Page 1 of 2 12 LastLast
Results 1 to 10 of 12

Thread: Doxepin

  1. #1

    Doxepin

    I have tried many antidepressants for anxiety disorders including TcAís, Maoiís, Ssriís, Snriís. The only combination
    that worked for a few years was moclobemide and pregabalin. I have tried reinstating these at different doses over
    the last four years with no success.
    I could not get upto therapeutic doses especially on clomipramine and imipramine unfortunately.
    pdoc has give me this as a last option, starting at 25mg and working up to 75mg over time.

    Is this a good medication for depression/ anxiety, I see itís used a lot for insomnia/ hives and has a high affinity for
    histamine. Iím guessing thatís where the anxiety relief may come from similiar to mirtazapine.

    Any experiences with this med anyone and PDU I would appreciate your opinion?

    Thanks
    Mark

  2. #2
    Join Date
    Jan 2017
    Posts
    2,417

    Re: Doxepin

    Quote Originally Posted by sparky10 View Post
    I have tried many antidepressants for anxiety disorders including TcAís, Maoiís, Ssriís, Snriís.
    They didn't work, or you couldn't tolerate them, Mark?

    I could not get upto therapeutic doses especially on clomipramine and imipramine unfortunately.
    How did you take them and what happened?

    pdoc has give me this as a last option, starting at 25mg and working up to 75mg over time.

    Is this a good medication for depression/ anxiety, I see itís used a lot for insomnia/ hives and has a high affinity for
    histamine. Iím guessing thatís where the anxiety relief may come from similiar to mirtazapine.
    Yes, mirtazapine and doxepin are very sedating antihistamines which mostly ease anxiety through sedation. They are not really antidepressants which work by stimulating the growth of new brain cells in the hippocampal regions of the brain. That said, they can be effective enough for some.

    It is probably worth a try, however, doxepin has been phased out in some countries and I note it isn't listed on the NHS Cost Comparison Chart (PDF, section 4:3, p 27) which may, or may not indicate it won't be available for much longer in the UK either so it would pay to check. Your chemist/pharmacist could know more about this than your GP.
    __________________
    .

    - - What to know about: Telepsychiatry | Teletherapy - -




    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  3. #3
    Join Date
    Feb 2016
    Posts
    1,741

    Re: Doxepin

    Doxepin is unavailable, now it's not being produced any more. The closest alternative is Amitriptyline.
    __________________
    If you are one of the lucky souls allowed to enter NZ at this time please remember two things:

    1. We did the hard months in lockdown abiding by rules for you to get here.
    2. No one gives a shit if you prefer white towels or hotels with sea views.
    You're in quarantine for fourteen days ...obey the rules.

  4. #4
    Join Date
    Jan 2017
    Posts
    2,417

    Re: Doxepin

    Quote Originally Posted by WiseMonkey View Post
    Doxepin is unavailable, now it's not being produced any more. The closest alternative is Amitriptyline.
    It is still available here, or at least it is still on the Pharmaceutical Benefits Scheme list of meds in 10mg, 25mg and 50mg tablets/capsules. There doesn't seem to be anything about it being dropped, but who knows.
    __________________
    .

    - - What to know about: Telepsychiatry | Teletherapy - -




    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  5. #5

    Re: Doxepin

    Quote Originally Posted by panic_down_under View Post
    They didn't work, or you couldn't tolerate them, Mark?

    I struggled to tolerate a lot of them but stayed on them for example, Prozac, effexor, parnate, phenelzine for a good length
    of time. They never helped me though so feel stuck and therapy hasn’t done anything either. Prozac I was on for 18 months and the
    others for 4 months. It was only diazepam that enabled me to stay on them.



    How did you take them and what happened?

    i took them at a low dose but the anxiety was too much especially clomipramine and I just felt in a daze most of the time.
    it never got any better the longer I stayed on it.



    Yes, mirtazapine and doxepin are very sedating antihistamines which mostly ease anxiety through sedation. They are not really antidepressants which work by stimulating the growth of new brain cells in the hippocampal regions of the brain. That said, they can be effective enough for some.

    It is probably worth a try, however, doxepin has been phased out in some countries and I note it isn't listed on the NHS Cost Comparison Chart (PDF, section 4:3, p 27) which may, or may not indicate it won't be available for much longer in the UK either so it would pay to check. Your chemist/pharmacist could know more about this than your GP.
    I got my prescription over here in the U.K., they have not said anything about it being discontinued.

