Effects of doxepin (insomnia): A Synthesis of Findings from 21 Studies

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Original Abstract of the Article

Main Research Findings

Doxepin is a tricyclic antidepressant that has been approved by the FDA for the treatment of insomnia. 21 Studies have shown that low doses of doxepin (3mg-6mg) are effective in improving sleep quality, including sleep maintenance and duration. 21 The mechanism of action is thought to be related to its ability to block histamine H1 receptors, which promotes non-REM sleep. 18 Doxepin has been shown to be safe and effective for insomnia in older adults. 19 Doxepin has also been used to treat insomnia in patients with chronic orofacial pain. 13 Research suggests that doxepin may have anti-inflammatory effects in the brain, potentially benefitting patients with neurodegenerative diseases. 7 The anti-inflammatory effect is thought to be mediated through activation of the PI3K-Akt signaling pathway. 7

Benefits and Risks

Benefits Summary

Doxepin can be a valuable treatment option for insomnia, particularly in improving sleep maintenance and duration. Its effectiveness has been demonstrated in older adults and patients with chronic pain. Furthermore, doxepin may offer additional benefits by reducing inflammation in the brain.

Risks Summary

Doxepin, like other medications, carries potential side effects, which include headache, drowsiness, and dry mouth. Interactions with other drugs are also possible. It's crucial to consult a doctor before taking doxepin to ensure it's appropriate for your specific health needs.

Comparison of Research

Commonalities in Studies

A consistent finding across multiple studies is the effectiveness of doxepin in improving sleep quality. Doxepin has also been shown to have a favorable safety profile compared to some other sleep medications.

Differences in Studies

The specific benefits and risks associated with doxepin can vary depending on the research study design, participant characteristics, and other factors.

Consistency and Contradictions in Findings

While doxepin shows promise in treating insomnia, research findings aren't always perfectly aligned regarding its effectiveness and potential risks. This variability can be attributed to differences in study design and participant characteristics. Therefore, it's crucial to consult a doctor to determine if doxepin is the right treatment for you.

Practical Applications and Considerations

Doxepin can be a helpful treatment option for insomnia, but it's important to understand that it may not be suitable for everyone. It's essential to discuss your specific medical history and concerns with a doctor. They can assess your individual needs and determine the most appropriate course of treatment.

Limitations of Current Research

Further research is needed to fully understand the effects and risks associated with doxepin. Studies comparing doxepin to other sleep medications, as well as long-term studies, are particularly important.

Future Directions for Research

To gain a more complete understanding of doxepin's effectiveness and safety, additional research is necessary. Studies comparing doxepin to other sleep medications, exploring its long-term effects and side effects, and investigating its use in specific populations are all valuable directions for future research.

Conclusion

Doxepin can be a promising treatment option for insomnia, potentially offering improvements in sleep quality. However, it's essential to consult a doctor to determine if it's the right choice for you. Further research is needed to fully understand its effects and risks, and to guide its use in various populations.

Literature analysis of 21 papers
Positive Content
20
Neutral Content
1
Negative Content
0
Article Type
0
5
5
10
20
1.

Mirtazapine: A One-Stop Strategy for Treatment of Opioid Withdrawal Symptoms.

Author: LalaniElisha, MenonRaakhi, MuftiMariam A, KumfaCecil, RajiMukaila

Opioid withdrawal treatment

Opioid withdrawal symptoms can be challenging to manage, often requiring polypharmacy. This review presents evidence supporting mirtazapine as a single-drug strategy for treating multiple symptoms of opioid withdrawal, potentially reducing polypharmacy and improving outcomes for people with opioid use disorder (OUD).

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

2.

Alliance for Sleep Clinical Practice Guideline on Switching or Deprescribing Hypnotic Medications for Insomnia.

Author: WatsonNathaniel F, BencaRuth M, KrystalAndrew D, McCallWilliam V, NeubauerDavid N

Insomnia treatment

These guidelines provide evidence-based recommendations for deprescribing or transitioning between insomnia medications. Tapering is recommended for benzodiazepines and some Z-drugs, but not for other classes of insomnia medications.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

3.

The Comparative Effectiveness and Safety of Insomnia Drugs: A Systematic Review and Network Meta-Analysis of 153 Randomized Trials.

