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Panic Disorder and Tricyclics

Read more about Tricyclics.

Overview

Tricyclic antidepressants regulate the neurotransmitters serotonin and/or noradrenalin in the brain. They are at times prescribed to help treat anxiety disorders, including panic disorders, though were originally created as a treatment for depression.

Common names include:

  • Doxepin (Adapin, Sinequan)
  • Clomipramine (Anafranil)
  • Nortriptyline (Aventyl, Pamelor)
  • Amitriptyline (Elavil)
  • Imipramine (Janimine, Tofranil)
  • Maprotiline (Ludiomil)
  • Desipramine (Norpramin, Pertofrane)
  • Trimipramine (Surmontil)
  • Protriptyline (Vivactil)

Effect of Tricyclics on Panic Disorder

The majority of the TCAs are thought to act primarily as serotonin-norepinephrine reuptake inhibitors (SNRIs) by blocking the serotonin transporter (SERT) and the norepinephrine transporter (NET) which results in an elevation in concentration of these neurotransmitters. By increasing the concentration of these calming neurotransmitters, the person subsequently might become more calm, less anxious, and possibly, less likely to suffer from a panic attack or panic disorder.

Side Effects and Warnings

TCAs have also been linked to sudden death syndrome in children. For this reason, many clinicians put them at the bottom of the list of ADHD medications for children. TCAs can also be risky for substance abusers. Before starting TCA treatment for children, doctors recommend getting a baseline EKG in addition to monitoring side effects.

Side effects

The side effect associated with Tricyclic antidepressants are usually mild. These may include:

  • Dry mouth
  • Drowsiness
  • Constipation
  • Weight gain
  • Difficulty with urination
  • Blood pressure changes
  • Risk of severe mood and behavior changes, including suicidal thoughts (Young adults may be at a higher risk for this side effect.)

To reduce the risk of side effects, your doctor will prescribe a low starting dose and slowly increase the amount. Tricyclics are generally well-tolerated especially in low doses. The doses needed to induce pain relief are typically lower than the doses recommended for treating depression

All of the Tricyclics have the same side effects, but in varying degrees. To fully understand these potential side effects, they are grouped as follows:

  • Anticholinergic- These side effects range from unpleasant (dry mouth, dry skin, blurred vision, and constipation) to serious (paralytic ileus, cessation of the movement of the intestine, which can lead to intestinal rupture and death; and urinary retention, inability to urinate, which in serious cases can lead to rupture of the bladder).
  • Adrenergic- Side effects can include sweating, sexual dysfunction, and orthostatic hypotension-- sudden drop in blood pressure upon rising and a sensation of lightheadedness. This condition can lead to a fall and, in turn, to fractures, which can have serious medical consequences, particularly in the elderly.
  • Antihistaminic- Side effects include sedation and weight gain.
  • Miscellaneous- Other side effects include lowered seizure threshold, cardiac arrhythmia, hepatitis, rashes, sweating, anxiety, and elevated heart rate.

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