10 hours ago, Pokey449 said:

@Chippy  is there any information on SA or here about when to take your daily dose(s) in relation to meals. It just dawned on me. I ask because I take my 1st 1/2 of my doxepin dose at 8am which is 2hrs to 30 minutes after my breakfast, depending on when I get up. I take my 2nd 1/2 dose at noon which is near my lunch time. I’m just wondering if food is affecting the absorption of my doxepin doses, thus WD symptoms. 

Hey Pokey. I think you might be over thinking a bit here. Not to say food doesn’t affect how we ingest the drugs. But you need to not change things. Here you sound like you are searching for a solution and an excuse to tweak things again. This has been the hallmark of the last year or so. You need to leave things alone and let your system settle my friend. This process can take a long time and there are no quick fixes for it im afraid. 
 

Thinking of you as always mate. 

 

Chippy

@Chippy no I’m not looking to change anything about my doxepin dose amount or timing., but maybe when I have my breakfast and lunch in relation to my 8am and 12 noon doxepin doses so the food in my stomach doesn’t affect absorption of the  medication as much. 
 

I got a fair amount of sleep last night, for which I’m very thankful, but it wa “troubled sleep”. For one, I’m pretty sure the doxepin on top of the mirtazapine is making my sleep apnea worse. I could go into a long discussion of why I am sure that’s the case but will spare you. But the symptoms I awaken with are telling and it’s very concerning. Sleep apnea is hard on brains and hearts putting one at higher risk for stroke and heart attack not to mention other conditions.  
But this brings to mind why my psych doctor didn’t think of such negative possibilities. It’s not uncommon these days for psychiatrists to put folks on two ADs for which I still question the validity of doing but I’ve learned that doxepin & Mirtazapine are seldom if ever combined. Primarily for the risk of serotonin syndrome. However that was assessed before placing me on the doxepin and ruled out due to the low doses of both I’d be on. But still they didn’t seem to consider that I have an AFib history and have sleep apnea for which doxepin is not a good choice. Butttt I should have researched this more myself & said no to the doxepin.  So I can’t put all the blame on the ignorance of my psych doctor. 
So here I am. All I can do is taper slowwwww and do the best I can with my cpap therapy, diet & exercise and cross my fingers. 
 

45 minutes ago, Pokey449 said:

@Chippy no I’m not looking to change anything about my doxepin dose amount or timing., but maybe when I have my breakfast and lunch in relation to my 8am and 12 noon doxepin doses so the food in my stomach doesn’t affect absorption of the  medication as much

Good mate. Glad to hear it. 
 

45 minutes ago, Pokey449 said:

I got a fair amount of sleep last night, for which I’m very thankful

Pleased to hear this mate. Hope this continues!

 

45 minutes ago, Pokey449 said:

still question the validity of doing but I’ve learned that doxepin & Mirtazapine

They should have never gone there, zero doubt in my mind. 
 

45 minutes ago, Pokey449 said:

Butttt I should have researched this more myself & said no to the doxepin.

You trusted the professionals which you should be able to do!!!

 

45 minutes ago, Pokey449 said:

here I am. All I can do is taper slowwwww and do the best I can with my cpap therapy, diet & exercise and cross my fingers

That’s it bud. One day at a time. I know it’s a grind but I hope and believe in time things will get easier for you. 
 

Chippy

Thanks @Chippy I don’t know what all of us would do without guys like you, @Luke et al. I’m sure all of us poor souls here appreciate everything you chaps do to make our lives better during a very trying time in our lives. 

13 minutes ago, Pokey449 said:

Thanks @Chippy I don’t know what all of us would do without guys like you, @Luke et al. I’m sure all of us poor souls here appreciate everything you chaps do to make our lives better during a very trying time in our lives. 

Bless you Pokey for saying that. We are just doing our best. No one wants to join this club let alone run it! Happy to try and at least help where we can.

Hi @Pokey449 Stay strong Bud, slow and steady.

Take care,          B.🤞

Stopping by to say hi...I read your posts often and my heart goes out to you. 

I asked ChatGPT about food and your dose...this is what I got...

"General Effect

Doxepin can be taken with or without food. Food does not significantly change how much of the drug is absorbed, but it can affect how you tolerate it.

🍽️ Taking Doxepin With Food

May reduce stomach upset

May lessen nausea

Can make it easier to tolerate if you’re sensitive to medications

🌙 If You’re Taking It for Sleep (Low-Dose)

At very low doses (like 3–10 mg for insomnia), taking it:

On a relatively empty stomach may help it work a bit faster

A heavy or high-fat meal might delay onset slightly"

 

I am holding as well, waiting for stability...one day at a time.... We have come this far. ❤️🙏

Thanks @LostinCanada  that’s good info to have. 

