Morning @Chippy well the first round of being medically checked out has showed nothing of consequence. Blood work all normal. I’ve not got the results from my echocardiogram yet but I’m guessing it will not show anything of a serious nature. But I still need advice.  
I continue to wake multiple x in the wee hours in great discomfort, often nauseated, in a various nature of pain and sometimes SoB, just feeling shitty-rotten. After I finally drag myself out of bed I pick up to some degree, but still

 don’t feel all that well 

Im currently take 1/2 of my tapering dose at 8am, 1/2 at noon. I’ve been holding with this schedule as advised. Been doing this now for 16 days. 

But I still wonder if continuing to move the 2nd 1/2 of my dose closer to bedtime would help. Or moving my 8am dose to combine with my noon dose so I’m taking a full dose then wound be of any help with my sleep.  

Having fractured sleep is bad enough but waking up + feeling sick & dragging thru the day is a miserable existence. 
Just trying to figure out a tolerable compromise to get better rest. 
Thanks. 

@Pokey449 I wouldn't be surprised if the ECG is normal too. They are only really good for picking up arrythmias and acute ischaemia i.e. angina, myocardial infarction. Have you ever had an echocardiogram?

1 hour ago, Pokey449 said:

Morning @Chippy well the first round of being medically checked out has showed nothing of consequence. Blood work all normal. I’ve not got the results from my echocardiogram yet but I’m guessing it will not show anything of a serious nature. But I still need advice.  
I continue to wake multiple x in the wee hours in great discomfort, often nauseated, in a various nature of pain and sometimes SoB, just feeling shitty-rotten. After I finally drag myself out of bed I pick up to some degree, but still

 don’t feel all that well 

Im currently take 1/2 of my tapering dose at 8am, 1/2 at noon. I’ve been holding with this schedule as advised. Been doing this now for 16 days. 

But I still wonder if continuing to move the 2nd 1/2 of my dose closer to bedtime would help. Or moving my 8am dose to combine with my noon dose so I’m taking a full dose then wound be of any help with my sleep.  

Having fractured sleep is bad enough but waking up + feeling sick & dragging thru the day is a miserable existence. 
Just trying to figure out a tolerable compromise to get better rest. 
Thanks. 

Hey mate. Glad to see your tests are all good.

I think your sleep is suffering because of the destabilisation not interdose wd. You’ve only been holding 16 days. A long hold is months not days mate. I don’t think there is a magic dose shift to fix all this. Just time and consistency is your best bet. In my opinion. It’s obviously your call what you do, I can only share my thoughts mate. 

@Chippy  I hear your logic about all this. I just got to thinking about the possibility of interdose WD as I found an online description of doxepin having a 1/2 life of 6-26 hours with an average of 15-17. I assume that is dependent if one is a fast or slow metabolizer of drugs. I have no idea which I am. Just thought if im a fast metabolizer maybe im getting some interdose WD issues ???

@Sminismoni yes it’s an echo that I’m waiting to hear about. I’ve had oodles of echocardiograms.  Since 2005 I’ve known I have mitral valve prolapse with moderate level mitral regurgitation.  I’ve been considered for surgery twice but twice ruled out. I also have a history of atrial flutter & AFib. I’ve had two atrial ablations. I as well as my psych doc should have done more research and never have put me on the doxepin even though it’s a low dose. It’s a TCA and is not the best choice for someone with a history of AFIB. Thankfully my AFib remains silent since the ablation 🤞🤞

But I continue to be concerned about the mirtazapine/doxepin combination. I still worry about my sxs possibly being an ADR between the two although Horowitz expressed no such concern to me.And no one here thinks im

having an ADR. In higher doses there is a risk of serotonin syndrome. A psychopharmacologist who reviewed my case advised that at my low doses he was not concerned about serotonin syndrome either. But still I wonder about other possible issues other than simply being in a wave from to many ups & downs of tapering. If I could just smooth out my sleep a bit that would help me a lot. 
Doxepin is said to have a 6-20hr 1/2 life. Avg 15-17 hrs. I’m taking my doxepin dose 1/2 at 8am & 1/2,at noon in an effort to avoid possible interdose WD. Wondering if moving 1/3 my dosing closer towards bedtime would help my sleep. I don’t know if I’m a fast or slow metabolizer which could have a bearing on the level of doxepin in my system in the wee hours when my sleep goes to crap. Or I could simply be in a wave as Chippy suggests where  I just have to hold for a long time & wait it out. I’m going to take Chippys advice for now  & going to hold as is and hope my sleep smooths out. 🤞🤞


 

 

2 hours ago, Pokey449 said:

@Chippy  I hear your logic about all this. I just got to thinking about the possibility of interdose WD as I found an online description of doxepin having a 1/2 life of 6-26 hours with an average of 15-17. I assume that is dependent if one is a fast or slow metabolizer of drugs. I have no idea which I am. Just thought if im a fast metabolizer maybe im getting some interdose WD issues ???

