SIndications-Antidepressants are indicated for the treatment of neuropathic pain and are more effective against the constant burning dysaesthetic type of pain. They are also useful for pain complicated by insomnia or depression.     Action-The analgesic effect is seen with doses lower than required for the treatment of depression (50-75 mg/d amitriptyline), occurs more quickly than the antidepressant effect (2-3 days) and has been documented in patients with no features of depression. The action is thought to relate to blocking the re-uptake of serotonin and noradrenaline in the central nervous system. Antidepressants can also aid analgesia by increasing night-time sedation, improving mood and relieving depression.     Drugs-For neuropathic pain, a tricyclic antidepressant (amitriptyline, imipramine or doxepin) should be used and may be superior to newer non-tricyclic antidepressants. Amitriptyline is started at a dose of 25-50 mg at night, increasing to 50-75 mg at night. If there is no benefit in one week the drug can be stopped. There is considerable individual variation in patients’ responses to different drugs, and a trial of a second antidepressant is sometimes successful.     Side effects-The side effects of these drugs (sedation, anticholinergic effects and postural hypotension) are usually mild when used in low dose for neuropathic pain.*62\55\2*