Bach asked
Hello, I have been taking Imipramine for about 10 years. I take 250mg at bedtime. I take it for General Anxiety Disorder. Lately, I've been feeling increased anxiety as well as depression. My question is, basically, what would you recommend I ask my Dr to prescribe in addition to the imipramine to get the anxiety and depression under control? I understand sometimes a combination of medication can be effective.
Answer
There are many different ways you can go here. The situation you are going through is not uncommon. Very often, antidepressants can lose their efficacy over time and the reason for this is not certain. Usually when this happens you have the choice to either:
- Increase the dose of the current medication
- Switch to another medication in the class
- Switch to a different class
- Add on another medication from a different class
You are already at a high dosage of imipramine so I wouldn't think increasing that is an option. Also, making things slightly more difficult, is that every other drug that is indicated for generalized anxiety disorder affects the neurotransmitter serotonin, which imipramine also affects. In most cases, it is not a good idea to add on two different drugs that both work on serotonin although there are cases where it may be necessary and beneficial.
I can't really recommend anything as I am not your provider and don't have your medical history. What I can tell you is the following drugs are approved for generalized anxiety disorder:
- Alprazolam
- Buspirone
- Duloxetine
- Escitalopram
- Paroxetine
- Venlafaxine
Many other drugs are also used off-label including many drugs in the antipsychotic class.
I would recommend discussing your options with your provider or a specialist. Certainly if you need my specific thoughts on a drug or a drug therapy I can help out.
