Doxepin was invented in the early 1950s during the explosion in pharmacological research that was happening at that time. Today, tricyclic antidepressants like Sinequan have largely been replaced by the use of selective serotonin reuptake inhibitors (SSRIs). SSRIs tend to have milder side effects than tricyclics for most patients, as well as a 30% success rate with new patients, which is high for the treatment of depression. Tricyclics like Sinequan are now generally prescribed as the second line of treatment for depression after SSRIs fail.
Tricyclic antidepressants are more effective at treating a specific type of depression called melancholic depression. Melancholic depression is a severe form of depression that occurs in conjunction with major depressive disorder (MDD) and bipolar disorder. Melancholic depression is characterized by anhedonia, the inability to find pleasure in positive things and lack of mood reactivity.
Newer antidepressants like SSRIs are less likely to induce feelings of hopelessness and suicidal thoughts when compared to doxepin. Suicidal thoughts are a common risk factor for many antidepressants during the first few weeks of treatment, and when doses are missed or suddenly stopped.
Most of the severe side effects of Sinequan can be avoided by gradually increasing doses when beginning treatment, and gradually tapering off when it’s time to stop taking the drug. In general, discontinuing antidepressants can result in withdrawal symptoms that can last anywhere from a couple of weeks to a few months. Withdrawals can begin within the first 24 hours of stopping the medication and tend to be worst after a few days. Many patients report that it can take up to 90 days before they begin to feel normal.
Officially, doxepin is considered non-addictive. This is because as the body is cleansed from doxepin, the symptoms that occur are considered predictable and easily managed under the supervision of a physician or psychiatrist. Medical professionals refer to these symptoms as “discontinuation syndrome.” Side effects of discontinuation syndrome include nausea, insomnia, poor coordination, and headaches. Severe symptoms can also include intense suicidal thoughts in some patients.
Sinequan is the brand name of the tricyclic antidepressant doxepin. The side effects of Sinequan are the most severe within the first weeks of treatment. During this time, patients may experience intense suicidal thoughts. The risk of suicide is greatest who are in patients in their early twenties or younger.
One of the effects of doxepin is that it blocks the activity of the neurotransmitter acetylcholine. In doing so, doxepin can cause cognitive or memory impairment, constipation, infrequent urination, increased body temperature, dry nose, blurry vision, and dry mouth. More severe side effects of taking Sinequan include dizziness, confusion, anxiety, apathy, drowsiness, restlessness, weight fluctuations, decreased appetite, sweating, muscle twitches, hypertension, rapid heart rate, weakness, nausea, vomiting, and occasionally irregular heart rhythms.
In the event of a patient taking too much of the drug , doxepin can cause hallucinations, delirium, and coma. For people with severe pre-existing nutrient deficiencies, rhabdomyolysis can occur. Rhabdomyolysis is the deterioration and breakdown of the muscles.
Long-term use of tricyclics like doxepin has been linked to the increased risk of developing dementia later in life. Researchers think that this is because drugs like Sinequan block the activity of the neurotransmitter acetylcholine. Proper acetylcholine function is essential to learning and memory. Studies show that the doxepin’s dementia-promoting effects are irreversible.
Drinking alcohol while taking Sinequan isn’t considered to be a health risk; however, doctors discourage mixing alcohol with doxepin because it can lead to increased drowsiness and confusion.
Sinequan and other tricyclics should never be taken in conjunction with MAO inhibitors (monoamine oxidase inhibitors). MAO inhibitors are most commonly prescribed for atypical presentations of depression after SSRIs and tricyclics fail. MAO inhibitors have an increased risk of complications across the board and have toxicity issues when combined with other medications.
Parkinson’s disease is another common indicator for the administration of MAO inhibitors. Doxepin does not mix well with MAO inhibitors because of its impact on serotonin receptors. Combining Sinequan with an MAO inhibitor can lead to a serotonin overload in the brain. This can result in serious side effects, including severe hypertension and psychosis.
Doxepin is a tricyclic antidepressant. There are roughly a couple dozen different variations of tricyclics. Each one interacts with serotonin and norepinephrine production to varying degrees. Doxepin impacts serotonin and norepinephrine production equally. Taking Sinequan with an MAO inhibitor can result in serotonin overload and psychosis. Mixing alcohol with Sinequan does not cause toxicity, but can result in increased drowsiness and confusion. Talk to your doctor if you want to stop taking doxepin. Doses need to be reduced gradually to minimize the effects of discontinuation syndrome. Suddenly stopping Sinequan treatment can trigger increased depression and thoughts of suicide.
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