The symptom of dry mouth (technically called Xerostomia) is a very common side effect of the older group of tricyclic antidepressants, and occurs in a minority of people taking modern antidepressants.


This symptom typically becomes more of a problem in social situations, when people are attempting to talk, and may or may not be slightly more anxious than usual.  Those who have to speak publicly find it a major nuisance.


Apart from the irritation of having a continuously dry mouth, especially on waking in the morning, dry mouth significantly increases the risk of gum disease and tooth decay, as our mouth is normally protected to a large extent by the presence of normal amounts of saliva.  Accordingly, particularly good dental hygiene is very important while this problem persists.


Most people interpret the dry mouth sensation as being thirsty.  In fact, this is not the case, and drinking a lot of fluid really does not help the problem.  The mechanism that is occurring is that the antidepressants have blocked the messages which allow the normal flow of saliva to occur, and therefore your salivary glands are not producing saliva as needed.  This is one of the group of side effects of antidepressants known as an anticholinergic side effect, as the cholinergic system is the chemical pathway which controls various automatic functions of our body.  Other symptoms in this group of anticholinergic side effects include blurring of vision, dry eyes, dry tissues, trouble passing urine,  and constipation.


INTENSELY BITTER DRINKS will briefly directly stimulate your salivary glands and cause them to produce saliva again, relieving the dry mouth sensation.  Bitter lemon drinks or confectionery may achieve this affect.  Squeezing lemon juice directly into water or soda water is a useful way of producing a bitter drink that will stimulate the salivary glands and temporarily reduce thirst.


BETHANECHOL (tradename Urocarb)is a simple antidote which will relieve the anticholinergic side effects of antidepressants in the majority of people.  This medication normally has no side effects itself, and needs to be taken in a dose of 10-20 mgs three times per day usually.  While the timing of the medication is not an issue for the majority of people, some people find Bethanechol works far better if taken on an empty stomach, and half an hour before any food is consumed. If you have a dry mouth in the morning, taking Urocarb at night will lessen the damage that can occur to your teeth during the night. You need a prescription to buy this medication.


CHEWING GUM   will increase salivary flow for some time, but it is important to use only sugarless gum in view of the absence of the protective effect of normal saliva. Biotene is a trademark of a gum which can be chewed for a long time without becoming unpleasant, usually sold in pharmacies.


ARTIFICIAL SALIVA SPRAYS will also be useful for short periods of time, and can be obtained in your pharmacy or drug store without a prescription.


In some cases, it may be possible for your doctor to change your tricyclic antidepressant to one with fewer anticholinergic side effects in most people, (eg Nortriptyline or Dothiepien), or consider Mianserin, a derivative of the tricyclic antidepressants with no anticholinergic side effects  (but more weight gain risk).  However, do keep in mind that a new antidepressant may not necessarily give you the same benefits as the one you are currently taking.


This information is intended to improve your knowledge of the treatment you are receiving.  Any further points can be discussed at your next consultation with your doctor.


Important Disclaimer:  This site is medical information only, and is not to be taken as diagnosis, advice or treatment, which can only be decided by your own doctor.

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