Examples

Generic Name	Brand Name
clomipramine	Anafranil
desipramine	Norpramin
imipramine	Tofranil

Tricyclic antidepressants are usually taken in tablet or capsule form.

How It Works

Tricyclic antidepressants (TCAs) affect certain brain chemicals (neurotransmitters) and reduce the number and severity of panic attacks associated with panic disorder.

Why It Is Used

TCAs are used to reduce the number and severity of panic attacks.

How Well It Works

Imipramine has been shown to be effective in reducing symptoms and relapses of panic attacks in panic disorder.¹

TCAs generally can be an effective treatment to reduce the number and severity of panic attacks in panic disorder. However, when panic disorder is associated with other anxiety disorders (such as obsessive-compulsive disorder), another medication or a combination of medications may be prescribed.²

Side Effects

Side effects of TCAs vary. Most are reduced as the person continues to take the medications. Side effects include:

• Blurred vision.
• Abnormally fast heart rate (tachycardia).
• Heart palpitations .
• Blood pressure changes. You may experience low blood pressure when you stand up, which can make you feel dizzy.
• Drowsiness.
• Dry mouth.
• Headache.
• Upset stomach and constipation.
• Weight gain.
• Loss of sexual desire or ability.
• Loss of or change in appetite.

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

TCAs are usually started at low doses that are increased gradually. They may take several weeks or months to start working.

Never suddenly stop taking TCAs. The use of any antidepressant should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medications can cause negative side effects or a relapse of your condition.

You may need to have your blood checked while taking TCAs because the medication can build up in your blood. Excess amounts of the medication can cause serious problems such as heart conditions, and even death. People who have thoughts of suicide need to be monitored closely and given only small amounts of the medications at one time, to avoid an overdose.

TCAs usually are not given if you have certain heart problems, such as irregular heartbeats or low blood pressure. They may not be the first drug of choice for older adults who may have more difficulty with some of the side effects.

Be sure to tell your doctor about all the medications you are currently taking. TCAs can interact poorly with certain heart medications—digoxin (for example, Lanoxin)—and/or with other medications, such as those used to treat seizures—phenytoin (Dilantin).

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

1. Kumar S, Oakley-Browne M (2007). Panic disorder, search date May 2006. Online version of BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
2. Ballenger JC, et al. (1998). Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry, 59(8): 47–54.