  6. #6
    Join Date
    Jan 2017
    Posts
    2,417

    Re: Doxepin

    Quote Originally Posted by sparky10 View Post
    I struggled to tolerate a lot of them but stayed on them for example, Prozac, effexor, parnate, phenelzine for a good length of time. They never helped me though so feel stuck and therapy hasnít done anything either. Prozac I was on for 18 months and the others for 4 months. It was only diazepam that enabled me to stay on them.
    Unfortunately, while diazepam may have eased the anxiety in the short term it was likely making things worse overall. ADs don't work directly in the way diazepam does. Anxiety and depression are the emotional expressions of an underlying brain disorder, atrophy of parts of the two hippocampal regions of the brain caused by high brain stress hormone levels killing brain cells and inhibiting the growth of new ones. ADs stimulate the growth of new cells (neurogenesis). It is the new cells and the interconnections they forge which provide the therapeutic response. Unfortunately, diazepam and other benzodiazepines (BZDs) impair neurogenesis (Villasana LE, 2019; Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Song J, 2012; Wu X, 2009; Stefovska VG, 2008).

    BTW - therapy also works by neurogenesis.

    i took them at a low dose but the anxiety was too much especially clomipramine and I just felt in a daze most of the time. it never got any better the longer I stayed on it.
    The low doses may have been the problem. To initiate and sustain neurogenesis the dose of most serotonergic ADs needs to be high enough to saturate at least 80% of the serotonin transporters (5-HTT).

    Unfortunately, ADs will often make anxiety worse in the beginning. There is no way of preventing this, however, it can usually be minimized by starting at a low dose, no more than a quarter of the recommended minimum therapeutic dose and ramped up slowly by a similar amount every few weeks. Small doses of sedating antihistamines such as hydroxyzine or mirtazapine can help ease the initial anxiety spike too, as may BZDs in the short-term.

    Given your experience with SSRIs and clomipramine maybe an AD that targets noradrenaline, aka norepinephrine, reuptake such as nortriptyline might be worth a shot.
    __________________
    .

    - - What to know about: Telepsychiatry | Teletherapy - -




    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  7. #7

    Re: Doxepin

    Quote Originally Posted by panic_down_under View Post
    Unfortunately, while diazepam may have eased the anxiety in the short term it was likely making things worse overall. ADs don't work directly in the way diazepam does. Anxiety and depression are the emotional expressions of an underlying brain disorder, atrophy of parts of the two hippocampal regions of the brain caused by high brain stress hormone levels killing brain cells and inhibiting the growth of new ones. ADs stimulate the growth of new cells (neurogenesis). It is the new cells and the interconnections they forge which provide the therapeutic response. Unfortunately, diazepam and other benzodiazepines (BZDs) impair neurogenesis (Villasana LE, 2019; Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Song J, 2012; Wu X, 2009; Stefovska VG, 2008).

    BTW - therapy also works by neurogenesis.



    The low doses may have been the problem. To initiate and sustain neurogenesis the dose of most serotonergic ADs needs to be high enough to saturate at least 80% of the serotonin transporters (5-HTT).

    Unfortunately, ADs will often make anxiety worse in the beginning. There is no way of preventing this, however, it can usually be minimized by starting at a low dose, no more than a quarter of the recommended minimum therapeutic dose and ramped up slowly by a similar amount every few weeks. Small doses of sedating antihistamines such as hydroxyzine or mirtazapine can help ease the initial anxiety spike too, as may BZDs in the short-term.

    Given your experience with SSRIs and clomipramine maybe an AD that targets noradrenaline, aka norepinephrine, reuptake such as nortriptyline might be worth a shot.
    Thanks pdu for your insightful reply. The amount of diazepam I was on was relatively low so not sure if this
    would affect neurogenesis with the length of time I was on the antidepressants. Tops 5mg
    The nortriptyline didnít suit me at all it made me very dissociated aswell as deer in the headlights syndrome. I definetely
    dont think norepinephrine is the answer as Cymbalta had similiar effects.

  8. #8
    Join Date
    Jan 2017
    Posts
    2,417

    Re: Doxepin

    Quote Originally Posted by sparky10 View Post
    Thanks pdu for your insightful reply. The amount of diazepam I was on was relatively low so not sure if this would affect neurogenesis with the length of time I was on the antidepressants. Tops 5mg
    If taken daily that 5mg mounts up especially given the long diazepam half-life.

