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Sinequan

Generic Sinequan is used for treating depression or anxiety in certain patients. It may also be used for other conditions. Generic Sinequan is a tricyclic antidepressant. It increases the activity of certain chemicals in the brain, which help elevate mood.

Other names for this medication:

Similar Products:
Anafranil, Norpramin, Noveril, Lomont, Pamelor, Aventyl, Norpress

 

Also known as:  Doxepin.

Description

Generic Sinequan is a tricyclic antidepressant. It increases the activity of certain chemicals in the brain, which help elevate mood.

Generic name of Generic Sinequan is Doxepin.

Sinequan is also known as Doxepin, Aponal, Deptran, Doneurin, Doxin, Mareen, Quitaxon, Sinepin, Spectra, Xepin.

Brand name of Generic Sinequan is Sinequan.

Dosage

Take Generic Sinequan by mouth with or without food.

Taking Generic Sinequan at bedtime may help reduce side effects (eg, daytime drowsiness).

If you want to achieve most effective results do not stop taking Generic Sinequan suddenly.

Overdose

If you overdose Generic Sinequan and you don't feel good you should visit your doctor or health care provider immediately.

Storage

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F) away from moisture and heat. Throw away any unused medicine after the expiration date. Keep out of the reach of children.

Side effects

The most common side effects associated with Sinequan are:

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Side effect occurrence does not only depend on medication you are taking, but also on your overall health and other factors.

Contraindications

Do not take Generic Sinequan if you are allergic to Generic Sinequan components.

Be careful with Generic Sinequan if you are pregnant, planning to become pregnant, or are breast-feeding.

Do not take Generic Sinequan if you take clonidine, an H1 antagonist (eg, astemizole, terfenadine), or ibutilide, or you have taken a monoamine oxidase inhibitor (MAOI) (eg, furazolidone, phenelzine, isocarboxazid) within the past 14 days.

Do not take Generic Sinequan if you have certain prostate problems (eg, asymptomatic prostatic hypertrophy), glaucoma, or trouble urinating.

Be careful with Generic Sinequan if you have a history of heart problems, seizures (eg, epilepsy), overactive thyroid, prostate problems (eg, benign prostatic hypertrophy [BPH]), blood problems (eg, porphyria), other mental or mood problems, suicidal thoughts or attempts, or alcohol abuse.

Be careful with Generic Sinequan if you take antiarrhythmics (eg, quinidine, propafenone, flecainide), antifungal medicines (eg, fluconazole, terbinafine), carbamazepine, cimetidine, mibefradil, phenothiazines (eg, chlorpromazine, thioridazine), or selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine, sertraline) because they may increase the risk of Generic Sinequan 's side effects; anticoagulants (eg, warfarin), H1 antagonists (eg, astemizole, terfenadine), ibutilide, sulfonylureas (eg, tolazamide, glipizide), sympathomimetics (eg, phenylephrine, pseudoephedrine), or tramadol because the risk of their side effects may be increased by Generic Sinequan; clonidine, guanadrel, guanethidine, or guanfacine because their effectiveness may be decreased by Generic Sinequan; MAOIs (eg, furazolidone, phenelzine, isocarboxazid) because severe toxic effects may occur.

Avoid alcohol.

Be careful when you are driving or operating machinery.

It can be dangerous to stop Generic Sinequan taking suddenly.

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The tricyclic antidepressants trimipramine and doxepin, and the neuroleptic agents trifluoperazine and haloperidol were tested for their effect on histamine H2-receptor-mediated adenylate cyclase activity and H+ secretion in guinea-pig parietal cells. All compounds inhibited histamine-stimulated adenylate cyclase and H+ secretion in a concentration-dependent manner. The antisecretory potency was 1-2 orders of magnitude higher than that for adenylate cyclase inhibition. All drugs caused a rightward shift in the concentration-response curves of histamine-induced adenylate cyclase activation with Schild-plot lines having a slope significantly different from unity. Histamine-stimulated H+ secretion was inhibited by the drugs in a noncompetitive fashion. These results demonstrate that antidepressants and neuroleptics interfere noncompetitively with the parietal cell histamine H2-receptor and that this receptor blocking activity is not related to the antisecretory activity of the drugs.

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In a double-blind study, 19 adults received bedtime doses of either 150 mg of doxepin hydrochloride (N = 9) or placebo (N = 10). After 3 weeks the subjects were instructed to stop smoking and continue taking medication for 4 additional weeks. Cessation was reported by all nine doxepin subjects 1 week after cessation and by seven doxepin subjects 9 weeks after cessation. One placebo subject reported cessation. Cotinine assays generally confirmed cessation but were subject to interpretation. Doxepin assays suggested that the precessation level was associated with cessation. Further studies with larger samples and extended follow-up are needed to determine the reliability of these results.

