Antidepressants may increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders (caution in high-risk patients during initiation of therapy). May unmask bipolar disorder (active hypomania). The drug is not FDA approved for the treatment of bipolar depression. May cause anticholinergic effects (caution in history of urinary retention, increased intraocular pressure, or angle-closure glaucoma). May rarely cause bone marrow suppression. May also cause orthostatic hypotension (use with caution in cerebrovascular disease, cardiovascular disease, hypovolemia, or concurrent medication use which may predispose to hypotension/bradycardia). May cause sedation. Caution in history of cardiovascular disease, diabetes mellitus (may alter glucose regulation), hepatic, or renal impairment. Use cautiously in patients with hyperthyroidism or those receiving thyroid supplementation. Caution in the elderly (risk of falling or confusional states), and in patients at risk of seizures (head trauma, brain damage, alcoholism, medications which may lower seizure threshold). Effects may be potentiated with other sedative drugs or ethanol. Discontinue prior to general anesthesia. Therapy should not be discontinued abruptly in patients receiving high doses for prolonged periods. May increase the risks associated with electroconvulsive therapy.