Tricyclic antidepressants

Tricyclic antidepressants such as imipramine are among the most promising medication available for the treatment of anxiety disorders.

Antidepressants are divided in distinct groups, such as tricyclic antidepressants and selective serotonin re-uptake inhibitors. Whereas the selective serotonin re-uptake inhibitors aim at blocking receptors that are responsible for the re-uptake of specific messenger substances, tricyclic antidepressants are active on several systems simultaneously.

Antidepressants do not lead to dependency, however they must be taken over a longer period of time in sufficient dosage. Several weeks can go by before the first effects are being felt, what may be a source of insecurity for many people, especially when no previous explanations were provided. Often, secondary effects can be felt in the first 2 to 3 weeks, but these usually vanish over time.


In use for about 45 years, imipramine is the oldest antidepressant on the market, and showed its efficacy against anxiety attacks at an early stage already. Known as an “old” tricyclic antidepressant, it is also the antidepressant with the best efficacy proof in the treatment of panic disorders. All antidepressants have a mood uplifting effect as well as a normalizing effect on compulsive drives. The name is derived from the main site of action in case of depression. Indeed, the word tricyclic refers to the three rings in the chemical formula. These antidepressants inhibit the re-uptake of diverse messenger substances, are active at various levels and in different ways on other neurotransmitter systems.

Most people can support a progressive increase of imipramine relatively well. However with anxiety patients in particular, this antidepressant must be dosed very slowly. For men suffering from a prostate enlargement accompanied with residual urine, imipramine is usually not recommended, or only in consultation with an urologist. People suffering from angle-closure glaucoma should also not take imipramine, as well as people with heart failure.

In case of uncertainty, such illnesses should be ruled out before starting a treatment. In the first weeks, it is not uncommon that certain effects can appear, but these usually disappear after some time. Some of these symptoms are similar to those of anxiety attacks. Most often, these are intense sweating, shaking, dry mouth (xerostomia), dizziness, or low blood pressure, constipation, urinary retention, fatigue or insomnia. Such symptoms decrease inversely to a dosage increase. Therefore it is worthwhile to persist.

Other active substances

Other active substances of the tricyclic antidepressant group include clomipramine as well as doxepin. The type of anxiety disorder of which you are affected, as well as other illnesses that may also be present, determine which particular substance is most adequate for each patient.

Text: Helga Grafe – 03/2016
Translation: MyH – 05/2016