Which medications in the drug class Tricyclic Antidepressants are used in the treatment of Anxiety Disorders?

Updated: Mar 27, 2019
  • Author: Nita V Bhatt, MD, MPH; Chief Editor: David Bienenfeld, MD  more...
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Answer

Tricyclic Antidepressants

The tricyclic antidepressants are a complex group of drugs that have central and peripheral anticholinergic effects, as well as sedative effects. They include imipramine (Tofranil) and clomipramine (Anafranil). Caution is warranted in the use of TCAs because of their higher toxicity and potential lethality in overdose. Their use should be limited to cases in which SSRIs are ineffective or cannot be afforded. Clomipramine has an FDA indication in the treatment of OCD and is the only TCA effective in the treatment of this condition. Indeed, it can be effective in cases refractory to treatment with SSRI agents.

Imipramine (Tofranil)

Tricyclic antidepressant that has norepinephrine and serotonin reuptake-inhibition properties. One of the oldest agents available for the treatment of depression and has established efficacy in the treatment of panic disorder. Elderly and adolescent patients may need lower dosing or slower titration.

Amitriptyline (Elavil)

Desipramine (Norpramin)

Tricyclic antidepressant that has norepinephrine and serotonin reuptake-inhibition properties. One of the oldest agents available for the treatment of depression and has established efficacy in the treatment of panic disorder. Elderly and adolescent patients may need lower dosing or slower titration.

Clomipramine (Anafranil)

Dibenzazepine compound belonging to family of tricyclic antidepressants. Inhibits membrane pump mechanism responsible for uptake of norepinephrine and serotonin in adrenergic and serotonergic neurons. Clomipramine affects serotonin uptake while it affects norepinephrine uptake when converted into its metabolite desmethylclomipramine. Believed that these actions are responsible for its antidepressant activity.

Nortriptyline (Pamelor)

Has demonstrated effectiveness in the treatment of chronic pain. By inhibiting the reuptake of serotonin and/or norepinephrine by the presynaptic neuronal membrane, this drug increases the synaptic concentration of these neurotransmitters in the central nervous system. Pharmacodynamic effects such as the desensitization of adenyl cyclase and down-regulation of beta-adrenergic receptors and serotonin receptors also appear to play a role in its mechanisms of action.

Protriptyline (Vivactil)

Increases synaptic concentration of serotonin and/or norepinephrine in CNS by inhibiting their reuptake by the presynaptic neuronal membrane.

Doxepin (Sinequan)

Increases concentration of serotonin and norepinephrine in the CNS by inhibiting their reuptake by presynaptic neuronal membrane. These effects are associated with a decrease in symptoms of depression.

Amoxapine

Inhibits reuptake of norepinephrine or serotonin (5-hydroxytryptamine, 5-HT) at presynaptic neuron. Metabolite (7-hydroxyamoxapine) has significant dopamine receptor blocking activity similar to haloperidol. Elicits strong anticholinergic effects.

Trimipramine (Surmontil)

Inhibits reuptake of norepinephrine or serotonin (5-hydroxytryptamine, 5-HT) at presynaptic neuron. Elicits strong anticholinergic effects.


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