My smart watch has been acting off lately   I’m not sure how much total sleep I got last night. It says I got 4.5hrs. But I got up in the middle of the night for a bit and then went back to bed for what I think was approximately 3 hrs. So I think I got at least 6. That’s all well and good except for how I feel when I wake up. 
I feel awful upon awakening. Hard to describe. An unwell feeling throughout my body. Pain.  Sickening anxious waves that come & go that make me draw my body up into a ball. Headache. Sometimes nausea. The need to take some deep breaths. Weird little aches and pains only in my left arm & hand which makes me concerned my heart is being affected. Worried I’m going have a heart attack. I have to get up. I Work the sxs  off which takes time. Eventually the sxs go away only to be there the next time I wake up. I don’t think the sxs could come & go like that if WD sxs. 
im concerned what’s going on is more than WD. My CPAP therapy has gotten worse with time as well. I think the doxepin is affecting my breathing while asleep which in turn can affect a lot of other things, especially your brain & heart. To be completely honest I’m afraid of dying in my sleep or waking up some night and having to call 911. I think what’s happening it’s more ominous than garden variety WD. And I dont know anything that I can do anything about it.
Bottom line: I’m scared. 

@NT1100B @Chippy Morning B & Chippy. I’m deliberately hailing you both this morning because I’m feeling very afraid and alone this morning. I hope that’s OK?  I had another terrible night and feel horrible.  I awoke numerous times feeling starved for air, my whole body in a painful, sickening & exhausted state. My CPAP therapy is getting worse because my breathing while sleeping is getting worse. I wake up needing to take deep breaths. 
im finding myself in disagreement with Horowitz. I asked him the other day if the “cocktail” of mirtazapine & doxepin would negatively impact respiratory drive, that is, how my brain controls my breathing. He said NO!! With all due respect I think he maybe  wrong. My breathing during sleep seems to be getting progressively worse. My nightly CPAP data says it is. I’m having more apnea events and I’m waking feeling more unwell & needing to take deep breaths as time goes by. I’m feeling more sedated at night. It’s been a gradual worsening. Who knows what’s happening metabolically, but felt plain sick this morning. 
I truly think I’m in a “no mans land” with what’s going on. I’m not saying WD has nothing to do with it. I’m quite sure it does but I think it’s more complicated than that. What’s called an idiosyncratic reaction. Something modern psychiatry has no knowledge  of. Mirtazapine & doxepin are not commonly given together. In fact everything I can find says not to give them together. Why in the hell did my psych doc not know this. I believe I’m in dangerous territory pharmacologically. Thing is there’s likely nothing that can be done about it at this point. I’ll either survive or I won’t. 
My wife is out of state currently. I’m alone here. I have no one else that can check on me. Im going to ask her to do a daily well check to confirm I made it through the night. 
It’s my day to go to the health club for my exercise routine. Not sure I’m going to make it today.
Thanks for listening. 
 

Hey @Pokey449

 

I hate seeing you like this mate. Of course it’s ok to check in with us. B is having a rough time at the moment too I’m afraid. 
 

I understand your concerns. I don’t think there is much more you can do at the moment. I’m no expert of your other issues and how they might interact with your wd. It’s always possible and as we know Mirt and Doxepin aren’t ideal to be taking at the same time. I do think you need to give it lots of time. It might be a bumpy road ahead but I truly hope some time holding here will help things. You need your body to recalibrate now it’s  having no more changes. This can take a long time. 
 

Wish I could do more mate. Thinking of you. 
 

chippy

Dear @Pokey449 I can understand very well that you are worried. Breath is life! I’m so sorry for you. I wish I could help you. You are not alone, people are thinking of you.
just wondering : Is there maybe a chance to get more oxygen at night? I don’t know about this therapy You are having with the mask, but maybe there’s a possibility for updosing the oxygen you receive? I’ve worked with patients, who had machines in their sleeping room that gave them oxygen. Maybe you have something like that or you maybe could get it ? I’m sure none of my patients had to go to a sleep lab before to receive something like that.
I hope you make it to the health club today, but if not, you have every right just to rest.

take care!

 

2 hours ago, Pokey449 said:

asked him the other day if the “cocktail” of mirtazapine & doxepin would negatively impact respiratory drive, that is, how my brain controls my breathing. He said NO!! With all due respect I think he maybe  wrong. My breathing during sleep seems to be getting progressively worse. My nightly CPAP data says it is. I’m having more apnea events and I’m waking feeling more unwell & needing to take deep breaths as time goes by

You are absolutely correct...I put this info into ChatGPT and there is a definite problem complicated by sleep apnea.

