From the Guidelines
Doxepin is recommended for the treatment of insomnia in adults, particularly for improving sleep maintenance, with a suggested dosage of 3-6 mg. The evidence from recent studies, such as 1, suggests that doxepin has a positive effect on sleep variables, including wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE). The benefits of doxepin in improving sleep quality and reducing symptoms of insomnia outweigh the potential harms, which are generally mild and include side effects such as headache, diarrhea, somnolence, and upper respiratory infection. Key findings from the studies include:
- Clinically significant improvements in WASO, TST, and SE with doxepin 3-6 mg
- Minimal improvement in sleep latency (SL) but moderate to mild improvement in sleep quality
- Limited adverse effects, with somnolence being the most notable side effect at the 6 mg dosage
- The majority of well-informed patients would likely choose doxepin over no treatment due to its demonstrated benefits in improving sleep maintenance. Overall, the evidence supports the use of doxepin as a treatment option for insomnia in adults, with careful consideration of the potential benefits and harms.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Doxapen Overview
- Doxepin is a tricyclic antidepressant with a sedative effect, similar to amitriptyline 2.
- It is used to treat depression, anxiety, and sleep disturbances, with a mood-elevating effect similar to amitriptyline but possibly less marked than imipramine 2.
Efficacy and Safety
- Doxepin has been shown to be effective in improving sleep quality in patients with comorbid insomnia and anxiety disorders, with a low adverse reaction rate 3.
- A study comparing doxepin and citalopram found that both significantly improved sleep latency, duration, and disturbances, as well as daytime dysfunction and anxiety 3.
- Doxepin has also been compared to other antidepressants, such as dothiepin and desipramine, with varying results 4, 5.
Comparison to Other Antidepressants
- A systematic review of second-generation antidepressants found that the evidence guiding the selection of an antidepressant based on accompanying symptoms of depression is limited 6.
- The review found that selective serotonin reuptake inhibitors (SSRIs) do not differ in their effectiveness for treating anxiety, insomnia, and pain, with moderate evidence 6.
- Doxepin has been found to have a more marked sedative effect than imipramine, making it more useful in depressed patients with sleep disturbances and anxiety 2.