Doxepin: Approved Uses, Off-Label Anxiety Use and Warnings

What doxepin is

Doxepin is a tricyclic antidepressant that comes in more than one form. MedlinePlus describes capsules and a liquid concentrate for mood, and a tablet for sleep. These forms have separate FDA labels with different uses and warnings, so it matters which one you are reading about.

The capsules and liquid are sold under the generic name. The tablet is sold as Silenor and as a generic. NIMH says older antidepressants such as tricyclics are associated with more side effects than the newer ones prescribed most often, though they can suit some people.

What is approved, and what is off-label

The current label for doxepin capsules and oral solution lists one use: major depressive disorder in adults. The Silenor label lists insomnia marked by trouble staying asleep, and says the trials behind that use lasted up to three months.

Anxiety needs care here. MedlinePlus still says doxepin is used to treat depression and anxiety, but the current FDA labels for capsules and solution do not list anxiety. On those labels, anxiety use is off-label, and that is how you should read it. MedlinePlus also says it is sometimes used for long-lasting hives with no known cause, which is off-label too.

How it is thought to work

The capsule label says doxepin's mechanism in depression is not well understood. MedlinePlus says it increases natural substances in the brain that help maintain mental balance. For the sleep tablet, MedlinePlus says it works by slowing activity in the brain to allow sleep.

What taking it can be like

MedlinePlus says capsules or concentrate may take several weeks or longer to reach full effect. Sedation is a known effect. Keeping notes on mood, sleep and daytime alertness gives you something concrete to bring to a follow-up.

Do not stop doxepin without talking to your prescriber. The capsule label says that when it is stopped, the amount should be reduced gradually, and MedlinePlus says your doctor will probably want to do the same.

The Silenor tablet is used differently. MedlinePlus says you will probably feel very sleepy soon after taking it and need time in bed afterward, and to call your doctor if sleep does not improve within 7 to 10 days. The Silenor label warns about complex behaviors such as sleep-driving and says not to use it with alcohol.

Side effects and warnings

Boxed warning on capsules and solution: antidepressants increase the risk of suicidal thoughts and behavior in children and young adults in short-term studies. All patients should be closely watched for worsening mood and for these thoughts. These products are not approved for use in children. The Silenor label does not carry a boxed warning, but warns that depression may worsen and suicidal thinking may occur. If you are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services. See our crisis resources for more.

The most common effects on the capsule label are sleepiness, dry mouth, dizziness, constipation and tiredness. Less often, people had blurred vision, fast heartbeat, low blood pressure, trouble sleeping, shaking, nausea, sweating and weight gain. For Silenor, the most common were sleepiness, nausea and upper respiratory infections.

• Contraindicated on the capsule label: allergy to doxepin, glaucoma, current or past urinary retention, and MAOIs, including linezolid and intravenous methylene blue, or use within 14 days of one.
• Serotonin syndrome risk rises with other medicines that affect serotonin.
• Sedation: the label warns against driving or using dangerous machinery, and alcohol's effects may be stronger.
• Older adults: sedating medicines can cause confusion and oversedation. MedlinePlus says older adults should not usually take this form.
• Bipolar disorder, seizures and psychosis: it may bring on a manic or mixed episode, lower the seizure threshold or activate psychosis.
• Tell your prescriber if you are pregnant, planning a pregnancy or breastfeeding.

Managing doxepin online in Pennsylvania and New York

Doxepin is taken at home. The capsule label says it is not a controlled substance, and the labels do not limit it to a certified healthcare setting. A video visit can cover what form you have, your eye and urinary history, your sleep and your mood.

A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine (DO) with more than three decades of practice, offers online depression treatment and online anxiety treatment by secure video, for people physically located in Pennsylvania or New York during each visit. Our therapists do not prescribe. See also medication management.

Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help, through our medication contact form.