3 hours ago, Pokey449 said:

feeling very afraid and alone this morning

I am sorry you are dealing with this...I got this sensation after my cold turkey as well....these drugs are brutal.

Hope as your day goes on, you are doing a bit better.... sending hugs ❤️🙏

@Nemina Thanks for your post. I live in a town where there is a large university with a medical school with multiple healthcare facilities spread across the area. There is another large medical system in the area as well. Lots of doctors & facilities but I am pretty sure none would have an understanding of what I’m going through much less know what to do about it. My psych told me at one point if I get to feeling really bad go to the ER. I asked him what the hell are they going to do for me.  He said they’d likely admit me right away to the psych unit. Again I asked what can they do. All they know how to do is put more different kinds of pills down your throat. The problem is much of medicine in the US & UK I suspect has any understanding, training or sympathy for what all of us here are going through much less how to help us.  Im either going to survive this on my own or I’m not which leaves me feeling so scared and alone. 
 

@LostinCanada You said you checked ChatGPT.  What is ChatGPT and I’m not sure what you meant exactly in your statement about there being a complication related to sleep apnea. Could you share a bit more on that? 

I personally think what’s happening is the meds/withdrawal is making my sleep apnea worse. 

ChatGPT is an AI app.

 

This is what it says:

Both doxepin and mirtazapine can affect breathing in certain situations — but for most healthy people, they do not directly damage the lungs. The risk depends heavily on dose, other medications, and whether you have underlying respiratory conditions.

Here’s a clear breakdown:

🟢 Doxepin

What it is: A tricyclic antidepressant often used for depression, anxiety, insomnia, and sometimes chronic pain.

Respiratory Effects:

❗ Can cause sedation

❗ May suppress breathing at high doses or in overdose

⚠️ Can worsen breathing in people with:

COPD

Severe asthma

Sleep apnea

⚠️ Higher risk if combined with:

Opioids

Benzodiazepines

Alcohol

Other sedatives

It does not typically damage lung tissue, but sedation can reduce respiratory drive.

🟢 Mirtazapine

What it is: An antidepressant commonly used for depression, anxiety, and insomnia.

Respiratory Effects:

Usually does NOT suppress breathing directly

Sedating (especially at lower doses)

Can potentially worsen sleep apnea due to muscle relaxation and sedation

Very rarely associated with:

Shortness of breath (usually allergic reaction)

Pulmonary issues (extremely uncommon)

Interestingly, some small studies have even looked at mirtazapine for sleep apnea because of serotonin effects — but it is not standard treatment.

🚨 When Breathing Risk Is Higher

You’re at higher risk if you:

Have sleep apnea

Have COPD or severe asthma

Are elderly

Take opioids, benzos, or alcohol

Take high doses of either medication

Have obesity with hypoventilation

💡 Important Question for You

Are you asking because:

You’re experiencing shortness of breath?

You have sleep apnea?

You’re combining them?

You feel overly sedated?

You have asthma or COPD?

The context matters a lot.

⚠️ Seek urgent care if you notice:

Slow or shallow breathing

Bluish lips/fingertips

Severe drowsiness you can’t stay awake from

Chest tightness or wheezing

Sudden swelling (possible allergic reaction)

If you’d like, tell me:

Your doses

Other medications you’re on

Any lung or sleep conditions you have

I can give a more specific risk assessment.

If you clink on this link, you can access it

Source: ChatGPT https://share.google/XS2d3NnPcyhA4hT8L

 

Thanks @Chippy  I think the meds/WD is making my sleep apnea worse. My nightly sleep apnea numbers jumped way up last night. About all I can do is work with one of my sleep doctors to deal with that. Otherwise I’m at the mercy of WD and time. I really think it’s the lousy sleeep that makes me  feel so rotten. The s***y sleep that both B & I are getting is really hard on a body. Especially a 77 y/o body. If I could get the sleep issues mitigated I think I’d be ok. But to be honest, I’m afraid I may not survive long enough to get it fixed. 

6 minutes ago, Pokey449 said:

Thanks @Chippy  I think the meds/WD is making my sleep apnea worse. My nightly sleep apnea numbers jumped way up last night. About all I can do is work with one of my sleep doctors to deal with that. Otherwise I’m at the mercy of WD and time. I really think it’s the lousy sleeep that makes me  feel so rotten. The s***y sleep that both B & I are getting is really hard on a body. Especially a 77 y/o body. If I could get the sleep issues mitigated I think I’d be ok. But to be honest, I’m afraid I may not survive long enough to get it fixed. 

Poor sleep is the worse thing mate. I get that. Try to change the things you can and accept the things you can’t. There is a lot to say for remaining calm. Your nervous system will thank you. Sleep can take time to come back. Your nervous has been through a lot. Acceptance is so important. I’m praying you get a peaceful night mate tonight. 