Author: PanBei, GeLong, LaiHonghao, HouLiangying, TianChen, WangQi, YangKelu, LuYao, ZhuHongfei, LiMengting, WangDeren, LiXiuxia, ZhangYuqing, GaoYa, LiuMing, DingGuowu, TianJinhui, YangKehu

Insomnia management

This study aimed to determine the relative effectiveness, safety, and tolerability of drugs for insomnia. The study found that there is a lack of evidence comparing the relative effectiveness, safety, and certainty of evidence among drug classes and individual drugs for insomnia.

Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

4.

Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis.

Author: De CrescenzoFranco, D'AlòGian Loreto, OstinelliEdoardo G, CiabattiniMarco, Di FrancoValeria, WatanabeNorio, KurtulmusAyse, TomlinsonAnneka, MitrovaZuzana, FotiFrancesca, Del GiovaneCinzia, QuestedDigby J, CowenPhil J, BarbuiCorrado, AmatoLaura, EfthimiouOrestis, CiprianiAndrea

Pharmacological treatments for insomnia

This study aimed to compare the effectiveness of different pharmacological treatments for insomnia in adults. While behavioral, cognitive, and pharmacological interventions are effective for insomnia, medications are more widely used due to resource limitations.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

5.

Doxepin in children and adolescents with symptoms of insomnia: a single-center experience.

Author: ShahYash D, StringelVirginia, PavkovicIvan, KothareSanjeev V

Pediatric insomnia treatment

This study evaluated the efficacy and tolerability of doxepin in pediatric patients with insomnia.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

6.

Efficacy and safety of non-benzodiazepine and non-Z-drug hypnotic medication for insomnia in older people: a systematic literature review.

Author: SysJudith, Van CleynenbreugelSimon, DeschodtMieke, Van der LindenLorenz, TournoyJos

Insomnia treatment

This study aims to study the efficacy and safety of alternative sedative medications for treating insomnia in older people, excluding benzodiazepines and Z-drugs.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

What do Cochrane systematic reviews say about interventions for insomnia?

Author: MeloFlorence de Lucca, MendozaJuan Fulgencio Welko, LatorracaCarolina de Oliveira Cruz, PachecoRafael Leite, MartimbiancoAna Luiza Cabrera, PachitoDaniela Vianna, RieraRachel

Improved insomnia symptoms
Limited evidence

Cochrane reviews suggest potential benefits for insomnia from acupuncture, music, physical exercise, and specific medications like paroxetine, doxepin, trimipramine, and trazodone. However, the evidence is uncertain, requiring further research to confirm benefits and risks.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

9.

[The interesting anti-H1 effects in maintenance insomnia: A reflection on the comparative advantages of doxylamine and doxepin].

Author: DupuisG, VaugeoisJ-M

Insomnia treatment

Doxylamine, a histamine H1 inverse agonist, is commonly used for insomnia. This article suggests its potential use for treating insomnia in the last third of the night, highlighting the need for better information for pharmacists to prescribe it appropriately.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : French

10.

Antidepressants for insomnia in adults.

Author: EverittHazel, BaldwinDavid S, StuartBeth, LipinskaGosia, MayersAndrew, MaliziaAndrea L, MansonChristopher Cf, WilsonSue

Hypnotic medications
Insomnia treatment
Dependence
Tolerance

Insomnia is a common condition that affects sleep quality and can lead to problems with mood, substance use, and overall health. While sleep medications are used, they can cause tolerance and dependence, and many people take them long-term. Antidepressants are also used for insomnia, but there's no strong evidence to support their effectiveness. This may be due to concerns about long-term use of sleep medications and limited access to psychological treatments.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

11.

Treatment of insomnia with tricyclic antidepressants: a meta-analysis of polysomnographic randomized controlled trials.

Author: LiuYang, XuXiaomin, DongMeixue, JiaShiyu, WeiYoudong

Improved sleep
Somnolence

Tricyclic antidepressants (TCAs) were found to be an effective treatment for insomnia, as they were found to improve sleep outcome measures, with the notable exception of an 82% increase in somnolence.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

12.

A Review of Suvorexant, Doxepin, Ramelteon, and Tasimelteon for the Treatment of Insomnia in Geriatric Patients.

