Non sedating antidepressants
For this reason, the medication trial should probably be initiated with a very low dose -- as little as 10 to 25 milligrams (mg) per day of imipramine, for example. Typically taken in one dose at bedtime, but can be divided. Use during pregnancy or breast-feeding only after approval from your physician. Headache, drowsiness, dizziness, nervousness, trouble sleeping, dry mouth, nausea, vomiting, blurred vision, altered taste, sweating, stomach upset, constipation, loss of appetite, anxiety, or yawning may occur. Some people may experience side effects on dosages as low as 10 mg per day: jitteriness, irritation, unusual energy, and difficulty falling or staying asleep. One-third of panic-prone individuals become jittery and actually experience more anxiety symptoms for the first two to three weeks. The sedating side effects can limit productivity and concentration during the day. Consult your physician before using during pregnancy or breast-feeding. Start at 25 to 75 mg per day and increase over one or two weeks to an average dose of 75 to 150 mg and a maximum dose of 300 mg. Nausea and dizziness can be be common side effects.Your doctor may suggest that you begin to taper your TCA six months to a year after you have controlled your panic attacks. Because it is slowly metabolized by the body, you can take it once daily, usually at bedtime. If they are bothersome to you, it may be possible to switch to a different TCA with less anticholinergic effects. Other common side effects are blurred vision, urinary retention, fatigue, weight gain, postural hypotension, nervousness, muscle twitching, decreased ability to have orgasm (42% of men), increased sweating, and sedation (sleepiness). Elderly patients may experience confusion and memory impairment. Taking the dose at night can sometimes reduce the side effects. You can taper it gradually over a two- to three-week period as a way to avoid the flu-like symptoms that commonly occur if you abruptly stop the medication, however even more gradual tapering can help monitor for a relapse in panic attacks. Dizziness from a lowering of blood pressure is moderate. It takes four to six weeks to notice significant therapeutic benefits from clomipramine .
Whom it may be suitable for: Can be ideal for the elderly because of fewer side effects when prescribed at lower doses. Men with an enlarged prostate should avoid certain antidepressants. Weight gain can be as much as one pound per month with about 25% of patients gaining 20 pounds or more. Should not be used by patients with narrow-angle glaucoma or certain heart abnormalities.Although some patients require a smaller or larger dosage, the usual maintenance dosage is between 150 mg and 250 mg per day. Insomnia and the tendency for weight gain are mild. Source: Best Health Magazine, September 2008 Most of these (among the most-prescribed antidepressants in Canada) work the same way, says Wende Wood, a psychiatric pharmacist with the Centre for Addiction and Mental Health in Toronto.
It’s the worst one for weight gain, and among the worst for withdrawal symptoms (unless properly managed).