Antidepressants are now widely used worldwide, especially to treat depression, but also for other conditions such as insomnia or anxiety. Here we will get to know doxepin, a tricyclic antidepressant .

Doxepin-a tricyclic antidepressant

There are different types of antidepressants: MAOIs, tricyclics, serotonin inhibitors, noradrenaline inhibitors, duals, etc. Doxepin is a tricyclic antidepressant.

Tricyclic and tetracyclic antidepressants are among the first antidepressants to be developed. They are effective, although have now been replaced by other antidepressants with fewer side effects . However, they are still the most effective for certain disorders such as melancholic depression.

Going back to doxepin, its trade name is Silenor . This medicine is used to treat insomnia, which is difficulty falling or staying asleep, as well as depression and anxiety, mainly.

Mechanism of action

The mechanism of action of doxepin consists of blocking the reuptake of neurotransmitters by the neuronal membrane .

Its functioning is based on slowing down the brain’s activity so that sleep can take place, through the modification of the amounts of certain natural substances in the brain necessary for mental balance.

Therapeutic indications

The indications for doxepin are mainly psychoneurotic disorders where anxiety and/or depression are predominant symptoms: neurosis with anxiety with or without somatic symptoms, reactive depression, mixed anxiety depression .

It is also indicated for psychotic depressions including involutional melancholy and the depressive phase of manic-depressive psychosis. In addition, doxepin is also indicated for treating insomnia.

1. Insomnia

If used for insomnia, doxepin is taken in tablet form to be taken by mouth. As for dosage, it is usually taken once a day, 30 minutes before going to sleep. It should not be taken within 3 hours after a meal.

After taking it, the person usually feels very sleepy, and remains asleep for a while after taking the medicine . It is recommended not to take doxepin if the person will not go to bed immediately and if he or she does not have the idea of staying asleep for 7 and 8 hours.

When treatment begins, the person will feel better for the first few days. If in a week or 10 days it does not improve, or even gets worse, it is advisable to call the doctor.

2. Anxiety and depression

In this case, doxepin is taken as a capsule or concentrate (liquid) to be taken by mouth. It can be taken with or without food three times a day. It is recommended to take it at approximately the same time every day.

3. Others

Doxepin is also sometimes used to treat chronic urticaria without a known cause . In addition, the drug can be prescribed for other uses, although the most frequent are those mentioned: insomnia, anxiety and depression.

Contraindications

Contraindications (when not to be used) to doxepin are when there is hypersensitivity to the drug or in elderly people with acute angle glaucoma or with tendency to urinary retention.

Side effects

As for side effects, doxepin can cause nausea and dizziness, as well as some others:

  • Vomiting.
  • Fatigue or weakness .
  • Increased pupil size.
  • Dry mouth.
  • Mouth sores .
  • Skin more sensitive to sunlight than usual.
  • Blush.
  • Changes in appetite or weight
  • Change in the taste of things.
  • Indigestion .

Also, call your doctor if you have any unusual problems while taking doxepin, or if one or more of the side effects listed above is severe or does not go away.

Suicidal tendencies with doxepin

It is important to note that during clinical trials of doxepin, a small number of children, adolescents, and young adults (up to 24 years of age) who took antidepressants such as doxepin were suicidal. These translated into thoughts of hurting or killing themselves, planning to do so, or trying to do so.

It is known that children, adolescents, and young adults who take antidepressants to treat depression or other mental disorders are more likely to have suicidal thoughts than those who do not take antidepressants to treat such conditions. However, experts don’t know exactly how much this risk varies and to what extent such a phenomenon should be considered if a young child or adolescent must take an antidepressant.

It should be noted that children under 18 years of age should not take doxepin regularly, although in some cases, your doctor may decide that doxepin is the best option.

Bibliographic references:

  • Doxepin (Insomnia. NIH MedlinePlus Health [Internet]. 2017; Available from: https://medlineplus.gov/spanish/druginfo/meds/a617017-es.html. English, Spanish.
  • Doxepin (Depression, anxiety. NIH MedlinePlus Health [Internet]. 2017; Available from: https://medlineplus.gov/spanish/druginfo/meds/a682390-es.html. English, Spanish.