-line treatment in overactive bladder (OAB) and urge incontinence. A 1999 study of Veterans Affairs medical centers found imipramine to be the third mostcommon drug used in urge incontinence.1 Animal and in vitro studies support a complex mechanism of action, on the lower urinary tract as well as the central nervous system. Unfortunately, high quality clinical studies are lacking. Recently, duloxetine, a structurally unrelated compound but also an antidepressant, has shown promise for use in stress and possibly mixed incontinence.
BASIC SCIENCE
