Antidepressants increase risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder (MDD) and other psychiatric disorders. Imipramine is FDA approved for treatment of nocturnal enuresis in children ≥6 years of age. May worsen psychosis in some patients or precipitate shift to mania or hypomania in bipolar disorder. Monotherapy in bipolar disorder should be avoided. Imipramine not FDA approved for treatment of bipolar depression. May cause anticholinergic effects (use with caution in decreased GI motility, paralytic ileus, urinary retention, BPH, xerostomia, or visual problems). TCAs may rarely cause bone marrow suppression. May cause orthostatic hypotension (use with caution in cerebrovascular disease, cardiovascular disease, hypovolemia, or concurrent medication use which may predispose to hypotension/bradycardia). Associated with photosensitization. May cause sedation. Use with caution in the following: history of cardiovascular disease (including previous MI, stroke, tachycardia, or conduction abnormalities), diabetes mellitus (may alter glucose regulation), hepatic or renal impairment, risk of seizures (including patients with history of seizures, head trauma, brain damage, alcoholism, or concurrent therapy with medications which may lower seizure threshold), hyperthyroidism or patients receiving thyroid supplementation due to concerns of pro-arrhythmogenesis. Effects may be potentiated when used with other sedative drugs or ethanol. Use with caution in the elderly. Recommended to discontinue prior to elective surgery requiring general anesthesia. Therapy should not be abruptly discontinued in patients receiving high doses for prolonged periods. Might increase risks associated with electroconvulsive therapy.