Question. Do you have a list of drugs for depression, and non-addictive medications for anxiety? Tricyclics of the older vintage would be helpful.

Answer. I am providing you with a list of commonly used antidepressants, as well as their usual doses:

Maintenance Dosage and Tablet Size for Non-MAOI Antidepressants

With respect to non-addictive medications for anxiety, it is first important to realize that the term addiction is defined in many ways. The medications most commonly used in the treatment of anxiety – the benzodiazepines, such as Valium, Librium, Ativan, etc. – are not highly addictive for the vast majority of people who are prescribed them for the right reasons. These agents may be abused or become habit-forming, however, in individuals with a history of alcohol and substance abuse, and, very rarely, in individuals who do not have such problems. The antianxiety agent buspirone (BuSpar) is a good alternative, and is not habit-forming or prone to abuse; however, while buspirone is useful for generalized anxiety, it is not helpful for panic attacks or obsessive-compulsive states.

Sometimes, low doses of the older tricyclic agents, such as doxepin 15-25 mg/day, may be useful for generalized anxiety in patients who are not good candidates for benzodiazepines. If you want more details about available medications for mood and anxiety disorders, you may want to call the NIMH Depression Awareness program.

Question. I have a problem with antidepressants exacerbating my hypertension. Are there any that don’t increase blood pressure? Are there new antidepressants that might soon be available?

Answer. There are many antidepressants that do not increase blood pressure for MOST adults, but there are always exceptions. For example, the older tricyclic antidepressants (such as imipramine or nortriptyline) typically result in decreased blood pressure. (Children can sometimes have hypertensive reactions to some of the tricyclics, as do a minority of adults). The new antidepressant nefazodone (Serzone) is also unlikely to raise blood pressure, and often will reduce it. This is also true of its close cousin trazodone (Desyrel). Although the MAOIs (monoamine oxidase inhibitors) are associated with hypertensive reactions (very high blood pressure) when an individual goes off the special MAOI diet, these drugs also generally reduce blood pressure. The antidepressants that are most likely to raise blood pressure are venlafaxine (Effexor) and bupropion (Wellbutrin), but this reaction can often be controlled by adjusting the patient’s blood pressure medication.

There is a new antidepressant called citalopram that is expected to be released shortly. It is in the same general class as Prozac and Zoloft (the “SSRIs”), and I have not seen any data yet on its blood pressure effects. My suggestion is to discuss the use of either nefazodone (Serzone) or trazodone (Desyrel) with your doctor.