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    For this reason, the medication trial should probably be initiated with a very low dose -- as little as 10 to 25 milligrams (mg) per day of imipramine, for example. Typically taken in one dose at bedtime, but can be divided. Use during pregnancy or breast-feeding only after approval from your physician. Headache, drowsiness, dizziness, nervousness, trouble sleeping, dry mouth, nausea, vomiting, blurred vision, altered taste, sweating, stomach upset, constipation, loss of appetite, anxiety, or yawning may occur.

    Some people may experience side effects on dosages as low as 10 mg per day: jitteriness, irritation, unusual energy, and difficulty falling or staying asleep. One-third of panic-prone individuals become jittery and actually experience more anxiety symptoms for the first two to three weeks. The sedating side effects can limit productivity and concentration during the day. Consult your physician before using during pregnancy or breast-feeding. Start at 25 to 75 mg per day and increase over one or two weeks to an average dose of 75 to 150 mg and a maximum dose of 300 mg. Nausea and dizziness can be be common side effects.

    The use of psychotropic medicines to treat psychiatric illness has increased dramatically in recent times.

    Although the biological etiologies of most psychiatric disorders are still unclear, effective pharmacological treatments have been developed over the past 50 years that have become part of the standard of care in the treatment of most major psychiatric disorders.

    Some of these side effects will disappear with the passage of time or with a decrease in the dosage.

    The anticholinergic effects of dry mouth, blurred vision, constipation, and difficulty in urination; postural hypotension; tachycardia, loss of sex drive; erectile failure; increased sensitivity to the sun; weight gain; sedation (sleepiness); increased sweating.

    A complete history should be obtained and the patient should be examined.

    Medical or neurological etiologies that may contribute to the presentation of psychiatric illness should be identified and addressed.

    Treato does not provide medical advice, diagnosis or treatment.

    Nearly 10% of patients presenting with a psychiatric complaint will turn out to have a medical problem as the primary cause.(Hall, Popkin et al.

    1978) Active substance abuse, if present, should be treated before or at the same time that pharmacological therapies are initiated.

    Zammit is president and CEO of Clinilabs, director of the Sleep Disorders Institute, and clinical associate professor at the Columbia University College of Physicians and Surgeons in New York City. Zammit is a consultant to Boehringer-Ingelheim, sanofi-aventis, Sepracor, and Takeda; receives research support from Forest, Glaxo Smith Kline, Pfizer, sanofi-aventis, Sepracor, Takeda Pharmaceuticals North America, Transcept, and Wyeth; and receives honoraria from Takeda. Possible trazodone potentiation of fluoxetine: a case series.

    Acknowledgments: The author would like to thank Ms.

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