@LostinCanada thanks for the reference.  Tells me how incompetent my healthcare providers were that put me on doxepin when I was already on mirtazapine.  It was in my healthcare record that I had sleep apnea. My psych doc was aware of that. Also i later learned if you have a history AFIB you should not be out on doxepin. That was known as well. But ultimately it’s my fault. I should have researched more and refused the doxepin 

Pokey it wasn't your fault. It was the responsibility of the prescribers to know this. I can see that you are on Mag glycinate and melatonin 5mg. Not sure what your thoughts are on increasing your Melatonin to 10mg? Or trying the supplement L theanine. It isn't sedating but helps with anxiety. Things are fairly desperate so I don't think you've much to lose?

8 minutes ago, Sminismoni said:

Pokey it wasn't your fault. It was the responsibility of the prescribers to know this. I can see that you are on Mag glycinate and melatonin 5mg. Not sure what your thoughts are on increasing your Melatonin to 10mg? Or trying the supplement L theanine. It isn't sedating but helps with anxiety. Things are fairly desperate so I don't think you've much to lose?

It’s so important to not make sudden changes to your system pokey as we discussed. The brain is desperate for stability. Adding extra things isn’t something I would do 😊

38 minutes ago, Pokey449 said:

Especially a 77 y/o body. If I could get the sleep issues mitigated I think I’d be ok. But to be honest, I’m afraid I may not survive long enough to get it fixed. 

Try not to look beyond today...we never know. I don't sleep well either. 

Stability is more important than cessation. ❤️🙏

Thanks @Sminismoni but I think I’m of the same opinion as @Chippy  I don’t want to add any more possible fuel to the fire. Actually im

not currently taking the magnesium.  
I can go to sleep just fine. I think currently I could sleep much if the night if I was not being wakened due my breathing issues. I think the doxepin/Mirt combo is suppressing my respiration to the point my cpap cannot compensate enough. I think I need to approach my sleep doc and see what if anything can be done. Otherwise I fear the possible negative consequences if this continues. The lack of decent sleep alone has me about worn completely out. 

Pokey Dose History Archive

 

1985-2008 1-2 mg of Xanax.  Off 2008

1985-2014 50-100mg doxepin. Tapered off 2014

15mg Mirtazapine 2014-2018 Tapered off 2018-19

 

Current Medication:

2.5mg of nebivolol for BP

5mg Eliquis x2.

Vitamin D, 40mg Famotidine PRN

Magnesium glycinate ,5mg melatonin

 

2022 Approx - Mirtazapine 7.5mg

13 Jan 2025 - Doxepin 25mg

16 Jan 2025 - Doxepin 50mg (+100%)

17 Jan 2025 - 05 Feb 2025 - Mirtazapine Taper 7.5mg to 2.65mg (-64.66%)

06 Feb 2025 - Mirtazapine - 5.3mg (+100%)

20 March 2025 - Mirtazapine - 7.5mg (+41.5%)

24 March 2025 - Doxepin 45mg

04 April 2025 - Sleep went to ‘hell in a hand basket’

07 April 2025 - Stated you would start split dosing Doxepin

09 April 2025 - Stated you had moved your Doxepin from Bedtime to morning

14 April 2025 - Doxepin 43mg

20 April 2025 - Doxepin 41mg 

28 April 2025 - Doxepin 40mg (-20% from 50mg in 4 weeks approx.)

09 May 2025 - Doxepin 39mg (Date appox)

May 2025 - Certainly, having a hard time of it

15 May 2025 - Started Split dosing again no crossover I think

18 May 2025 - Doxepin 38mg

27 May 2025 - Doxepin 37mg 

31 May 2025 - Doxepin switched back to morning dosing

31 May 2025 - Doxepin 37mg

01 June 2025 - Doxepin 36mg

15 June 2025 - Doxepin 35mg

08 July 2025 - Mirtazapine Xtra ¼ tablet taken

15 July 2025 - Doxepin 34mg 

17 July 2025 - Doxepin 35mg

19 July 2025 - Seem a bit better but not perfect

20 July 2025 - Still having night issues

23 Aug 2025 - Doxepin 34mg

07 Sept 2025 - Doxepin 33mg

25 Sept 2025 - Doxepin 32mg

15 Oct 2025 - Doxepin 31.5mg

?? Oct 2025 - Doxepin 30.5mg

07 Nov 2025 - Doxepin 30mg

17 Jan 2026 - Doxepin 29.5mg

28 Jan 2026 - Doxepin 29mg

06 Feb 2026 - Starting spitting Doxepin doses and moving 2nd half gradually later. Paused at Midday.

20 Feb 2026 - Doxepin 29.6mg (0.6mg updose)