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In a randomized, double-blind safety and efficacy study, 50 patients with chronic pruritus were given either doxepin 10 mg/d or hydroxyzine 25 mg/d for 4 weeks. Pruritic score was calculated for each patient before treatment and 1 month after.

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To assess the relative toxicity of specific tricyclic antidepressants (TCAs), a serotonin and noradrenaline reuptake inhibitor (SNRI), a noradrenergic and specific serotonergic antidepressant (NaSSA), and selective serotonin reuptake inhibitors (SSRIs).

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The effects of nortriptyline, amitriptyline, desipramine, chlorimipramine, protriptyline, doxepin, nisoxetine, fluoxetine and iprindole were determined on responding by pigeons under a multiple fixed-ratio 30-response, fixed-interval 10-minute schedule of grain presentation. Those drugs which have been shown to block uptake of norepinephrine decreased fixed-interval quarter-life values. Those which are considered most selective as norepinephrine uptake inhibitors also increased overall fixed-interval responding. These increases in fixed-interval responding, both on local and overall rates, in pigeons appear to be due to the actions of these drugs to inhibit uptake of norepinephrine rather than to other actions.

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Both doxepin application forms improved sleep significantly and reduced mean cortisol levels from 9.0+/-1.7 microg/l (single placebo i.v.) to 7.5+/-1.6 microg/l (single doxepin i.v.) or 7.6+/-2.0 microg/l (subchronic doxepin p.o.). The duration of the quiescent period of the cortisol rhythm was significantly prolonged following both doxepin administrations compared with placebo.

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In vitro gastric decontamination experiments for antidepressant amitriptyline, clomipramine, and doxepin showed that SPS has higher qmax values than the corresponding experiments with AC. Therefore, we suggest SPS is a better gastric decontaminating agent for the management of acute TCA intoxication.

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There was one trial each of moclobemide, sertraline and venlafaxine, two of fluoxetine and nortriptyline, and five trials of bupropion, one of which tested long term use to prevent relapse. Nortriptyline and bupropion both increased cessation. In one trial the combination of bupropion and nicotine patch produced higher quit rates than patch alone.

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A double-blind parallel-group comparison study of moclobemide versus doxepin in 237 patients with major depression confirmed that moclobemide was equal in efficacy and better tolerated than doxepin. It was less sedating and caused fewer anticholinergic adverse events as measured by the UKU side-effect rating scale. Unexpectedly, moclobemide therapy more often than doxepin resulted in increased sexual desire. An exploratory analysis of UKU-measured symptoms of impaired sexual function prior to commencement of the study revealed that moclobemide more often than doxepin led to an improvement of reduced libido and impaired erection, ejaculation and orgasm. This finding is compatible with the assumption that there is a greater likelihood that the anticholinergic reuptake inhibitor doxepin has a higher risk of impairing sexual function than the non-anticholinergic RIMA moclobemide. A single case report of moclobemide-induced sexual hyperarousal supports the alternative assumption that moclobemide has a specific sexually stimulative effect in depression.

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A randomized evaluation of fluoxetine and doxepin measured a 50% change in the Hamilton Depression Rating Scale (HDRS) score as a response to therapy and was correlated with measures of standard deviation of the mean of all 5-minute segments of normal electrocardiographic R-R intervals (SDANN), standard deviation of all normal R-R intervals (SDNN), root mean square of successive differences in R-R intervals (r-MSSD), and percentage difference between adjacent normal R-R intervals that are greater than 50 msec (pNN50) from 24-hour electrocardiogram (ECG) tapes.

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With the introduction of an antidepressant drug monitoring service in this hospital, it became necessary to have a completed request form prior to analysis. The importance of ordering these tests selectively and of basic pharmacokinetics for antidepressants was stressed through special lectures and a newsletter. This study was undertaken to assess whether the use of this form assisted in optimizing drug monitoring of antidepressants. Information provided on the form was used to assist in interpretative reporting and to improve clinical use of the results. Requested information included the name, age, sex, height, and weight of the patient; time of last dose; date therapy started at present dose; reason for the request; and a list of concurrent medications. Results obtained for 600 specimens in 18 months showed that the form was completed fully, sampling time was appropriate, and drug concentration was at steady state 82, 73, and 95% of the time, respectively. Major reasons for requesting analysis were suspicion of subtherapeutic (52%), uncertain (20%), above therapeutic (15%), and toxic (10%) ranges. The most popular monitoring requests were for imipramine (40%), doxepin (28%), amitriptyline (14%), and desipramine (11%). Clinical impression of efficacy in the treatment of endogenous depression agreed with plasma levels 60% of the time in the subtherapeutic range, but agreement was only 32% above the therapeutic range. It was concluded that a special request form helps to assure appropriate sampling, explain observed drug interactions, and facilitate interpretative reporting for the medical and nursing staff.

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Three patients taking conjugated estrogens developed akathisia induced by tricyclic antidepressants. The interaction between tricyclic antidepressants and conjugated estrogens could play a role in the development of akathisia.

