Surmontil works by restoring the balance of certain natural substances (neurotransmitters) in the brain. Surmontil increases risk of suicidal thinking and behavior in children, adolescents, and young adults; monitor for clinical worsening or unusual changes. Screen for bipolar disorder. Monitor for serotonin syndrome; discontinue if occurs. Seizure disorders. ECT. Mania/hypomania. Psychosis. Urinary retention. Angle-closure glaucoma. Cardiovascular disease. Diabetes. Hyperthyroidism. Hepatic impairment. Avoid abrupt cessation. Elderly. Pregnancy (Cat.C). Nursing mothers.