I think theres a bit of tolerance involved in interdose wd. So I think it tends to affect those on the drug for a long period of time.
 

You’ve got some spread from your split so far so youve half covered your bases there already.
 

For me there is more evidence of  nervous system dysfunction and so I see long hold myself. 
 

Trouble with shifting your dose around is it’s more changes which causes more dysfunction if done not stable. Then you’re back to square one but maybe worse. 

 

Just my thoughts mate. 

@Chippy I’ve been reading about taking my doxepin doses in relation to when I eat. I take 1/2 dose at 8am and the other 1/2 at 12,noon. I eat breakfast anywhere between 6-8am and lunch anywhere between 1130-1:00. My doxepin is in liquid form. Everything I read says it can be taken with meals but optimum absorption might occur better on an empty stomach. I’m wondering if when I eat & take my doses is causing absorption issues and thus the reason for some of my negative symptoms.  I took both doses on time today but am feeling crummy. Other days I can feel myself perk up an hour or so after I take my doses despite when I eat. I’m just trying to figure out how to make all this less miserable. 

6 hours ago, Pokey449 said:

@ChippyI’m just trying to figure out how to make all this less miserable. 

I know mate.  We all feel the same. But there aren’t quick fixes. Overthinking and making changes to try to be proactive often causes us more problems. At some point we learn to accept the process is messy. Some days are better than others.

ADR friends Your WD symptoms could be a sign of something more than you think depending on your individual circumstances. Consider my experience. 
 

My smart watch said I got 6hrs 58 minutes of sleep last night. I should be elated. I know most of us would kill for that much sleep. I would too many nights. Yes, it really helped, I’ll take it. But it’s not that great in all respects. When I awoke for the final time this morning I had a roaring headache, dry mouth, groggy thick  head, stiff & achy all over. Felt starved for air. Despite Dr. H telling me my mirtazapine/doxepin cocktail does not suppress respiratory drive  I’m not buying it. I’m convinced it’s making my sleep apnea worse. Getting off these poisons is hard on all bodies in multiple ways. 
I’ve developed a pattern of going to sleep with my CPAP mask on. Waking up on average 3-4hrs later feeling air starved, taking my mask off, falling back to sleep without it to then awaken later with all classic signs of sleep apnea, which is not good for ones brain, heart and other bodily functions. Somehow I need to break this pattern and keep my Cpap mask on all night. While WD in & of itself won’t kill you, sleep apnea can. 

Everyone please pay attention to what your body is telling you, it could be more serious than you think.  
Pokey 
 

 

Hey Pokey

 

Im glad you got some sleep last night. That’s good news. Not good you can’t make the night with your mask on. I wish I knew more about this but I don’t I’m afraid. And of course the doctors won’t likely understand you wd issues so it is a catch 22. Hopefully you can start to stabilise a bit and that will help. 

I swear to god I can’t figure out if it’s WD symptoms that I’m having when I wake up 2-3x at night or something medically wrong going on. 
I know sleep disruption is a classic WD symptom. But it’s how I’m feeling when I wake up that I can’t figure out. I wake up feeling literally sick!!! Awful!!! Often nauseous, sometimes with the inability to lay still. Often feel like I need to take some deep breaths. But it’s the miserable exhausting SICK feeling that’s the worst. Literally feel like my body is failing & I might die. I go back n forth in and out of sleep. Finally at 6 this morning I couldn’t lay there any longer. Had to get up. Felt unstable on my feet, woozy. After I’m up and have a light breakfast I feel a little better but still don’t feel well. This  has been getting progressively worse. 
I had some blood tests last week all of which came back normal. My echocardiogram was normal as well. 
I remain concerned it’s an ADR between the doxepin & mirtazapine. Whatever it is it’s been getting progressively worse making me feel sicker. I don’t know how much more of this I can take.
It’s going to be a day spent on my recliner🫩

20 minutes ago, Pokey449 said:

I know sleep disruption is a classic WD symptom

Hey mate. So is nausea unfortunately 😞

 

21 minutes ago, Pokey449 said:

remain concerned it’s an ADR between the doxepin & mirtazapine.

