Physicians use tricyclic antidepressants in the treatment of panic disorder, PTSD, generalized anxiety and depression that occurs with anxiety. If uncomfortable side effects appear, one approach is to wait two to three weeks for them to diminish before increasing to the next higher dose. The sedating side effects can limit productivity and concentration during the day. Of this family, imipramine has been the focus of most of the panic treatment research. Often effective in reducing panic attacks and elevating depressed mood. If the patient adjusts to the side effects, the physician increases the dosage every two or more days until the patient is taking the preferred dosage. One quarter to one half of imipramine patients relapse after tapering from the drug. Initial use of imipramine occasionally causes an increase in anxiety that usually diminishes in several weeks. Patients with certain abnormal electrocardiograms, with narrow-angle glaucoma, or with an enlarged prostate should not take this medication. Like imipramine, you may experience more general anxiety the first few days up to three weeks. Increase by 25 mg every three to four days to 100 mg per day, usually taken in one dose. Avoid during first three months of pregnancy and consult physician before using last six months and before breast-feeding. This report considered two broad classes of antidepressants: , i.e., drugs developed for the management of depression that lack significant sedating effects.The sedating antidepressants are the tricyclic antidepressants amitriptyline, imipramine, and doxepin and the related compounds mianserin and mirtazapine.Pros: A very effective SSRI that can be easier to start and stay on than others.Side effects: Nausea, insomnia, headaches, sexual dysfunction, jitteriness; possibly drowsiness, dry mouth, constipation. Some of these side effects will disappear with the passage of time or with a decrease in the dosage. The anticholinergic effects of dry mouth, blurred vision, constipation, and difficulty in urination; postural hypotension; tachycardia, loss of sex drive; erectile failure; increased sensitivity to the sun; weight gain; sedation (sleepiness); increased sweating.
Tricyclics are chemical compounds that contain three interconnected rings of atoms.
Possible side effects initially (including insomnia, tremor, or both) may last up to the first two to three weeks of treatment.
If daytime sedation or other side effects are bothersome to the patient, the physician may suggest taking the full dosage at night before bed. Not recommended while breast-feeding and used only with physician consent while pregnant. Anticholinergic effects are stronger than most other antidepressants. Avoid during last three months of pregnancy to prevent withdrawal symptoms in infant. The most common side effects are headaches, drowsiness, dry mouth, constipation and insomnia. Raise the dose over the next few weeks to a maximum of 300 mg.
Subclasses include: the tricyclic antidepressants (e.g., amitriptyline and doxepin); the serotonin-specific reuptake inhibitors (SSRI) including fluoxetine (Prozac); monoamine oxidase inhibitors (MAOIs), including phenelzine (Nardil); and several new drugs such as venlafaxine (Effexor) and nefazodone (Serzone). (2004) cites EMCDDA (1999) who reviewed controlled experimental studies and concluded that impaired performance is associated with the use of most sedative tricyclic antidepressants.
New-generation antidepressants do not seem to interfere with performance, except when used at higher doses.
Examples of nonsedating antidepressants include the monoamine oxidase inhibitor moclobemide, the selective serotonin reuptake inhibitors fluoxetine, paroxetine, and nefazodone, and the serotonin and norepinephrine uptake inhibitor (SNRI) venlafaxine.