Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Doxepin belongs to a class of drugs called
tricyclic antidepressants (TCAs) that are used primarily to treat depression and
anxiety. Other examples of TCAs include
amitriptyline (Elavil), nortriptyline
(Pamelor), desipramine (Norpramin), and several others. Depression is an
all-pervasive sense of sadness and gloom. In some patients with depression, an
imbalance in levels of neurotransmitters in the brain may be the cause of the
depression. Neurotransmitters are chemicals that nerves use to communicate with
each other. Neurotransmitters affected by doxepin include serotonin,
norepinephrine, acetylcholine, and histamine. Doxepin may elevate mood by
raising the levels of serotonin and norepinephrine. It also blocks the activity
of acetylcholine and histamine. The FDA approved doxepin in March 1974.
STORAGE: Doxepin should be stored below 30 C (86 F) in a tight, light
resistant container.
PRESCRIBED FOR: Doxepin is used for treating depression and
anxiety.
It also is used for treating depression due to
alcoholism or brain damage and
depression associated with bipolar disorder.
DOSING: The usual dose of doxepin is 75 to 300 mg daily administered
at bedtime or in three divided doses. Doses greater than 300 mg daily are not
more effective. Optimal improvement in depressive symptoms is seen after 2-3
weeks; anti-anxiety effects occur much sooner.
DRUG INTERACTIONS: Tricyclic antidepressants should not be used with
monoamine oxidase inhibiting drugs, for example, tranylcypromine (Parnate),
because high fever, convulsions, and even death may occur from such
combinations.
Cimetidine (Tagamet) increases the breakdown of doxepin by the liver and can
increase doxepin blood levels, possibly causing side effects from doxepin.
PREGNANCY: There are no adequate studies of doxepin use in
pregnant
women.
NURSING MOTHERS: It is not known if doxepin is secreted in
breast
milk. There is one report of apnea (cessation of breathing) and drowsiness
occurring in a nursing infant whose mother was taking doxepin.
SIDE EFFECTS: The most common side effect of doxepin is drowsiness.
Drowsiness improves as therapy continues. Other side effects associated with
doxepin include blurred vision, urinary retention (difficulty urinating),
dry
mouth, constipation, weight gain or loss, and low blood pressure when rising
from a sitting position (orthostatic hypotension). Rash, hives, rapid heart
rate, seizures, and hepatitis are rare side effects. Doxepin also can cause
elevated pressure in the eyes of some patients with glaucoma. If
antidepressants, including doxepin, are discontinued abruptly, symptoms such as
dizziness, headache, nausea, and changes in mood may occur. Such symptoms of
withdrawal may occur even when a few doses of antidepressant are missed.
Therefore, it is recommended that the dose of antidepressant be reduced
gradually when therapy is discontinued.
Antidepressants increased the risk of
suicidal thinking and behavior in
short-term studies in children and adolescents with depression and other
psychiatric disorders. Anyone considering the use of any antidepressant in a
child or adolescent must balance this risk with the clinical need. Patients who
are started on therapy should be closely observed for clinical worsening,
suicidal thinking or behavior, and unusual changes in behavior.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Overactive bladder is a sudden involuntary contraction of the muscle wall of the bladder causing urinary urgency (an immediate unstoppable need to urinate). Overactive bladder is is a form of urinary incontinence. Treatment options may include Kegel exercises, biofeedback, vaginal weight training, pelvic floor electrical stimulation, behavioral therapy, and medications.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
Alcohol is the most frequently used drug by American teenagers. Teens that drink are more likely to drive under the influence, have unprotected sex, and use other drugs, like marijuana, cocaine, and heroin. Symptoms of alcohol abuse in teens include lying, breaking curfew, becoming verbally or physically abusive toward others, making excuses, smelling like alcohol, having mood swings, and stealing.
Urinary retention (inability to urinate) may be caused by nerve disease, spinal cord injury, prostate enlargement, infection, surgery, medication, bladder stone, constipation, cystocele, rectocele, or urethral stricture. Symptoms include discomfort and pain. Treatment depends upon the cause of urinary retention.
Childhood depression can interfere with social activities, interests, schoolwork and family life. Symptoms and signs include anger, social withdrawal, vocal outbursts, fatigue, physical complaints, and thoughts of suicide. Treatment may involve psychotherapy and medication.
Dysthymia is a less severe form of chronic depression. Symptoms and signs include insomnia, suicidal thoughts, guilt, empty feeling, loss of energy, helplessness, sluggishness, and persistent aches and pains. Treatment may involve psychotherapy, electroconvulsive therapy, and antidepressants.
Depression in the elderly is very common. That doesn't mean, though, it's normal. Treatment may involve antidepressants, psychotherapy, or electroconvulsive therapy.
Experts are not sure what causes dysthymia. This form of chronic depression
is thought to be related to brain changes that involve serotonin, a chemical or
neurotransmitter that aids your brain in coping with emotions. Major life
stressors, chronic illness, medications, and relationship or work problems may
also increase the chances of dysthymia.
What Are the Signs and Symptoms of Dysthymia?
The symptoms of dysthymia are the same as those of major depression but not
as intense and include the following:
Persistent sad or empty feeling
Difficulty sleeping (sleeping too much or too little)
Insomnia (early morning awakening)
Feelings of helplessness, hopelessness, and worthlessness
Depression RSS
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