As you reduced your dose of doxepin did you get better or worse? ADR are dose sensitive so should lessen as you come down. 

25 minutes ago, Pokey449 said:

I swear to god I can’t figure out if it’s WD symptoms that I’m having when I wake up 2-3x at night or something medically wrong going on. 
I know sleep disruption is a classic WD symptom. But it’s how I’m feeling when I wake up that I can’t figure out. I wake up feeling literally sick!!! Awful!!! Often nauseous, sometimes with the inability to lay still. Often feel like I need to take some deep breaths. But it’s the miserable exhausting SICK feeling that’s the worst. Literally feel like my body is failing & I might die. I go back n forth in and out of sleep. Finally at 6 this morning I couldn’t lay there any longer. Had to get up. Felt unstable on my feet, woozy. After I’m up and have a light breakfast I feel a little better but still don’t feel well. This  has been getting progressively worse. 
I had some blood tests last week all of which came back normal. My echocardiogram was normal as well. 
I remain concerned it’s an ADR between the doxepin & mirtazapine. Whatever it is it’s been getting progressively worse making me feel sicker. I don’t know how much more of this I can take.
It’s going to be a day spent on my recliner🫩

I’m so sorry you’re going through this! 
 

Did the little updose help for a while?

@Chippy you asked as I reduced my dose from the start at 50mg to where I am now at 29.5mg did I feel better or worse?  Gradually WORSE!!

@Finni the small up dose of 0.5mg that Horowitz recommended hasn’t helped at all. 

As I’ve shared previously I’ve split my total dose into 2 halves with the intention of compensating for possible interdose WD sxs since Doxepin has a 1/2 life of 6-20hrs with an average of about 15-17hrs. I guess it all depends if a person is a slow or fast metabolizer. It’s usually about 18-20 our after my last 1/2 dose that I wake with these symptoms. I take 1/2 my dose at 8am, the 2nd 1/2 at noon. Thing is that’s when I have breakfast & lunch. Wondering if food in my stomach is affecting dose efficacy as well. Wondering if I’d sleep better if I took the doxepin at bedtime instead, 4 hours after the evening meal???? 
 

1 minute ago, Pokey449 said:

@Chippy you asked as I reduced my dose from the start at 50mg to where I am now at 29.5mg did I feel better or worse?  Gradually WORSE!!

So no evidence of adr really here. 
 

2 minutes ago, Pokey449 said:

Wondering if I’d sleep better if I took the doxepin at bedtime instead, 4 hours after the evening meal???? 

I hear you mate. And I don’t know tbh. Maybe. But I do know your nervous system has been through a lot and needs a rest from changes imo. 
 

All of this is your choice bud. We can’t make decisions for you. You know your body. We support you what ever you choose. 
 

Holds can need to be very long to work sometimes. Each time you make a change you’re resetting the start of the process. Wouldn’t want to make yourself worse fishing for solutions. I know you are suffering but it can get a lot worse than you are now, as you have seen with others no doubt. 
 

Out of curiosity as you have move the 1/2 dose over from 8am to midday I think?, Have you seen any improvement?

I know it’s so confusing!
 

How long ago did you split your dose?

 

I know sometimes it can take the nervous system a while to settle in to something new.

 

I certainly don’t have the answers, but I just want you to know you’re going to get through this.

 

Is the main problem coming from not being able to keep your CPAP on?

@Chippy I haven’t moved the morning 1/2 dose to noon as of yet. I think I will start that gradual slow transition tomorrow so I’m taking a full dose at noon. The fact the 1/2 life could be as short as 6hrs could be the problem. 
 

@Finni yes keeping my cpap on is a big challenge. I’m working with a doctor now to determine if a relatively simple surgical procedure could eliminate my need to use cpap. 

40 minutes ago, Pokey449 said:

 I haven’t moved the morning 1/2 dose to noon as of yet. I think I will start that gradual slow transition tomorrow so I’m taking a full dose at noon. The fact the 1/2 life could be as short as 6hrs could be the problem. 

No I meant you split your dose to now 8am and 12 noon right? Did you notice any improvements from having done this?
 

I’d not take it all at noon if it were me. You want to have an even dose if anything so you don’t get inter dose wd. Taking it all at once won’t be the way to do this. Might cover the night better but you’d then get interdose wd the following morning if your thesis is right. Hence the reason to split the dose. 
 

As I said I wouldn’t do anything. IMO 

 

If I did anything I’d be creeping your midday dose closer to bed as Dr H said. If you’re really keen on doing this. Why not do it really slowly to trick your brain into not noticing?! Like 15 mins a day or something. 

