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Elavil vs Doxepin
Introduction
For patients with major depressive disorder (MDD) or other types of depression, certain drugs that alter the concentrations of compounds in the brain that are linked to mood, called neurotransmitters, can help in stabilizing depressive lows and managing symptoms. Elavil (amitriptyline) and Doxepin are two such drugs that are prescribed for depression. They each impact different neurotransmitters in the brain but both have mood-stabilizing effects in patients with depression. Elavil is a tricyclic antidepressant (TCA), affecting levels of serotonin and norepinephrine. On the other hand, Doxepin also belongs to the TCA class of medications primarily affecting levels of norepinephrine along with high affinity towards blocking H1 histamine receptors which makes it effective for insomnia as well.
Elavil vs Doxepin Side By Side
| Attribute | Elavil | Doxepin |
|---|---|---|
| Brand Name | Elavil | Doxepin |
| Contraindications | Should not be taken with or within 5 weeks of MAO inhibitors. | Should not be taken with or within 5 weeks of MAO inhibitors. |
| Cost | Brand name: around $80 for 30 tablets of 25 mg. Generic: about $4 - $10 per month. | Brand name: about $100 for 30 capsules of 75 mg. Generic: about $20-$50 per month. |
| Generic Name | Amitriptyline | Doxepin |
| Most Serious Side Effect | Increased thoughts about suicide or self-harm, particularly for those under 25. | Allergic reaction symptoms like rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, or trouble breathing. |
| Severe Drug Interactions | MAO inhibitors. | MAO inhibitors. |
| Typical Dose | 25-150 mg/day, with 75 mg/day generally sufficient for most adults. | 75–150 mg/day for adults, with a maximum of 300 mg/day. |
What is Elavil?
Amitriptyline (the generic name for Elavil) and doxepin are both part of the tricyclic antidepressants (TCAs) category, which were among the first types of antidepressant drugs developed. Amitriptyline was approved by the FDA in 1961. It works by increasing levels of free serotonin and norepinephrine in the brain, preventing them from being reabsorbed quickly and therefore prolonging their mood-lifting effect. This drug is commonly prescribed to treat a variety of conditions such as depression, anxiety disorders, migraines, neuropathic pain among others.
Doxepin, on the other hand while still being a TCA has some distinct characteristics: it has much stronger anti-histamine effects than amitriptyline making it more sedating and thus often used for insomnia or severe itching. Both medicines can cause side effects like drowsiness and dry mouth due to their anticholinergic actions but these tend to be more pronounced with Doxepin due to its greater H1 receptor antagonism.
What conditions is Elavil approved to treat?
Elavil is approved for the treatment of several mental and mood disorders:
- Major depressive disorder (MDD)
- Anxiety, in combination with other treatments
- Neuropathic pain, particularly that associated with certain medical conditions like fibromyalgia or shingles.
How does Elavil help with these illnesses?
Elavil, also known as Amitriptyline, helps to manage depression by increasing the amount of serotonin and norepinephrine available in the synapses of the brain. It does this by inhibiting their reabsorption into nerve cells, allowing these neurotransmitters to remain active for longer periods. Serotonin and norepinephrine are neurotransmitters that play critical roles in mood regulation among other functions such as cognition, memory, sleep patterns and appetite. By boosting these neurotransmitter levels, Elavil can curb depressive symptoms and help patients stabilize their mood.
On the other hand, Doxepin works similarly but is primarily used to treat anxiety disorders or insomnia rather than major depression due its strong antihistaminic properties causing sedation at lower doses. However like Elavil it increases levels of serotonin and noradrenaline in your brain altering your mood enhancing feelings of wellbeing while reducing anxiety.
What is Doxepin?
Doxepin, marketed under various brand names including Sinequan and Silenor, is a tricyclic antidepressant (TCA). It functions by inhibiting the reuptake of norepinephrine and serotonin in the brain, thereby elevating mood. Additionally, it has antihistaminic properties which make it useful for treating itchiness or hives. Doxepin was first approved by the FDA in 1969.
