Key points
- The FDA label lists one use: treatment of depression.
- The boxed warning covers suicidal thoughts and behavior in children, teens and young adults.
- The label asks for extreme caution with heart disease or a family history of sudden death.
- The label says it is not recommended for children, and reports sudden deaths in children.
- It must not be used with MAOIs or within 14 days of one.
What desipramine is
Desipramine is a tablet in the tricyclic group of antidepressants, sold under its generic name. The label describes it as a secondary amine tricyclic. That group may work more on norepinephrine, one of the brain's chemical messengers, while tricyclics such as amitriptyline may act more on serotonin. That is a documented difference in how they act, not a statement that either one is the better choice.
NIMH says older antidepressants such as tricyclics are associated with more side effects than the newer medicines prescribed most often, while still suiting some people.
What it is approved for, and off-label uses
The current FDA label says desipramine is indicated for the treatment of depression, and that it is not approved for treating bipolar depression. The label says safety and effectiveness in children have not been established, and that it is not recommended for use in children.
MedlinePlus says only that it is sometimes prescribed for other uses, without naming them, so this page does not list any. Your prescriber or pharmacist can tell you more.
How it is thought to work
The label says the exact way tricyclics work is unknown. A leading theory is that they restore normal levels of chemical messengers by blocking their re-uptake between nerve cells. It also says desipramine is not an MAOI and does not act mainly as a stimulant.
What taking it can be like
The label says the earliest effects may occasionally appear in 2 to 5 days, but that the full benefit usually takes 2 to 3 weeks. MedlinePlus gives the same 2 to 3 weeks. Early changes can be small, so short notes on sleep, energy and mood can help you and your prescriber see what is happening.
Do not stop desipramine without talking to your prescriber. Stopping suddenly after long use may bring on nausea, headache and a general unwell feeling. The label says these are not signs of addiction, and MedlinePlus says your doctor will probably lower the amount gradually.
The label warns it may affect your ability to drive or use machinery, so give yourself time to learn how it affects you. It can also strengthen the effects of alcohol. MedlinePlus lists skin that is more sensitive to sunlight among its side effects.
Side effects and warnings
Boxed warning: in short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, teens and young adults. Adults over 24 showed no such increase, and adults 65 and older showed less risk. People of every age should be watched for worsening depression or unusual behavior, with families staying in touch with the prescriber. If you are thinking about suicide or in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services. Our crisis resources page lists more help.
The heart deserves special attention with this medicine. The label asks for extreme caution in people with heart disease, and in people with a family history of sudden death, irregular heart rhythm or heart conduction problems. It reports heart rhythm problems, stroke and heart attack, and reports of sudden death in children. MedlinePlus says to tell your doctor if anyone in your family has had an irregular heartbeat or has died suddenly.
Side effects listed by MedlinePlus include nausea, drowsiness, weakness or tiredness, nightmares, dry mouth, changes in appetite or weight, constipation, trouble urinating or urinating often, changes in sex drive and heavy sweating.
- MAOIs: use together or within 14 days of each other is contraindicated because of serotonin syndrome risk. This also applies to beginning desipramine during treatment with linezolid or intravenous methylene blue.
- Heart attack: contraindicated during the acute recovery period.
- Seizures: it lowers the seizure threshold, and the label says seizures came before rhythm problems and death in some people.
- Extreme caution also applies to a history of urinary retention or glaucoma, and to thyroid disease or thyroid medicine.
- Serotonin syndrome can occur, especially with triptans, tramadol, lithium or St. John's wort. Cimetidine may also interact.
- Older adults: MedlinePlus says they should not usually take it, so talk through risks and benefits.
- Tell your prescriber if you are pregnant, planning a pregnancy or breastfeeding.
Can it be managed online in Pennsylvania and New York
Desipramine tablets are taken at home, and the label does not limit them to a certified healthcare setting. A video visit is well suited to reviewing your history, your family's heart history, your mood and any side effects. It cannot examine your heart or record a heart tracing, so if your history calls for that, ask how it would be arranged locally.
A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine (DO) with more than three decades of practice, offers online depression treatment by secure video for people physically located in Pennsylvania or New York during each visit. Our page on medication management explains what ongoing visits cover. Therapists on our team do not prescribe.
Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help through our medication contact form. Asking is a good next step, and things can get better with the right support.
Common questions
What should I tell my prescriber about my family's heart history?
Tell them if anyone in your family has had an irregular heartbeat, a heart conduction problem or a sudden death. The label asks for extreme caution in those situations, and MedlinePlus says to mention them before taking desipramine. Also share your own history of heart disease, high blood pressure, chest pain or a heart attack.
Is desipramine used for children?
The label says safety and effectiveness in children have not been established, and that desipramine is not recommended for them. It reports sudden deaths in children, and says anyone considering it for a child or teen must balance the potential risks with the clinical need. A parent with questions should talk with their child's doctor. Ask us whether our psychiatrist can help.
How long does desipramine take to work?
The label says early effects may occasionally show in 2 to 5 days, while full benefit usually takes 2 to 3 weeks. NIMH says antidepressants more generally usually take 4 to 8 weeks to work. Timing differs from person to person, and your prescriber can tell you what to expect and when to check in.
Sources
Published by Locascio Wellness. Published November 5, 2026. Clinically reviewed by Kenneth M. Levy, DO, Psychiatrist (Pennsylvania license OS007464L). This page is general information, not medical advice or a diagnosis.