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Tricyclic Antidepressants

An Overview of TCAs for Panic Disorder

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Updated July 02, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

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TCAs are a type of antidepressant that can be used to treat panic disorder.

Photo © Microsoft

Tricyclic antidepressants (TCAs) are a type of antidepressant medication that were first introduced in the 1950s to treat major depressive disorder. TCAs have since been found to be safe and effective in treating other conditions, including a variety of mood and anxiety disorders.

Although newer types of antidepressants, like selective serotonin reuptake inhibitors (SSRIs), now dominate the market, TCAs are still considered an effective treatment option for panic disorder and other conditions.

The name, tricyclic antidepressant, is derived from the three-ring chemical structure that makes up these medications. Some of the most common TCAs include:

  • Elavil (amitriptyline)
  • Asendin (amoxapine)
  • Norpramin (desipramine)
  • Adapin, Sinequan (doxepin)
  • Tofranil (imipramine)
  • Pamelor (nortriptyline)
  • Vivactil (protriptyline)
  • Surmontil (trimipramine)

How TCAs Work to Treat Panic Disorder

The human brain consists of many chemical messengers called neurotransmitters, which are believed to be imbalanced for people with mood and anxiety disorders. TCAs affect two of these neurotransmitters: serotonin and norepinephrine. Among several other regulatory functions, serotonin is associated with mood and sleep regulation, while norepinephrine is linked to a person’s fight-or-flight stress response. TCAs work to prevent the absorption of these two neurotransmitters by the brain cells. By stabilizing these neurotransmitters, TCAs assist in enhancing mood, alertness, and sleep patterns while reducing feelings of panic and anxiety. TCAs can also help lower the intensity and frequency of panic attacks.

Side Effects of TCAs

Some of the most common side effects of TCAs include:

  • Blurred vision
  • Dry mouth
  • Constipation
  • Changes in weight and appetite
  • Fatigue
  • Dizziness
  • Nausea

These common side of effects of TCAs often subside over time as your body becomes used to the medication. If side effects worsen or become unmanageable, contact your doctor to discuss your options. Never abruptly stop taking your prescription on your own, as this can lead to some unpleasant symptoms, such as headaches and nausea. Your doctor can assist you in gradually reducing your dosage if you decide that you no longer want to take your medication.

As with all medications, you may potentially develop an allergic reaction to a TCA. Additionally, there are certain medications that can cause dangerous drug interactions when taken with TCAs. MAOIs, another type of antidepressant, can be particularly harmful when combined with TCAs. MAOIs shouldn’t be taken with TCAs unless you are under the recommendation and close supervision of your doctor. Make sure that your prescribing doctor remains up-to-date on all of your prescription and over-the-counter medications.

Contact your doctor immediately if you experience any of the following less common side effects:

  • Seizures
  • Difficulty breathing
  • Fever
  • Bladder symptoms
  • Extreme weakness or fatigue
  • Lightheadedness or fainting

Precautions and Contraindications of TCAs

Medical History: Caution should be taken if you have a history of certain medical conditions. Consult your doctor before taking a TCA if you have been diagnosed with any of the following:

Pregnancy and Nursing: TCAs can be passed on to a child during pregnancy or through breastfeeding. If you are pregnant, planning on becoming pregnant, or nursing, consult your doctor about the potential risks of taking TCAs.

Older Adults: Older adults are often more susceptible to the effects of TCAs. Dosage or prescription adjustments may be required to limit these effects.

Antidepressants and Suicide: The Food and Drug Administration (FDA) cautions that antidepressants have the potential to increase the user’s risk for suicidal thoughts and behaviors, especially among adolescents and young adults. Prescribing doctors must carefully monitor young people starting on TCAs for worsening symptoms, including suicidal thoughts, increased depression, or unusual behaviors.

The information provided here is a basic overview of the use of TCAs for panic disorder. The general information here does not cover every potential risk, such as possible adverse side effects, precautions, and contraindications. Always consult your medical provider about any questions and/or concerns you may have about your prescription.

Sources:

Dudley, William. Antidepressants. San Diego, CA: Reference Point Press, 2008.

Silverman, Harold M. The Pill Book. 14th ed. New York, NY: Bantam Books, 2010.

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