Unlike SSRIs like Elavil (another tricyclic antidepressant), doxepin does not primarily focus on serotonergic systems. This means that its side-effect profile can differ from those associated with drugs such as Elavil. Although drowsiness can be a common side effect due to its antihistamine effects, less common are weight gain and sexual dysfunction - typical issues linked with many SSRI medications. The dual action on both norepinephrine and serotonin makes doxepin beneficial for treating various depressive disorders, particularly among patients who may not have responded adequately to more "traditional" SSRI treatments.
What conditions is Doxepin approved to treat?
Doxepin is an FDA-approved medication that can be prescribed to manage a variety of conditions, including:
- Major depressive disorder (MDD)
- Insomnia related to anxiety or depression
- Various types of chronic and acute pain It's also used off-label for the treatment of chronic hives.
How does Doxepin help with these illnesses?
Doxepin, like Elavil, is a tricyclic antidepressant. These drugs work by increasing the levels of serotonin and norepinephrine in the brain to help restore mood balance and relieve symptoms of depression. However, Doxepin has a unique profile when it comes to its effects on different neurotransmitters. It has potent antihistaminergic activity which can make it particularly effective for sleep disturbances associated with depression or anxiety disorders. In addition, doxepin's action on certain adrenergic receptors might also contribute to its therapeutic effect for those who struggle with chronic hives where traditional antihistamines have not provided relief. Like all antidepressants though, doxepin does not provide immediate relief from depressive symptoms; full therapeutic benefits may take several weeks to become apparent.
How effective are both Elavil and Doxepin?
Both amitriptyline (Elavil) and doxepin have established histories of success in treating patients with depression, anxiety, and certain pain syndromes. They were initially approved by the FDA within a few years of each other during the 1960s. Both Elavil and doxepin are tricyclic antidepressants (TCAs), so they act on similar neurotransmitters – primarily serotonin and norepinephrine – but might be prescribed under slightly different circumstances due to their secondary effects.
The effectiveness of amitriptyline versus doxepin was directly studied in several double-blind clinical trials over the past decades; both drugs exhibited comparable efficacy in managing symptoms of depression as well as similar safety profiles. However, individual patient responses can vary significantly between these two medications because TCAs affect multiple receptors besides those for serotonin and norepinephrine.
Amitriptyline has been shown to be effective from the first week or two of treatment at relieving depressive symptoms, nerve-related pain conditions like neuropathy or fibromyalgia, migraine prophylaxis, insomnia among others. Its side effect profile is generally favorable compared to many earlier generation antidepressants but less so than newer classes such as SSRIs due its anticholinergic effects which include dry mouth, constipation, urinary retention etc., though it's typically well-tolerated with gradual dose increases.
Doxepin also appears effective against a range of mental health disorders including anxiety and depressive disorders plus indications for pruritus (itching) associated with skin conditions like eczema when used topically. Like amitriptyline however it comes with significant anticholinergic side effects although some forms may cause less drowsiness making them more suitable for daytime use.
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At what dose is Elavil typically prescribed?
Oral dosages of Elavil (Amitriptyline) range from 25-150 mg/day, but studies have indicated that 75 mg/day is generally sufficient for treating major depressive disorder in most adults. Adolescents may be started on a lower dose like 10 mg/day. In either population, the dosage can be increased gradually over several weeks if there is no response. However, the maximum dosage that should not be exceeded in any case is 300 mg/day for hospitalized patients and 150mg/day for outpatients.
Similarly, oral dosages of Doxepin start at low levels such as 25-50mg per day but may increase to up to a total daily dose of between 100-300mg depending on the severity of symptoms and patient response. As with Elavil, increases are typically made incrementally over several weeks until an effective therapeutic level has been reached. Always consult your healthcare provider before making changes or starting these medicines as they also interact with many other medications and can cause side effects.
