Sedative tricyclics such as trimipramine are often given in anxiety disorders. Their full benefit may take several weeks in depression, but their useful hypnotic and anxiolytic properties are immediate and dose-related. For example, trimipra-mine 25 mg nocte regularly plus 25 mg mane p.r.n. will help sleep and make available a safe antianxiety treatment for daytime use in a patient with mild anxiety symptoms. Antidepressants are effective in panic disorder. MAOIs should be tried if other antidepressant classes are ineffective.

SSRIs are widely used in general practice; some patients probably benefit. However, in some patients, they can exacerbate anxiety, with troublesome agitation and gastrointestinal upset; the problem is so significant that some have recommended 'covering' a newly started SSRI with a second drug such as the notably sedative trazodone or a benzodiazepine. Unfortunately, it is not possible to predict which patients will experience these adverse effects.

I rarely if ever prescribe SSRIs for anxiety; cheaper and, in my hands, more effective drugs - tricyclics - are to be preferred. Trazodone, trimipramine, or, among the newer drugs, mirtazepine, have predictable and dose-related anxio-lytic effects, and are much more suitable.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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