Antidepressants

1. Tricyclic antidepressants are widely used to treat anxiety disorders. Their onset of action is much slower than that of the benzodiazepines, but they have no addictive potential and may be more effective. An antidepressant is the agent of choice when depression is present in addition to anxiety.

2. Sedating antidepressants often have an early effect of promoting better sleep, although 2-3 weeks may pass before a patient experiences an antianxiety benefit. Better sleep usually brings some relief from symptoms, and the patient's functional level begins to improve almost immediately.

3. Anxious patients benefit from the sedating effects of imipramine (Tofranil), amitriptyline (Elavil), and doxepin (Sinequan). The daily dosage should be at least 50-100 mg.

4. Desipramine (Norpramin) is useful if sedation is not desired. The selective serotonin reuptake inhibitors (fluoxetine [Prozac]) may worsen anxiety symptoms before relieving them.

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