Depression coupled with severe anxiety represents an often-debilitating psychiatric condition. Treatment is frequently a challenging proposition, marked by repeated trial and error. No two people are alike, and reactions to specific medications run the gamut from successful remission of symptoms to no effect whatsoever. In other cases, side effects may be so severe that someone is forced to discontinue a medication.
Severe mood issues and constant worry often lead to pronounced physical symptoms. Severe anxiety, for example, is well known to cause gastrointestinal complaints. Unfortunately, many of the most commonly prescribed antidepressant medications have stomach upset or nausea as one of their known side effects.
Sinequan (doxepin) is an older variety of antidepressant medication that has fallen out of favor because of its broad side effect profile. However, at low doses, these side effects mostly disappear. A pair of case studies demonstrated that a standard antidepressant such as Zoloft (sertraline), combined with low doses of Sinequan, offered noticeable improvements to both depression and anxiety without stomach upset. Both of these individuals had tried and failed with nearly every antidepressant and anti-anxiety medication on the market. Side effects or lack of noticeable benefit was the consistent result, regardless of treatment method.
Even combination treatments proved ineffective. Studies have shown that repeated non-remission of severe depression predicts a negative outcome. Therefore, discovering an effective treatment in these difficult cases is especially important.
Based on previous research findings, attending physicians in these case studies surmised that Sinequan would reduce or eliminate gastrointestinal symptoms at low doses. In the absence of nausea and stomach upset, the patients would be less inclined to discontinue their antidepressant regimen. Furthermore, the low dosage would avoid the most troubling of Sinequan’s side effects, such as drowsiness, weakness, and dry mouth. At regular doses, Sinequan has been known to cause nausea. The dosages in these case studies, however, were far below standard prescription levels.
For the people involved, remission of their gastrointestinal symptoms was instrumental in alleviating both their depression and anxiety. Further research will determine if low-dose Sinequan is applicable in a wider range of cases. The primary concern is with the safety of the medication, particularly in elderly patients or those with a long history of unsuccessful treatment.
- Doxepin – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved March 28, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000668/
- MacLean, L., & Ahmedani, B. (2011). Sertraline and Low-Dose Doxepin Treatment in Severe Agitated-Anxious Depression With Significant Gastrointestinal Complaints:Two Case Reports. The primary care companion to CNS disorders, 13(4). Retrieved March 28, 2012, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219524/?tool=pmcentrez
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