At what dose is Doxepin typically prescribed?
Doxepin treatment usually begins with a dosage of 75–150 mg/day for adults. The initial dose can be divided into two or three smaller doses throughout the day, depending on individual patient needs and tolerability. If necessary, the daily dosage may be increased gradually to a maximum of 300 mg/day. Typically, these increases are made in increments of 25-50mg every few days based on patient response to therapy. As is standard with all medications, always follow your doctor's instructions when adjusting dosages.
What are the most common side effects for Elavil?
Side effects that are common with both Elavil (Amitriptyline) and Doxepin include:
- Drowsiness or somnolence
- Dizziness, confusion
- Dry mouth
- Constipation
- Blurred vision
- Weight gain
- Difficulty urinating
- Increased heart rate -Nausea, vomiting -Unusual bleeding or bruising -Decreased sexual desire or ability -Trouble sleeping (insomnia) -Sweating
Remember to consult your healthcare provider if these side effects persist or worsen. Each individual may react differently to medication and not everyone will experience every side effect listed.
Are there any potential serious side effects for Elavil?
When taking Doxepin, it's important to be aware of potential serious side effects that can occur:
- Increased thoughts about suicide or self-harm, particularly for those under 25
- Signs of an allergic reaction: hives, difficult breathing, swelling in your face or throat
- Eye troubles such as blurred vision, eye pain or swelling
- Fast or pounding heartbeats and sudden dizziness; these could potentially lead to fainting
- Low sodium levels - symptoms include headache, confusion, slurred speech, severe weakness and unsteadiness
- Severe nervous system reaction which may cause very stiff (rigid) muscles high fever sweating confusion fast or uneven heartbeats tremors feeling like you might pass out.
- Serotonin syndrome is a possibility though rare. Look out for agitation hallucinations fever sweating shivering fast heart rate muscle stiffness twitching loss of coordination nausea vomiting diarrhea.
If you experience any of the above side effects while on Doxepin therapy seek medical attention immediately.
What are the most common side effects for Doxepin?
Potential side effects of Doxepin can include:
- Dry mouth, sore throat, stuffy nose
- Ringing in the ears
- Blurred vision or other changes in vision
- Nausea, vomiting, stomach pain, loss of appetite
- Constipation or diarrhea
- Sleep problems (insomnia), unusual dreams
- Increased sweating
- Feeling dizzy, tired or weak
- Swelling (especially of the face and tongue) and unexplained rash
-Anxiety or restlessness, -Fast heartbeat that you can feel -Unusual weight gain, -Increased urination especially at night. -Memory problems and mental/mood changes such as confusion.
Are there any potential serious side effects for Doxepin?
While Doxepin is generally well-tolerated, it can sometimes cause severe side effects. These could include:
- Allergic reaction symptoms like rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, or trouble breathing
- Unusual changes in mood or behavior such as increased anxiety, agitation, panic attacks, hostility or aggressive behavior
- The emergence of suicidal thoughts and tendencies
- Sudden vision changes like blurred vision or eye pain/swelling
- Heart problems which may manifest as chest pain, fast/irregular heartbeat
- Signs of a manic episode including an unusually high energy level, excessive talking or feelings of extreme happiness/sadness.
If you experience any of these serious side effects while taking Doxepin, discontinue its use immediately and contact your healthcare provider for further advice.
Contraindications for Elavil and Doxepin?
Both Elavil and Doxepin, along with most other antidepressant medications, can potentially exacerbate symptoms of depression in certain individuals. If you notice your depression worsening or an increase in suicidal ideation, thoughts, or behaviors while taking either medication, it is crucial to seek immediate medical attention.
Neither Elavil nor Doxepin should be consumed if you are currently taking or have recently finished a course of monoamine oxidase (MAO) inhibitors. Always inform your physician about any medication that you are on; MAOIs require approximately 5 weeks to be completely eliminated from the system to prevent harmful interactions with both Elavil and Doxepin.