@Chippy Got it. Understand!! Ok I’ll gradually move my mid day dose more towards evening.

 

I can’t believe how worthless I am today. I’m glued to my recliner. Fell asleep for a bit. Don’t feel like doing anything but drinking tea. This poison is robbing my life from me. 

2 minutes ago, Pokey449 said:

I can’t believe how worthless I am today. I’m glued to my recliner. Fell asleep for a bit. Don’t feel like doing anything but drinking tea. This poison is robbing my life from me. 

I’m so sorry my friend. Wish it was a quick process recovering from all this. Lord knows I know what poor sleep is like. Mines gotten a lot better but still far from perfect. Can grind you down can’t it. 

Well a different misery came upon me in spades yesterday. Awful nausea!!  Tried simmering it down last night at  bed time with some Gaviscon. Helped me get to sleep but awoke about 4 hours later sick to my stomach and that was it for the night for sleep. Took some more Gaviscon and finally got up at 5. It’s starting to settle down finally but still feel s****y!!!  I’ve got a history of a grouchy/toychy stomach. But tapering off an AD doesn’t help it though. 

Also I’m gradually moving 1/2 of my daily dose towards later in the day. I take the first 1/2 at  8am. The intent is to get the other 1/2 to 8pm and so as to not be as close to meals for better absorption. I’m hoping this will alleviate what I think is likely interdose WD sxs due to doxepins 15 hr 1/2 life and I hope it helps me sleep through the night which now I wake up daily multiple x anywhere from 2-5am.  But I’m going slow doing this. Moving the dose by only 1/2 hour each time every 1-2days. 🤞🤞🤞

 

@Chippy is there any discussions in the “library” here about liquid forms of ADs?  I’m wondering if they are as stable as capsules or tablets. The liquid doxepin that I take comes directly from the pharmacy. It’s not something I mix so should be good. The expiration date on it indicates it’s good for a year. Still I wonder?? I just got a new refill 2 days ago and have 2 partial bottles of previous prescriptions.  One was filled back in August. I’m going to throw out the older ones and go with the new prescription. The fewer the variables  the better. 
I’m also concerned that taking my doses adjacent to a meal may be a problem. Everything I read says I can take doxepin with food. But I have to wonder if the small 1.5ml (15mg)  of a dose mixed in with a bowl of oatmeal at 8am if I’m getting the full benefit of the dose? Makes sense to me that it would interfere with absorption of the full dose. My second 1/2 dose has been at 12noon, lunchtime. I’m slowly moving that dose towards 8pm. Today I’ll take it at 1:30, 1/2 hour later than yesterday. 
Would appreciate your thoughts.

Thanks 

Hey Pokey. 
 

There is no problems with the stability of liquid forms of ads in general. 
 

33 minutes ago, Pokey449 said:

The fewer the variables  the better. 

Agreed

 

34 minutes ago, Pokey449 said:

Everything I read says I can take doxepin with food.

I think your answer is right here mate. 
 

You’re a tinkerer and have to try to fiddle and improve things. I can see it. I’d love to see your garage! 
 

Trouble is with all this we have to learn the less we mess the better. It’s counter intuitive. You’re just not there yet. Takes time to work that out. 

On 3/3/2026 at 5:27 AM, Pokey449 said:

@namastejen1 I play a French horn. Played one since freshman in high school. I’ve only played in community groups, but really enjoyed doing so. When I lived in Oregon I helped form a community orchestra and was president of the board for 5 years. I really miss being part of something like that. 

Maybe you can get back into it when you start to feel better--which you will! I like brass instruments. We went to a holiday brass concert in December, in a local church where the acoustics were very good. The French horn is a nice instrument to play and listen too. I hope that you are doing well.  

 

I have been off of here due to feeling sick from an icky virus. I understand one of your posts where you feel like a lump on a log. I have been couch surfing too. I am usually more active, but sometimes our minds/bodies need rest. 

Edited March 14Mar 14 by namastejen1

@namastejen1  I’d love it if I could get back to playing my horn. Music is poetry, is an active form of meditation for me. I use to play in a trio & quartet which I loved and arranged some of the music for both groups. I love arranging the music too. It’s a creative process.  I’ve not been able to put together such a group here thus far. Maybe when & if I ever feeling better. Some days I fear I’ll be like this the rest of my life. I got to get more active again. This “couch surfing” is not good for one’s health. I feel fat, tired & out of shape. It sucks. Wishing you well @namastejen1