Tapering. Your doctor may suggest that you begin to taper your TCA six months to a year after you have controlled your panic attacks. 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. If you stop this medication abruptly, withdrawal symptoms may begin in twenty-four hours, including nausea, tremor, headache, and insomnia. Few symptoms should be evident with a gradual decrease in dose. Panic attacks will not usually return immediately after you stop the medication, but may recur several weeks later. Your doctor may suggest that you begin to taper your TCA six months to a year after you have controlled your panic attacks. 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. If you stop this medication abruptly, withdrawal symptoms may begin in twenty-four hours, including nausea, tremor, headache, and insomnia. Few symptoms should be evident with a gradual decrease in dose. Panic attacks will not usually return immediately after you stop the medication, but may recur several weeks later.

Of this family, imipramine has been the focus of most of the panic treatment research.

Possible Benefits. Blocks panic attacks in 70% of people. Non-addicting. Tolerance doesn't develop. Helps depression. Continued improvement for several months. Because it is slowly metabolized by the body, you can take it once daily, usually at bedtime. . Blocks panic attacks in 70% of people. Non-addicting. Tolerance doesn't develop. Helps depression. Continued improvement for several months. Because it is slowly metabolized by the body, you can take it once daily, usually at bedtime.

Possible Disadvantages. Not very helpful for anticipatory anxiety. Response takes weeks or months. One quarter to one half of imipramine patients relapse after tapering from the drug. Not recommended while breast-feeding and used only with physician consent while pregnant. . Not very helpful for anticipatory anxiety. Response takes weeks or months. One quarter to one half of imipramine patients relapse after tapering from the drug. Not recommended while breast-feeding and used only with physician consent while pregnant.

Possible Side Effects. See tricyclic antidepressants side effects, above. Initial use of imipramine occasionally causes an increase in anxiety that usually diminishes in several weeks. Anticholinergic effects are stronger than most other antidepressants. If they are bothersome to you, it may be possible to switch to a different TCA with less anticholinergic effects. Dizziness from a lowering of blood pressure is moderate. If postural hypotension troubles you, nortriptyline may work more effectively. Imipramine causes some jitteriness in about 20 to 25% of subjects, which usually lasts one to three weeks, but can be often avoided by starting with as little as 10 mg before bed. The tendency toward weight gain is moderate. Some patients, especially males, experience reduced sex drive or responsiveness while taking this drug. Other side effects are palpitations (changes in heart beat), sweating and drowsiness. One third of patients are unable to tolerate side-effects and must switch to another medication. . See tricyclic antidepressants side effects, above. Initial use of imipramine occasionally causes an increase in anxiety that usually diminishes in several weeks. Anticholinergic effects are stronger than most other antidepressants. If they are bothersome to you, it may be possible to switch to a different TCA with less anticholinergic effects. Dizziness from a lowering of blood pressure is moderate. If postural hypotension troubles you, nortriptyline may work more effectively. Imipramine causes some jitteriness in about 20 to 25% of subjects, which usually lasts one to three weeks, but can be often avoided by starting with as little as 10 mg before bed. The tendency toward weight gain is moderate. Some patients, especially males, experience reduced sex drive or responsiveness while taking this drug. Other side effects are palpitations (changes in heart beat), sweating and drowsiness. One third of patients are unable to tolerate side-effects and must switch to another medication.

Dosages Recommended by Investigators. Once daily dosing. The best way to reduce the early anxiety symptoms with the start of imipramine is to begin with a very small dose, typically 10 mg at bed time, and increase the dose 10 mg every day until you reach the dose of 50 mg per day. It can block panic in some patients with 50 mg per day, so maintaining this dose level for several days is a good strategy. If the dose is not effective, then the physician can increase it 25 mg every third day up to 100 mg. After one week, if panic continues, then the dose can increase by 50 mg every third day. Although some patients require a smaller or larger dosage, the usual maintenance dosage is between 150 mg and 250 mg per day. . Once daily dosing. The best way to reduce the early anxiety symptoms with the start of imipramine is to begin with a very small dose, typically 10 mg at bed time, and increase the dose 10 mg every day until you reach the dose of 50 mg per day. It can block panic in some patients with 50 mg per day, so maintaining this dose level for several days is a good strategy. If the dose is not effective, then the physician can increase it 25 mg every third day up to 100 mg. After one week, if panic continues, then the dose can increase by 50 mg every third day. Although some patients require a smaller or larger dosage, the usual maintenance dosage is between 150 mg and 250 mg per day.