From the FDA Drug Label
Withdrawal Symptoms: The possibility of development of withdrawal symptoms upon abrupt cessation of treatment after prolonged Doxepin administration should be borne in mind. The effects of long-term doxepin use include the possibility of withdrawal symptoms upon abrupt cessation of treatment. These symptoms are not indicative of addiction, and gradual withdrawal of medication should not cause these symptoms. Key effects of long-term use include:
- Potential for withdrawal symptoms
- Drowsiness is the most commonly noticed side effect, which tends to disappear as therapy is continued
- Other adverse effects such as nausea, vomiting, indigestion, taste disturbances, diarrhea, anorexia, and aphthous stomatitis have been reported 1 1.
From the Research
Long-term doxepin use is generally considered safe and effective for treating conditions like depression, anxiety, and insomnia when properly monitored. Doxepin, a tricyclic antidepressant, can be used for extended periods, typically at doses ranging from 25-300 mg daily for depression/anxiety (usually divided into multiple doses) or 3-6 mg at bedtime for insomnia (Silenor) 2. For long-term use, regular follow-up appointments are essential to monitor for side effects and evaluate continued need. Common side effects include drowsiness, dry mouth, constipation, blurred vision, and weight gain. These often improve with time, but persistent issues may require dose adjustment. Blood pressure and heart rate monitoring is important as doxepin can cause cardiovascular effects. Laboratory monitoring, including liver function tests and complete blood counts, may be recommended periodically. Patients should avoid abrupt discontinuation as this can cause withdrawal symptoms; tapering is necessary when stopping. Doxepin works by increasing levels of neurotransmitters like serotonin and norepinephrine in the brain, which helps regulate mood, anxiety, and sleep patterns. For elderly patients or those with certain medical conditions, lower doses are typically recommended due to increased sensitivity to side effects.
Some key points to consider when using doxepin long-term include:
- Monitoring for side effects and adjusting the dose as needed
- Regular follow-up appointments to evaluate continued need and potential side effects
- Avoiding abrupt discontinuation and tapering the dose when stopping
- Considering lower doses for elderly patients or those with certain medical conditions
- Being aware of the potential for cardiovascular effects and monitoring blood pressure and heart rate accordingly
It's also important to note that while doxepin can be effective for long-term use, it's not without potential risks and side effects. As such, it's essential to weigh the benefits and risks and consider alternative treatment options if necessary. Additionally, the use of doxepin in pediatric patients has been studied, with one study finding that low-dose doxepin was effective and well-tolerated in children and adolescents with insomnia 2. However, more research is needed to fully understand the effects of long-term doxepin use in this population.
In comparison to other treatments, such as selective serotonin reuptake inhibitors (SSRIs), doxepin has been found to be effective in treating depression and anxiety, although the evidence is not always consistent 3. Furthermore, the addition of cognitive behavior therapy (CBT) to SSRI treatment has not been shown to improve outcomes in adolescents with major depression 4. However, the use of low-dose amitriptyline, another tricyclic antidepressant, has been found to be effective in improving sleep maintenance in patients with insomnia disorder 5.
Overall, the decision to use doxepin long-term should be made on a case-by-case basis, taking into account the individual patient's needs and medical history. With proper monitoring and dose adjustment, doxepin can be a safe and effective treatment option for a range of conditions.