Managing Anxiety With Tricyclic Antidepressants and MAOIs

Tricyclic Antidepressants
Similarly, antidepressant medications called tricyclics are started at low doses and gradually increased. Tricyclics have been around longer than SSRIs and have been more widely studied as a treatment for anxiety.
 
For anxiety disorders other than OCD, tricyclics are as effective as the SSRIs, but many physicians and patients prefer the newer drugs because the tricyclics sometimes cause side effects, such as:
 
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Weight gain.
 
If these problems persist or are bothersome, a change in dosage or a switch in medications may be needed.
 
Tricyclics are useful in anxiety treatment for people with co-occurring anxiety disorders and depression. Clomipramine (Anafranil®), the only antidepressant in its class prescribed for OCD, and imipramine (Tofranil®), prescribed for panic disorder and GAD, are examples of tricyclics.
 
Monoamine Oxidase Inhibitors
Monoamine oxidase inhibitors, or MAOIs, are the oldest class of antidepressant medications. The most commonly prescribed MAOI for treating anxiety is phenelzine (Nardil®), which is helpful for people with panic disorder and social phobia. Tranylcypromine (Parnate®) and isoprocarboxazid are also used to treat anxiety disorders.
 
People who take MAOIs are put on a restrictive diet because these medications can interact with some foods and beverages, including cheese and red wine, which contain a chemical called tyramine. MAOIs also interact with some other medications, including SSRIs. Interactions between MAOIs and other substances can cause dangerous elevations in blood pressure or other potentially life-threatening reactions.
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