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Thread: Doxepin

  1. #11

    Re: Doxepin

    Quote Originally Posted by panic_down_under View Post
    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.


    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?

    The side effects I had with ssri’s is an increase in anxiety and no relief from depression. The anxiety never went down along with
    feeling flat on them all the time. Phenelzine gave me no relief from anxiety despite it affecting GABA and also a bad head tremor and shuddering when doing anything physical so I had to discontinue. I wonder if selegeline would be an option?



    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.

    This is problem none have ever worked for me so I’m stuck on the medigoround with few options left and a very low quality/ functioning life
    unfortunately.

    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.
    interesting so at the ten day mark is when I should be upping the dosage? I believe 75mg is the therapeutic dose for depression/ anxiety.
    Last edited by sparky10; 26-10-20 at 18:40.

  2. #12
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    Re: Doxepin

    Quote Originally Posted by sparky10 View Post
    interesting so at the ten day mark is when I should be upping the dosage? I believe 75mg is the therapeutic dose for depression/ anxiety.
    You should increase the dose as directed by your GP. Biologically, ten days is the earliest the dose should be increased, but taking an extra few days won't matter. However, in terms of side-effects severity there is no advantage in delaying increases. Any subsequent side-effects spike will be about as severe when upping the dose at 10 days as at 100 days.

    The usual doxepin dose range for healthy adults is 75-150mg with a maximum of 300mg for severe cases in an inpatient setting. So the first step should be to get to 75mg. Only time will tell if you will need to take a higher dose.
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  3. #13
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    Re: Doxepin

    I am 150mg of Doxepin but I read they no longer prescribe it to new patients. Never have a problem getting my prescription. It's been so easy to tolerate compared to Ssri's. It helps me a lot but I still.take Lorazepam 2mg too and now hrt..

  4. #14
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    Re: Doxepin

    Quote Originally Posted by karenp View Post
    I am 150mg of Doxepin but I read they no longer prescribe it to new patients.
    Doxepin is now regarded as a sedating antihistamine instead of an antidepressant (AD). Which doesn't mean it doesn't work, but it relies on sedation rather than stimulating neurogenesis which is the mechanism of true ADs (and also cognitive/behavioural/mindfulness therapies).

    It's been so easy to tolerate compared to Ssri's.
    The tricyclic class ADs (TCAs) tend to have less initial side-effects than SSRIs/SNRIs, but that is often at the expense of more ongoing issues such as constipation and dry mouth. They are also less prone to poop-out.

    I can't tolerate SSRIs either, but TCAs have kept my PD under control for 37 years.

    It helps me a lot but I still.take Lorazepam 2mg too and now hrt..
    Do you take the lorazepam daily, or only as needed?
    __________________
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  5. #15
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    Re: Doxepin

    I take 150mg of Doxepin. It's still available in the UK. It has really helped me the last 6 years but now I am perimenopausal, my anxiety is sky high and I'm not sleeping at all. I need a change of antidepressant I think, and I am on my 5th week of hrt.

  6. #16
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    Re: Doxepin

    Quote Originally Posted by karenp View Post
    I need a change of antidepressant I think, and I am on my 5th week of hrt.
    The heightened anxiety might be being driven by the hrt and may settle down, but as doxepin isn't really an antidepressant and may have an uncertain future now might be a good time to switch to another TCA such as amitriptyline, or imipramine.

    Once stabilized on an effective AD please talk to your GP about weaning off the lorazepam if you're taking it regularly as benzodiazepines block the mechanism by which AD work.
    __________________
    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.

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