Quick Facts
Generic NameDoxepin
Brand NameSilenor
Drug ClassTCA
FDA Approved1969
Starting Dose3–6mg at bedtime (insomnia); 25mg (depression)
Typical Range3–6mg (insomnia); 75–300mg (depression)
Max Dose300mg/day
Half-Life15–31 hours
MetabolismCYP2D6, CYP2C19
Generic AvailableVarious (TCA generic 1985; Silenor generic 2020)
What Is Silenor?
Doxepin (brand name Silenor) is a tricyclic antidepressant (TCA) prescribed for insomnia, depression, anxiety, and other psychiatric conditions. Two distinct clinical uses at different doses: insomnia (3–6mg as Silenor) vs. depression (75–300mg). At insomnia doses, essentially a pure antihistamine with minimal TCA side effects. Non-addictive sleep aid. The only FDA-approved insomnia medication specifically targeting sleep maintenance.
At Psychiatry Telemed, doxepin is prescribed and monitored by board-certified psychiatrists who understand the nuances of TCA pharmacology — selecting the right dose, managing side effects, monitoring drug interactions, and optimizing your treatment through consistent monthly medication management appointments.
Doxepin (Silenor) — TCA medication for psychiatric care
ManufacturerCurrax (Silenor); various (generic)
How Silenor Affects Neurotransmitters
How Silenor Works
At ultra-low doses (3–6mg), doxepin is essentially a pure antihistamine — the most potent H1 antagonist among all TCAs. This produces sleep maintenance improvement without the anticholinergic and cardiovascular side effects seen at antidepressant doses. At higher doses (75–300mg), typical TCA antidepressant mechanisms predominate.
Efficacy: Silenor vs. Comparators
Efficacy Comparison
Response & remission rates vs. comparators (Cipriani et al. meta-analysis)
Data from published meta-analyses. Individual response may vary.
Conditions Treated with Silenor
Insomnia
FDA-approved as Silenor (3–6mg) for insomnia. Most potent antihistamine at low doses.
Learn About InsomniaConsidering Silenor?
Board-certified psychiatrists can determine if doxepin is right for you.
Dosage Information
| Indication | Starting Dose | Typical Range | Maximum |
|---|---|---|---|
| Insomnia | 3–6mg at bedtime (insomnia); 25mg (depression) | 3–6mg (insomnia); 75–300mg (depression) | 300mg/day |
| Depression | 3–6mg at bedtime (insomnia); 25mg (depression) | 3–6mg (insomnia); 75–300mg (depression) | 300mg/day |
| Anxiety | 3–6mg at bedtime (insomnia); 25mg (depression) | 3–6mg (insomnia); 75–300mg (depression) | 300mg/day |
Brain Regions Targeted by Silenor
Side Effects
Like all medications, doxepin has potential side effects. Most are mild, occur early in treatment, and resolve within 1–2 weeks. Your psychiatrist monitors at every appointment.
Common Side Effects
DrowsinessHeadacheNausea (at higher doses: dry mouthconstipationweight gain)
Less Common
DizzinessGI UpsetUpper Respiratory Infection
Serious (Seek Immediate Help)
Cardiac Effects (high doses)Suicidal Thoughts (high doses)Serotonin Syndrome
Side Effect Profile: Silenor vs. Class Average
Side Effect Profile
Incidence rates from FDA prescribing information vs. class average
Percentages from clinical trial data. Actual experience may differ.
⚠️ FDA Black Box Warning
Antidepressants may increase suicidal thinking (at antidepressant doses). Low-dose insomnia use does not carry this warning.
Drug Interactions
Major Interactions
MAOIs (at antidepressant doses), CYP2D6 inhibitors, CNS depressants, anticholinergics
CYP Metabolism
Substrate of CYP2D6 and CYP2C19. At low insomnia doses (3–6mg), drug interaction risk is minimal.
Alcohol
Avoid alcohol during doxepin treatment. Both affect the CNS, increasing sedation and impairing judgment.
Generic Versions & Cost
Generic doxepin available since Various (TCA generic 1985; Silenor generic 2020). Approximate cost: $4–15/month. FDA-certified bioequivalent to brand-name Silenor.
Starting Silenor: What to Expect
First Weeks
Doxepin is typically started at 3–6mg at bedtime (insomnia); 25mg (depression) and increased gradually. Common initial side effects usually improve within 1–2 weeks. Full therapeutic benefit develops over 4–8 weeks.
When to Contact Your Psychiatrist
Contact your psychiatrist for: worsening depression/anxiety, thoughts of self-harm, unusual agitation, severe side effects, or any concerning changes.
Stopping Silenor Safely
Never stop doxepin abruptly. Your psychiatrist will develop a gradual tapering schedule to minimize discontinuation effects.
Timeline: When Silenor Starts Working
Timeline to Effectiveness
Expected improvement trajectory over the first 8 weeks
Based on clinical trial data. Full therapeutic effects may take 6–8 weeks.
Get Silenor from a Board-Certified Psychiatrist
At Psychiatry Telemed, doxepin is prescribed following comprehensive evaluation. All Florida via HIPAA-compliant telepsychiatry. 1–3 days. $299 eval, $149 follow-up.
Frequently Asked Questions
Prescribed for insomnia, depression, anxiety.
Typically 2–4 weeks for initial improvement, 4–8 weeks for full benefit.
Common: drowsiness, headache, nausea (at higher doses: dry mouth, constipation, weight gain). Most resolve within 1–2 weeks.
No. Not habit-forming but should not be stopped abruptly — gradual tapering recommended.
Two distinct clinical uses at different doses: insomnia (3–6mg as Silenor) vs. depression (75–300mg). At insomnia doses, essentially a pure antihistamine with minimal TCA side effects. Non-addictive s
Alcohol should be avoided — increases sedation, impairs judgment, and may worsen symptoms.
Resources
Medical Disclaimer: Educational only. Consult a psychiatrist before starting/stopping medication. Crisis: call 988 or 911.
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