Doxepin

Hi,
Doxepin pros and cons, to the best of my knowledge, follow.
FDA approved dosage forms are 3 and 6 mg, and at this dosage doxepin has some slight effect on sleep although I have not been able to find data on long term effect on deep or REM sleep*, and the low dosage impacts histamine (sort of like the antihistamine fexofenadine although fexofenadine is non-sedating).
At these low doses doxepin shouldn't have adverse effects of constipation, confusion, and dry mouth.
*I don't have robust access to psychiatric and pharmacological research journals, but sedative hypnotic medications impact on sleep is usually studied in short term trials (weeks), and good info on deep and REM sleep isn't common.
If you use low dose doxepin for a few weeks it might help, but you might consider cognitive therapy (psychologist), if you can access this, and try to ease off doxepin.
Best wishes.
(Further clarity, I have tried doxepin using 1/2 of a 10mg capsule, perhaps OK for occasional use, sleep quality seemed just OK. I wouldn't recommend amitriptyline for sleep, unless for some unusual reason you have a psychiatrist recommending amitripyline),

I've posted before on this topic, so I'll keep this really brief and you can search if you want the long form: I have found doxepin on its own to be ineffective. (You can get the liquid form intended primarily for children if you want to experiment with dosages other than 3 or 6 mg.) However, I've found the combination of doxepin and ramelteon, both of which are very safe, to be so effective it has pretty much weaned me off zolpidem, which is a lot stronger than amitriptyline.

Agree with tallbackhip that if you haven't really focused in your sleep hygiene and can find a CBTi psychologist (they are not thick on the ground), it's best to start there before hitting the drugs. If nothing else, better sleep practices will make the drugs more effective and potentially allow you to use less.

I found doxepin not very effective in doses of 3, 6, 10, and even 20 mgs. Neither would ramelteon(rozerrm) help me sleep. It’s interesting that they worked in combination. Perhaps I’ll try it if the doctor approves and will give me a prescription.

If it helps, you can remind your doctor that they both qualify as among the safest sleep aids you can find, so together, they are probably about as harmless a combination as exists. Plus, of course, better to be using a prescription combination than something with OTC drugs, since the prescription stuff is much more of a known quantity with reliable QA/QC.

For quite a while, I was mixing melatonin with doxepin and (distressingly frequently) zolpidem. A much less wise choice.

Shortly after my psychosis due to extreme fear upon sleeping I was given Doxepin for sleep and it did work well. I can see it as an alternative to Trazodone, plus you get a boost in serotonin.

What dosages of doxepin and ramelteon do you take?

Also in regard to combining doxepin and ramelteon, any data on hours per night of REM and/or deep sleep, total hours, either using a smart watch or in publications? I wonder about med effects over time, and ultimate benefits.

@toren123 , ramelteon is only available in the US in 8 mg tablets, and I have not tried splitting them or taking more than one daily. They are coated, so I'm guessing that splitting them would be contraindicated. Doxepin is a bit more complicated. For insomnia, it's available in two tablets (3 mg and 6 mg), and you can also get it in a liquid formulation (originally intended for pediatric use) where you control the dosage with an eyedropper. When I first started on doxepin, the tablets were absurdly overpriced compared to the liquid, so that's what I use -- generally 6 mg, but sometimes as little as 4 or as much as 10. To put this dosage in perspective, doxepin for depression or anxiety is generally 75-150 mg. I would suggest starting with 6 mg, which is the normal adult dose.

@tallbackhip, there is no data on combining these two in any form that I have found, and yes, the risks over the long term are unknown. These are both drugs approved for use long term because they have really excellent safety profiles -- about the best you are going to find for any drug for insomnia. I had reached the point where I was taking doxepin daily, and resorting to zolpidem several times a week, which is a much worse combination that I was trying to wean myself off of. Doxepin plus OTC melatonin was a fail, so I looked around for a better answer that would work and was as benign as I could get. When I proposed this solution to my PCP, he was amenable. I would only do this if you have chronic insomnia -- if you have occasional insomnia, the z-drugs and their alternatives are still what I would resort to. For most of my life, I would fall asleep at rock concerts. These days, I can't even nap on the sofa. Life happens...