Doxepin

Doxepin, commonly sold under the brand name Silenor, is a type of antidepressant known as a tricyclic antidepressant (TCA). This class of drugs includes some of the earliest antidepressants developed. They work by blocking the reabsorption of two neurotransmitters in the brain—serotonin and norepinephrine—in order to regulate mood and help relieve depression.

The FDA approved doxepin in 1969. Since then, newer classes of antidepressants have been developed that work differently and may result in fewer side effects.

Because doxepin can have significant side effects, it is not generally used as a first-line prescription treatment for depression. However, doxepin may still work well for some patients—particularly those for whom other treatments have not been effective.

Together, you and your provider can weigh the pros and cons of doxepin and determine if it’s the right choice for you.

At Brightside, our psychiatric providers specialize in personalizing treatment for each person. We give you personal attention and expert advice you can count on—and explain all your options. By using our expertise, we find the medication that’s right for you. It’s important that you understand how medications work and what to expect so that your treatment is worry-free.

If your Brightside provider prescribes doxepin, they will explain how it’s used as a treatment for depression and anxiety. Our goal is to provide treatment that helps improve your mood and feelings of well-being. Doxepin can also help relieve insomnia in those who have difficulty falling asleep or staying asleep. It may also help improve your energy levels.

Doxepin can help to improve mood and relieve anxiety and tension. Doxepin may also help to alleviate pain, fatigue, and worry. This medication can improve your overall sense of well-being and can also improve your sleep and energy level.

Making sense of different medications, their uses, benefits, and side effects can be challenging. That’s where we can help. Brightside providers have an in-depth knowledge of the strengths and drawbacks of each medication. You’ll get all the information you need to make an informed choice about your treatment.

At Brightside, we can help you in finding the right treatment to help you feel better. Many different factors influence how you respond to medication. We understand that you may have questions about taking a new medication and whether it will help you. You’re not alone—many patients have similar questions.

With doxepin, you may start to notice positive changes within a few days. Just keep in mind that it may take two to three weeks before you experience the full benefits of the medication.

Before starting a new medication like doxepin, it’s important to get a comprehensive health assessment from a provider who understands your health history. You should only take doxepin if a qualified psychiatric provider prescribed it for you.

Before you start taking doxepin, you may have some questions about how long you’ll need to take this medication. The length of time you need to take doxepin will depend on your diagnosis and specific symptoms.

Your Brightside provider will work with you to determine what course of treatment is best for your specific needs. Most importantly, we recommend that you keep taking your medication until your provider suggests it’s an appropriate time to stop.

Studies have shown that antidepressants relieve symptoms of depression about 40-60% of the time, and additional treatments (such as therapy and lifestyle improvements) on top of medication often lead to the best outcomes.

To get the best results with medication, it’s important to consistently measure progress during treatment. This is known as Measurement Based Care, and it’s the approach we use at Brightside. It’s common to adjust the dose and/or medication when starting antidepressants until you find just the right fit.

Many people worry that antidepressants will alter their personality or change who they are. As long as you’re taking the right dosage, doxepin will not change your personality or blunt your emotions. Actually, it will help you feel like yourself again by improving your mood, reducing your anxiety, and helping you let go of worries.

Just remember that your symptoms won’t improve overnight. Keep taking your medication as prescribed—even when you start to feel better—and talk to your Brightside provider if you have any questions or concerns.

When prescribing any medication, our providers work to make sure you experience as few side effects as possible.

It’s important to understand that doxepin may be slightly more likely to cause unwanted, temporary side effects when compared to newer classes of antidepressants. As a result, providers may prescribe doxepin as a second- or third-line treatment option for patients who have not had success with other antidepressants.

Side effects from doxepin are usually temporary, but talk to your provider if any of these symptoms become severe or don’t go away:

• Breast changes (increased size, milky discharge from nipples)
• Changes in sex drive 
• Changes to the way things taste
• Chills
• Constipation
• Difficulty urinating or frequent urination
• Dizziness
• Dry mouth
• Excessive sweating
• Excessive thirst
• Flushing
• Hair loss
• Headaches
• Increased pupil size
• Indigestion 
• Mouth sores
• Nausea, vomiting, or diarrhea
• Ringing in your ears
• Skin sensitivity to light
• Swollen testicles
• Weakness or tiredness
• Weight changes or changes in appetite

In rare cases, doxepin can also cause severe side effects. Contact your provider if you experience any of the following symptoms:

• Fast heartbeat
• Skin rash, itching, or swelling
• Unusual bleeding or bruising
• Yellowing of the skin or eyes

Before taking doxepin, tell your provider if you are taking or recently stopped taking a monoamine oxidase inhibitor (MAOI) such as phenelzine, selegiline, tranylcypromine, or isocarboxazid. MAOIs are often prescribed to treat depression, Parkinson’s disease, or bipolar disorder. Combining an MAOI with doxepin can lead to a severe reaction, including confusion, extremely high blood pressure, or tremor.

At Brightside, your health and safety are our highest priorities. We make sure you get individual attention and guidance, so you feel your best.

Antidepressants are not physiologically or psychologically addictive, but they can cause a discontinuation syndrome if stopped abruptly.

The discontinuation syndrome is a consequence of abruptly stopping certain types of antidepressants––particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Discontinuation syndrome can include a range of symptoms that may occur in patients who suddenly stop their antidepressants. These are the most common symptoms of discontinuation syndrome:

• Feeling anxious
• Feelings of vertigo
• Odd sensory symptoms, such as tingling feelings in the skin or what some people describe as a “zapping” sensation in the brain
• Trouble sleeping

Make sure to talk to your provider before stopping or changing how you take your medication so they can create a plan that gives your body enough time to adjust. This will keep you feeling well and prevent symptoms from returning.

If you are pregnant, plan to become pregnant, or nursing, please talk to your provider before starting or making any changes to a medication. For some, the benefits of staying on an antidepressant during pregnancy can outweigh the potential risks.

Some studies suggest using antidepressants during pregnancy can contribute to pregnancy complications like preterm birth and low birth weight.

Doxepin is generally considered non-addictive and is not habit-forming. However, it’s important to remember that you may still experience withdrawal symptoms if you stop taking it suddenly. If you have concerns about your dependence on this medication, don’t hesitate to talk to your Brightside provider.

You can view the FDA black box warning for doxepin here. If you have questions about whether the black box warning for doxepin applies to you, please talk to your provider.