Suresh Borade1, Mahesh Bhirud, Kranti Kadam. 1. Senior Resident, Department of Psychiatry, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital, Sion, Mumbai 400022.
Sir,One of the troublesome side-effects of tricyclic anti-depressants is urinary hesitancy due to their anticholinergic effects.1Reboxetine, the only selective noradrenaline reuptake inhibitor, is an effective and well-tolerated antidepressant. Since it has low affinity for muscarinic, cholinergic receptors,2 anticholinergic side-effects such as urinary retention or hesitancy are not expected.However, some patients on reboxetine (2–4 mg/day) complain of urinary hesitancy. A peripheral noradrenergic mechanism termed ‘pseudoanticholinergic syndrome’ may be responsible for this side-effect.3Tamsulosin, an alpha-1A receptor antagonist, is recommended for reboxetine-induced urinary hesitancy.45 Therefore, the following precautions should be taken while a patient is on reboxetine:Enquire about any history of urinary complaints beforehand.In elderly patients, titrate the dose upwards gradually.During follow-up visits, ask patients whether they have any urinary hesitancy.If reboxetine-induced urinary hesitancy does set in, then rather than withdrawing reboxetine, a trial of capsule tamsulosin (available locally as Urinat) can be started in a single dose of 0.4 mg half-an-hour after dinner every day.