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. Men with an enlarged prostate should avoid certain antidepressants. Weight gain can be as much as one pound per month with about 25% of patients gaining 20 pounds or more. Should not be used by patients with narrow-angle glaucoma or certain heart abnormalities.Panic attacks will not usually return immediately after you stop the medication, but may recur several weeks later. Can be helpful for panic, generalized anxiety, and PTSD. Other side effects are palpitations (changes in heart beat), sweating and drowsiness. The best way to reduce the early anxiety symptoms with the start of imipramine is to begin with a very small dose, typically 10 mg at bed time, and increase the dose 10 mg every day until you reach the dose of 50 mg per day. If you stop this medication abruptly, withdrawal symptoms may begin in twenty-four hours, including nausea, tremor, headache, and insomnia. If postural hypotension troubles you, may work more effectively. Therapeutic dose is typically between 50 and 75 mg per day, with some individuals requiring up to 150 mg, based on blood level. Clomipramine (Anafranil) Helps control obsessive-compulsive disorder by reducing the duration and intensity of these symptoms and the corresponding anxiety. Few symptoms should be evident with a gradual decrease in dose. Imipramine causes some jitteriness in about 20 to 25% of subjects, which usually lasts one to three weeks, but can be often avoided by starting with as little as 10 mg before bed. Some patients, especially males, experience reduced sex drive or responsiveness while taking this drug. Less jitteriness than imipramine; less postural hypotension than other tricyclic antidepressants; lightheadedness, mild sedation (sleepiness), weight gain, insomnia, impaired urination and anticholinergic effects (20% experience dry mouth). Your doctor may suggest that you begin to taper your TCA six months to a year after you have controlled your panic attacks. Because it is slowly metabolized by the body, you can take it once daily, usually at bedtime. If they are bothersome to you, it may be possible to switch to a different TCA with less anticholinergic effects. Other common side effects are blurred vision, urinary retention, fatigue, weight gain, postural hypotension, nervousness, muscle twitching, decreased ability to have orgasm (42% of men), increased sweating, and sedation (sleepiness). Elderly patients may experience confusion and memory impairment. Taking the dose at night can sometimes reduce the side effects.
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.