Tricyclic Antidepressants. The antidepressant drugs known as tricyclic antidepressants (TCAs) have also been effective in treating panic and obsessive-compulsive disorders. Studies on specific TCAs have suggested the following benefits:
- Imipramine (Tofranil, Janimine) is the most commonly used TCA for panic disorder. It is also effective in treating agoraphobia and GAD. In one study it was helpful in reducing side effects during withdrawal from benzodiazepines, the standard anti-anxiety drugs.
- Doxepin (Adapin, Sinequan) has been beneficial for people with a mix of generalized anxiety disorder and depression.
- Clomipramine (Anafranil) is also effective for panic disorders and has been approved for OCD. The drug causes significant reduction in OCD symptoms for patients, including some children, who can tolerate it. (The other tricyclics do not appear to benefit OCD patients.) Many patients stop using Anafranil, however, because of side effects.
Side effects of TCAs include sleep disturbance, abrupt reduction in blood pressure upon standing, weight gain, sexual dysfunction, and mental disturbance. Elderly patients and those with a history of seizures, cardiac problems, closed-angle glaucoma, and urinary retention or obstruction should be closely supervised when taking tricyclics.
Monoamine Oxidase Inhibitors. Monoamine oxidase inhibitors (MAOIs), typically phenelzine (Nardil) or tranylcypromine (Parnate), are antidepressants used for panic disorder or OCD that does not respond to other treatments. Moclobemide (Manerix, Aurorix) is a newer MAOI available in Canada and Europe that showed some benefits for social phobias in some, but not all studies.
MAOIs commonly cause weight gain, drowsiness, dizziness, sexual dysfunction, and insomnia. The main problem with most of these drugs is the need for dietary restrictions. Severe high blood pressure (hypertension) can be brought on by eating certain foods that have a high tyramine content including cheese, red wine, vermouth, dried meats and fish, canned figs, and fava beans. MAOIs can also lead to serious hypertensive interactions with certain drugs, including some common over-the-counter cough medications and decongestants. They can also cause birth defects and should not be taken by pregnant women.
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