Doxepin is a tricyclic antidepressant predominantly used to treat depression and anxiety. More specifically it is a serotonin–norepinephrine reuptake inhibitor (SNRI), thought to work by inhibiting the reuptake of serotonin and norepinephrine, among other effects, though the exact mechanism by which this medication works is unclear.

Doxepin is also used to help with insomnia, itchiness, and nerve pain, among other conditions. It should not be used in patients under age 12.

Conditions Treated

Doxepin is particularly good at treating depression and anxiety, which are often present in the same patient. It is an effective treatment regardless of the cause of depression or anxiety, including that associated with withdrawal from alcohol or recreational drugs.

Doxepin may be used in other mental conditions, but it does not stand out in treating them like it does with depression and anxiety.

The medication alleviates symptoms of:

• Depression
• Anxiety
• Fatigue
• Apprehension
• Worry
• Guilt
• Difficulty sleeping
• Tension

Doxepin provides additional benefit in:

• Stabilizing mood
• Controlling thoughts
• Improving impulse control
• Improving mental clarity and focus

Most patients notice improvement within days of starting Doxepin, particularly anti-anxiety effects. It will take two to three weeks for full anti-depression effects to be felt, however. Patients should give the medication at least a month before deciding it doesn't work.

Doxepin is also used to help with insomnia, nerve pain, and itching. For itching it is usually administered in cream form; for insomnia dosage is typically much lower than depression or anxiety. Nerve pain is highly variable and best discussed with a doctor; other medications are also often used.

Taking Doxepin

Doxepin comes in tablets, which should be swallowed whole. A pharmacist may offer the medication in an oral suspension for those unable to swallow tablets. Food is okay but not necessary; a glass of fluid is recommended with each dose.

To treat depression, anxiety, and similar disorders:

• Start with 75 mg per day.
• Dosage can be gradually increased up to 300 mg per day, if needed.
• Doses up to 150 mg per day can be taken in a single dose before bed.
• Doses greater than 150 mg should be divided into two daily doses.
• The majority of patients find 75 to 150 mg per day to be optimal.

Some patients, particularly younger patients, will be started on lower doses or will need dosage decreased rather than increased.

Treatment typically lasts around 9 months, though it may be shortened to 6 months or it may continue for longer than 9 months if needed.

For insomnia:

• Start with 25 mg per day, taken at bedtime.
• If needed dosage can be increased to 50 mg per day.

Using Doxepin to treat insomnia is variable. Some individuals use Doxepin as-needed, taking it just for a few days, while others take it daily. This partly depends on the cause of insomnia. At lower doses of 25 to 50 mg, daily treatment can continue for years if needed.

Warnings & Side Effects

Doxepin should not be used if an MAOI (also used to treat depression) has been taken in the past 14 days.

Doxepin should not be taken if allergic to similar medications, including amitriptyline, amoxapine, clomipramine, desipramine, imipramine, nortriptyline, protriptyline, or trimipramine.

Most side effects from Doxepin are mild and not cause for concern unless severe enough to be disruptive. Most are also transient, and stop occuring as the body adjusts to treatment. Common side effects include:

• Dry mouth
• Blurred vision
• Ringing in ears
• Swollen breasts (in both genders)
• Increased sweating
• Drowsiness
• Nausea
• Constipation
• Weight gain

More serious side effects are rare, but do warrant immediate medical attention if they occur:

• Rapid heartbeat
• Severe dizziness
• Hallucinations
• Confusion
• Difficult or painful urination
• Reduced urination
• Uncontrolled muscle movements
• Muscle weakness

Numerous other medications can interact with Doxepin. Check with a doctor or pharmacist before mixing treatments.