Which medications in the drug class Antidepressants, TCA are used in the treatment of Panic Disorder?

Updated: Mar 21, 2018
  • Author: Mohammed A Memon, MD; Chief Editor: Randon S Welton, MD  more...
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Antidepressants, TCA

Tricyclic antidepressants (TCAs) have the advantages of once-daily dosing, low risk of dependence, and no dietary restrictions. However, these drugs are discontinued in 35% of patients because of adverse effects, such as blurred vision, dry mouth, dizziness, weight gain, gastrointestinal disturbance, agitation, insomnia, headache, and decreased libido or ability to orgasm.

TCAs must be started in low doses to avoid amphetamine-like stimulation and can require up to 8-12 weeks for treatment response.

Imipramine (Tofranil, Tofranil-PM)

The mechanism of action of imipramine is not fully known. However, the clinical effect is hypothesized as being due to the inhibition of the reuptake of norepinephrine and serotonin (5-hydroxytryptamine [5-HT]) at presynaptic neurons.

Desipramine (Norpramin)

Desipramine may increase the synaptic concentration of norepinephrine in the CNS by inhibiting the reuptake by the presynaptic neuronal membrane. It may have effects in the desensitization of adenyl cyclase, downregulation of beta-adrenergic receptors, and downregulation of serotonin receptors.

Clomipramine (Anafranil)

Clomipramine affects serotonin uptake. This agent also affects norepinephrine uptake when converted into its metabolite, desmethylclomipramine.

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