Anxiolytics imipramine

Compared to antipsychotics, there are even fewer studies on the prescribing patterns of antidepressants done in Asian countries. Pi etal. (1985) conducted a survey of psychotropic prescribing practices reported by psychiatrists in 29 medical schools in 9 Asian countries. Daily dose range of tricyclic antidepressants (TCAs) such as amitriptyline, imipramine, and nortriptyline in Asian countries was comparable to the practice in USA. This is despite differences found between Asian and non-Asian populations in the pharmacokinetics of TCAs (Pi et al, 1993). A questionnaire on the practical prescribing approaches in mood disorders administered to 298 Japanese psychiatrists was reported by Oshima et al. (1999). As first-line treatment, the majority of respondents chose newer TCAs or non-TCAs for moderate depression and older TCAs for severe depression. Combination of antidepressants and anxiolytics was preferred in moderate depression, while an antidepressant and antipsychotic combination was common in severe psychotic depression. Surprisingly, sulpiride was the most favored drug for dysthymia. In a naturalistic, prospective follow-up of 95 patients with major depression in Japan, the proportion of patients receiving 125 mg/day or less of imipramine was 69% at one month and 67% at six months (Furukawa et al., 2000). 

Venlafaxine extended release, duloxetine, paroxetine, and escitalopram are FDA approved for treatment of GAD. Sertraline is also effective. Acute response and remission rates are approximately 65% and 30%, respectively. Imipramine may be used when patients fail to respond to selective serotonin reuptake inhibitors (SSRIs). In one trial, diazepam, trazodone, and imipramine had greater anxiolytic activity than placebo. 

Sussman N. (1998). Anxiolytic antidepressant augmentation. J Clin Psychiatry. 59(suppl 5) 42-48. Tadokoro C, Kiuchi Y, Yamazaki Y, Oguchi K, Kamijima K. (1998). Effects of imipramine and sertraline on protein kinase activity in rat frontal cortex. Eur J Pharmacol. 342(1) 51-4. 

Imipramine, a TCA, was the first pharmacological agent noted to treat panic disorder (Klein 1964). Other TCAs, notably clomipramine, have also been found to have significant anxiolytic properties (den Boer et al. 1990 Modigh 1992). Studies of ethnic differences in the pharmacokinetics of the TCAs in... 

Two studies have indicated that the tricyclic antidepressant (TCA) imipramine may be as effective as BZDs in the treatment of GAD ( 58, 59). No studies longer than 8 weeks duration have been conducted, however, and imipramine s onset of anxiolytic action may be even slower than that of buspirone. Aithough adverse effects also may limit usefulness, its lack of dependence liability may make it an appropriate alternative in chronically anxious patients who also suffer from panic and depression. 

The efficacy of TCAs, principally impramine, has also been tested as treatment of separation anxiety and school phobia. Four placebo-controlled studies involving 140 children have been conducted (153, 158, 159 and 160). Whereas early studies were positive, subsequent reports were not. Gittelman-Klein and Klein ( 161) demonstrated a significant benefit over placebo from 6 weeks of treatment with imipramine (mean dose = 159 mg per day) in 45 children with school phobia. A subsequent study using lower amounts of clomipramine (40 to 75 mg per day) was negative but the doses used make interpretation difficult. Also, because of its tolerability and safety profile, clomipramine is generally not used as an anxiolytic agent in children or adolescents. 

The coat state assessment is a fast and simple qualitative method of assessing mouse depression-like states through observation of the condition of an animal s fur. In rodents, coat state tends to decline with increased depression, similar to depressed patients who frequently exhibit poor hygiene (29-31). Antidepressants have been shown to improve the coat condition of mice while reducing depression-like symptoms (29-31). For example, the reduction of corticotropin-releasing factor (CRF) has been associated with improved coat state (and is implicated in depression) (32). Of importance here, antidepressants (e.g., imipramine) and anxiolytics (e.g., chlordiazepoxide) have been shown to interact with corticotropin-releasing factor (33) (see Note 7). 

---