    The nortriptyline didnít suit me at all it made me very dissociated aswell as deer in the headlights syndrome. I definetely dont think norepinephrine is the answer as Cymbalta had similiar effects.
    How long were you on nortriptyline and at what dose? Disassociation and the 'deer in headlight' feeling are not uncommon when first taking ADs, but it usually passes.

    You've been on a lot of different ADs and it is unusual for all to produce completely negative results given the array of different receptor, transporter and neurotransmitter system effected. I wonder how much of the issues were created by the meds and how much by anxiety. An anxious mind is more than capable of producing the most unpleasant side-effects imaginable.
    __________________
    .

    - - What to know about: Telepsychiatry | Teletherapy - -




    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  9. #9

    Re: Doxepin

    [QUOTE=panic_down_under;1971566]If taken daily that 5mg mounts up especially given the long diazepam half-life.



    How long were you on nortriptyline and at what dose? Disassociation and the 'deer in headlight' feeling are not uncommon when first taking ADs, but it usually passes.

    You've been on a lot of different ADs and it is unusual for all to produce completely negative results given the array of different receptor, transporter and neurotransmitter system effected. I wonder how much of the issues were created by the meds and how much by anxiety. An anxious mind is more than capable of producing the most unpleasant side-effects imaginable.[/QUOTE

    would 5mg stop the anti-depressant/ anxiety effects being produced though given the time I was on them?

    From memory as itís been a while since I tried nortriptyline it was 10mg/20mg , I know this is a low dose aswell
    but I just cannot tolerate higher doses of tricyclics. I would say I tried it for around a month or two. Norephenerine reuptake
    medications definetely do not help my conditions.
    I do have essential tremor aswell so a lot of meds affect it badly.
    i know when I first went on pregabalin it worked a charm and that lowers norephenerine but felt too doped up
    after a while so added moclobemide which felt stimulating and they combined well. Unfortunately thatís not the
    case now.
    like you say with hitting all the the different receptors and neurotransmitters something should have helped, I am
    at a loss what to try. Day 3 on doxepin, insomnia/ nightmares and all round spaced out /flat feeling.

  10. #10
    Join Date
    Jan 2017
    Posts
    2,417

    Re: Doxepin

    Quote Originally Posted by sparky10 View Post
    From memory as itís been a while since I tried nortriptyline it was 10mg/20mg , I know this is a low dose as well but I just cannot tolerate higher doses of tricyclics. I would say I tried it for around a month or two.
    Unfortunately, the dose never got near the therapeutic minimum. I suspect beyond the initial side-effects most of the problems were driven by anxiety rather than chemical.

    Norephenerine reuptake medications definetely do not help my conditions.
    You also found clomipramine and imipramine, which have only modest impact on norepinephrine/noradrenaline (NA) pathways, difficult.

    What side-effects were there with SSRIs and phenelzine?

    Day 3 on doxepin, insomnia/ nightmares and all round spaced out /flat feeling.
    Which are common initial side-effects. Unfortunately, there are no side-effects free ADs. While they can be awful meds at the beginning when they work they can almost magically transform lives and worth all the trauma. The trick is to keep focussing on the goal, not the here and now and to keep increasing the dose up to therapeutic levels.

    It takes about 10 days for doxepin plasma levels to stabilize to a steady-state. Increasing the dose sooner than 10 days may increase side-effects severity, but delaying increases won't significantly reduce the subsequent intensity no matter how long the delay.
    __________________
    .

    - - What to know about: Telepsychiatry | Teletherapy - -




    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

Page 1 of 2 12 LastLast

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. Anyone take doxepin? (Sinequan/silenor)
    By Jakemje in forum Medication
    Replies: 0
    Last Post: 23-07-17, 17:23
  2. Doxepin or Silenor for sleep
    By Mugs in forum Medication
    Replies: 12
    Last Post: 11-07-16, 05:02
  3. Doxepin
    By Neon in forum Medication
    Replies: 1
    Last Post: 25-07-14, 01:42
  4. Anyone else take Doxepin/sinequan?
    By omh in forum Medication
    Replies: 5
    Last Post: 25-06-08, 12:39

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •