Amoxapine is a medication that may be prescribed to treat depression, anxiety or sometimes bipolar disorder. It is part of a class of drugs called tricyclic antidepressants (TCAs). It was not one of the original TCAs, but was developed slightly later with the hope that it would have fewer side effects than the original TCAs. This was unfortunately not the case, and amoxapine, known by brand names like Asendin® does have a high profile of annoying and sometimes potentially dangerous side effects. It is nevertheless still prescribed, usually when treatments with first line antidepressants like SSRIs or SNRIs (selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors) are ineffective.
The drug acts in two ways to stabilize mood. It is similar to the SNRIs because it prevents reuptake of some norepinephrine, and it also makes more serotonin available. This second action is weaker, and usually isn’t as effective as the same action provided by SSRIs or modern SNRIs. Availability of these brain chemicals may help end depression or anxiety, though with side effects, the medication can also increase depression, or increase anxiety and restlessness. Usually if the drug will be effective, it tends to become active and start responding to symptoms after about two to three weeks of use, though some people may notice immediate improvement or side effects too grave to continue taking it.
The way this medication is prescribed can be different for each person. People generally take one dose per day, and dosage may be increased if the medication is tolerated well and is mildly but not completely effective. It’s important to follow doctor’s advice exactly on how, when and how much amoxapine to take, and this medication shouldn’t be discontinued without doctor’s counsel.
Some common side effects of amoxapine can include sensitivity to the sun, which can be helped by using sunscreen and not pursuing activities like tanning. Other less serious and possibly transient side effects are changes in weight or appetite, tiredness, dizziness, headache, breast swelling, rash, strange dreams, and decreased libido. There can be very serious side effects that develop while taking this drug and people should get emergency medical care if they experience fainting, confusion, seizures, numbness on one side of the body, rapid heart rate, high fever, or have trouble talking or seeing.
Another side effect that can occur is increase in suicidality, and this is most common in teens or young adults. This medication is not commonly prescribed for children. However, should it be or should a young adult or an adult of any age taking amoxapine feel more suicidal, this is a medical emergency that needs immediate care.
One of the reasons that TCAs have not been popular as treatment for depression is because of their potential to cause serious damage in event of overdose, which is more likely with people suffering from mood disorders. One of the rare effects of high levels of overdose with amoxapine is that people can appear to have recovered from an overdose with treatment, but then in two to five days will have significant damage to the kidneys. In most cases, this medication and others that hazard extreme health risk in overdose aren’t given to people who are actively suicidal or could become so.
There are also other populations that should avoid this medication. Patients should let doctors know about other conditions they have, especially heart disease, prior heart attack history, glaucoma, or diabetes. Usually doctors will not prescribe amoxapine until two weeks after a person has stopped taking a monoamine oxidase inhibitor, and they may also wait up to five weeks after an SSRI or SNRI has been stopped before they prescribe this drug. Be sure to bring a full list of medical history and any drugs taken (including herbs and over the counter medications) to a doctor before accepting any new drug prescription, since some drug interactions may be very serious.
