Taking SNRIs or Tricyclic Antidepressants for Anxiety
Serotonin-Norepinephrine Reuptake Inhibitors
Serotonin-norepinephrine reuptake inhibitors (SNRIs) are closely related to SSRIs. They have similar actions as SSRIs, although they have a tendency to have more "stimulatory" effects, probably due to the effects on norepinephrine. This can become a problem for some people who may experience insomnia or jitteriness. Others may develop high blood pressure as a result of the norepinephrine effects.
SNRI medications include:
- Desvenlafaxine (Pristiq®)
- Duloxetine (Cymbalta®)
- Levomilnacipran (Fetzima™)
- Milnacipran (Savella™)
- Venlafaxine (Effexor®)
- Venlafaxine XR (Effexor XR®).
Not all SNRIs are approved for anxiety treatment.
Tricyclic antidepressants have been around longer than SSRIs and have been more widely studied as a treatment for anxiety. However, they are generally more likely to cause intolerable or even dangerous side effects and (as a result) are not usually good choices for elderly individuals. Some of the potential side effects of tricyclic antidepressants include:
- Dry mouth (see Tricyclic Antidepressants and Dry Mouth)
- Confusion or delirium
- An irregular heart rhythm (arrhythmia).
If these problems persist or are bothersome, a change in dosage or a switch in medications may be needed. Tricyclics are especially useful when treating anxiety in people with co-occurring anxiety disorders and depression.
Examples of tricyclic antidepressants include:
- Amitriptyline (Elavil®)
- Amoxapine (Asendin®)
- Clomipramine (Anafranil®)
- Desipramine (Norpramin®)
- Doxepin (Sinequan®, Silenor®)
- Imipramine hydrochloride (Tofranil®)
- Imipramine pamoate (Tofranil PM®)
- Maprotiline (Ludiomil®)
- Nortriptyline (Pamelor®)
- Protriptyline (Vivactil®)
- Trimipramine (Surmontil®).
Not all tricyclic antidepressants are approved to treat anxiety.