Tricyclic treatment of generalized anxiety disorder

While tricyclic antidepressants (TCAs) have now long been used in treatment for depressive and panic-phobic disorders, we reviewed and reported on their efficacy in generalized anxiety states. These ill-defined states usually have admixtures of anxiety and depression. While there is no neat diagnostic categorization to fit this wasteland of yet-to-be-defined disorders, they show surprising responsiveness to imipramine. The onset of efficacy appears to begin at about 2 weeks or later and is probably superior to at least one well-known benzodiazepine, chlordiazepoxide, well beyond that time. It is not possible to dismiss these observed antianxiety effects as secondary to antidepressant effects or as attributable to the unintended inclusion of a peculiarly sensitive subset of individuals such as panic-phobic patients. These findings indicate that affect regulation by TCAs applies to so-called generalized anxiety as well as to depression and panic-phobic disorder. Brief reminders and guidelines are outlined for the possible clinical use of TCAs in anxiety disorders, but there remain more questions than answers. Several replication studies concerning the results reviewed here are now under way.