Author: EdmondsChelsey, SwanoskiMichael

Insomnia treatment
Cognitive impairment
Falls
Fractures

Geriatric patients often experience insomnia. This paper explores and outlines the available safety and efficacy data associated with suvorexant, doxepin, ramelteon, and tasimelteon and reviews their potential place in therapy in treating insomnia in the geriatric population.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

13.

An update of management of insomnia in patients with chronic orofacial pain.

Author: AlmozninoG, HavivY, SharavY, BenolielR

Chronic orofacial pain management
Insomnia treatment
Drug interactions
Substance abuse

This review discusses the management of chronic orofacial pain (COFP) patients with insomnia. A multidisciplinary approach is recommended, addressing both pain and insomnia using non-pharmacological and pharmacological modalities.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

14.

Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline.

Author: SateiaMichael J, BuysseDaniel J, KrystalAndrew D, NeubauerDavid N, HealdJonathan L

Insomnia treatment

This guideline establishes clinical practice recommendations for the pharmacologic treatment of chronic insomnia in adults. The guideline focuses on individual drugs commonly used to treat insomnia, including drugs that are FDA-approved and those that are not.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Practice GuidelineGuidelines and recommendations for the diagnosis and treatment of specific medical conditions in medical practice.

Language : English

16.

Review of Safety and Efficacy of Sleep Medicines in Older Adults.

Author: SchroeckJennifer L, FordJames, ConwayErin L, KurtzhaltsKari E, GeeMegan E, VollmerKrista A, MergenhagenKari A

Improved sleep latency
Increased total sleep time
Dementia
Fractures
Residual daytime sedation
Serious injury
Somnolence

This review focuses on the safety and efficacy of medications used to treat insomnia in older adults. Cognitive behavioral therapy and sleep hygiene are considered initial therapy for insomnia. Benzodiazepines are discouraged in the geriatric population, especially for long-term use.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

17.

New Developments in Insomnia Medications of Relevance to Mental Health Disorders.

Author: KrystalAndrew D

Improved sleep quality
Insomnia treatment
Targeted therapy

New insomnia medications target specific brain systems, offering a new approach to insomnia treatment. The article discusses a new paradigm for insomnia therapy that focuses on selecting specific medications for specific types of sleep difficulties, including those with co-occurring psychiatric disorders.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

18.

Doxepin and diphenhydramine increased non-rapid eye movement sleep through blockade of histamine H1 receptors.

Author: WangYi-Qun, TakataYohko, LiRui, ZhangZe, ZhangMeng-Qi, UradeYoshihiro, QuWei-Min, HuangZhi-Li

Insomnia treatment
Sleep promotion

This study used H1R knockout (KO) mice to investigate if the sleep-promoting effects of doxepin and diphenhydramine are dependent on blockade of the H1R.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

19.

Use of ultra-low-dose (≤6 mg) doxepin for treatment of insomnia in older people.

Author: Rojas-FernandezCarlos H, ChenYannan

Insomnia treatment

This review evaluated the evidence behind ultra-low-dose doxepin for treating insomnia, particularly in older adults. The review discussed the potential advantages and limitations of doxepin for treating insomnia in this population.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

20.

Drug treatment of primary insomnia: a meta-analysis of polysomnographic randomized controlled trials.

Author: WinklerAlexander, AuerCharlotte, DoeringBettina K, RiefWinfried

Improved sleep quality

A meta-analysis of 31 studies found that benzodiazepine receptor agonists and classical benzodiazepines were more effective for primary insomnia treatment than antidepressants (including low-dose doxepin) based on both objective and subjective outcome measures.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

21.

Doxepin for insomnia: a systematic review of randomized placebo-controlled trials.

Author: YeungWing-Fai, ChungKa-Fai, YungKam-Ping, NgTommy Ho-Yee

Insomnia treatment
Headache
Somnolence

Doxepin is a sedating medication that has been approved for the treatment of insomnia. This review found that low doses of doxepin (1-6 mg/day) were effective at improving sleep maintenance and sleep duration but not sleep initiation. The review also found that doxepin was well-tolerated, with the most common side effects being headache and drowsiness.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

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