How much do Elavil and Doxepin cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Elavil (25 mg) averages around $80, which works out to approximately $2.70/day.
- The price of 30 capsules of Sinequan, a brand-name version of Doxepin (75 mg), is about $100, working out to roughly $3.33/day.
Thus, if you are taking the standard dosage for either drug (i.e., between 25 and 300 mg/day for Elavil or up to 150mg for Sinequan), then brand-name Elavil tends to be less expensive on a per-day treatment basis. Please note that cost should not be your primary consideration in determining which medication is right for you.
As far as generic versions go:
- Amitriptyline (generic form of Elavil) costs significantly less with prices ranging from about $4 - $10 per month depending on dosage and location.
- Generic doxepin can also offer savings compared to its branded counterpart with monthly costs estimated at about $20-$50 depending on dose strength.
Even though both medications have lower-costing generic alternatives available, it's essential that cost does not supersede effectiveness when choosing a medication regimen suitable for your needs. It's always best practice to consult with your healthcare provider before making any changes in medication routines.
Popularity of Elavil and Doxepin
Amitriptyline, in generic form as well as brand names such as Elavil, was estimated to have been prescribed to about 2.4 million people in the US in 2020. Amitriptyline accounted for just over 8% of tricyclic antidepressant (TCA) prescriptions in the US; however, it appears to be the most-common TCA used due to its efficacy and affordability. The prevalence of Amitriptyline has remained steady since 2013.
Doxepin, including brand versions such as Silenor and Sinequan, was prescribed to 1 million people in the USA in 2020. In the US, doxepin accounts for just under 10% of both TCA and hypnotic prescriptions due mainly to its use at low doses for sleep disorders. It also represents around a third of TCA prescriptions overall. The prevalence of doxepin has seen a slight increase over the last decade with increasing off-label use for insomnia.
Conclusion
Both Elavil (amitriptyline) and Doxepin have long-standing records of usage in patients with depression, and are backed by numerous clinical studies indicating that they are more effective than placebo treatments. In some cases, the drugs may be combined, but this is subject to careful consideration by a physician given their similar mechanisms of action—both act as tricyclic antidepressants affecting serotonin and norepinephrine reuptake.
Elavil has been widely used for several decades as an antidepressant as well as for chronic pain conditions like migraines or neuropathic pain. On the other hand, while Doxepin can be used for depression, it is often prescribed at lower doses for insomnia due to its sedating effects.
Both medications are available in generic form which represents significant cost savings especially for patients who must pay out-of-pocket. Both Elavil and Doxepin require an adjustment period meaning that full therapeutic effects may not be noticeable right away.
The side effect profile is similar between these two drugs; both come with potential unwanted effects such as dry mouth, constipation, urinary retention and drowsiness. However, Elavil might cause weight gain more frequently than doxepin due its antihistaminergic properties. Patients should monitor their mood closely when starting treatment on either drug - if there's any worsening of depressive symptoms or emergence of suicidal thoughts they need to seek medical help immediately.
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Refrences
- McClure, E. W., & Daniels, R. N. (2021, January 13). Classics in Chemical Neuroscience: Amitriptyline. ACS Chemical Neuroscience. American Chemical Society (ACS).http://doi.org/10.1021/acschemneuro.0c00467
- Scharfetter, C. (1965). Vergiftung mit einem Antidepressivum. Archiv f�r Psychiatrie und Nervenkrankheiten Vereinigt mit Zeitschrift f�r die Gesamte Neurologie und Psychiatrie. Springer Science and Business Media LLC.http://doi.org/10.1007/bf00343771
- Diaz, D., Vallejos, Á., Torres, S., William Hernández, Calvache, J., Merchán, J., … Maldonado, L. (2020, January). Detection of potential risks in the prescription of tricyclic antidepressants through an online clinical alert system. Revista Colombiana de Psiquiatría. Elsevier BV.http://doi.org/10.1016/j.rcp.2018.05.001