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Olanzapine and quetiapine have high H1RO values in the human brain under their clinical minimum doses. This study provides a foundation of the properties by which new-generation antipsychotics block the central histaminergic system in humans.

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Tricyclic antidepressants (TCAs) are found to have an analgesic action for relieving cutaneous pain associated with neuropathies. The aim of this study was to assess cutaneous absorption and analgesia of topically applied TCAs. Percutaneous delivery was investigated using nude mouse and pig skin models at both infinite and saturated doses. We evaluated the cutaneous analgesia in nude mice using the pinprick scores. Among five antidepressants tested in the in vitro experiment, mesoridazine, promazine and doxepin showed a superior total absorption percentage. The drug with the lowest total absorption percentage was found to be fluphenazine (<7%) either at an infinite dose or at saturated solubility. The follicular pathway was important for mesoridazine and promazine delivery. Mesoridazine showed stronger skin analgesia than the other TCAs although the in vivo skin absorption of mesoridazine (0.34nmol/mg) was less than that of promazine (0.80nmol/mg) and doxepin (0.74nmol/mg). Mesoridazine had a prolonged duration of pain relief (165min) compared to promazine (83min) and doxepin (17min). The skin irritation test demonstrated an evident barrier function deterioration and cutaneous erythema by promazine and doxepin treatment, whereas mesoridazine caused no obvious adverse effect by topical application for up to 7days.

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Both drugs were equally effective in relieving symptoms of depression and anxiety. The cardiovascular effects of both drugs were minimal. Trimipramine did lower blood pressure but this was without clinical significance. Three trimipramine patients and five doxepin patients developed occasional premature ventricular or atrial contractions. Of these, two trimipramine patients and one doxepin patient were among those with abnormal ECG's at entry. The doxepin patient was withdrawn from the study after 21 days of treatment when the PVC's became increasingly frequent.

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A 66-year-old woman had tinnitus while receiving a conventional dose of doxepin. The tinnitus disappeared when the doxepin was discontinued, and returned when the patient was rechallenged with the drug.

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The simultaneous analysis of tricyclic antidepressant (amitriptyline, clomipramine, doxepin and nortriptyline) and β-blocker (alprenolol, labetalol and propranolol) drugs in wastewater was developed via sweeping-micellar electrokinetic chromatography (MEKC) together with a simple liquid-liquid extraction step. For sweeping-MEKC, the amount of organic modifier in the separation electrolyte, the concentration of phosphoric acid in the sample matrix and the injection time of the sample were optimized. Sensitivity enhancements of up to 305-fold were achieved via sweeping. This allowed limits of detection (LOD) from 7 to 27 ng/mL. The relative standard deviations of migration time, corrected peak area and peak height were less than 3.2%, 7.8% and 4.5%, respectively. Liquid-liquid extraction using dichloromethane as solvent afforded up to 21-fold enrichment of the drugs from spiked wastewater. No interference of the sample matrix was observed and recoveries were obtained in the range of 77-113% for all analytes except labetalol at three spiking levels of 16, 80 and 160 ng/mL. Detection at the ng/mL level makes this simple, environmentally friendly and cost effective method competitive against recently reported methods using advanced liquid-phase separation techniques for monitoring similar drugs in wastewater.

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Topical doxepin is effective in reducing pruritus in patients with atopic dermatitis. It has an apparent short-term low risk of major side effects or sensitization.

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The present meta-analysis suggests that antidepressants are efficacious in late-life MDD, but significant study heterogeneity suggests that other factors may contribute to these findings. A secondary analysis raises the possibility that efficacy of these agents may be reduced in trials involving patients aged 65 years or older. Why antidepressants may be less efficacious in elderly versus younger subjects remains unclear.

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DXP 1 mg and 3 mg administered nightly to elderly chronic insomnia patients for 12 weeks resulted in significant and sustained improvements in most endpoints. These improvements were not accompanied by evidence of next-day residual sedation or other significant adverse effects. DXP also demonstrated improvements in both patient- and physician-based ratings of global insomnia outcome. The efficacy of DXP at the doses used in this study is noteworthy with respect to sleep maintenance and early morning awakenings given that these are the primary sleep complaints of the elderly. This study, the longest placebo-controlled, double-blind, polysomnographic trial of nightly pharmacotherapy for insomnia in the elderly, provides the best evidence to date of the sustained efficacy and safety of an insomnia medication in older adults.

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The affinity constant for doxepin obtained from inhibition of histamine-induced contraction of guinea-pig intestinal smooth muscle at 30 degrees C was 2.6 +/- 0.18 X 10(10)M-1. The slope of a Schild plot was not significantly different from unity. The affinity constant of doxepin did not vary markedly with temperature. At 37 degrees C it was 3.75 +/- 0.02 X 10(10)M-1 and at 25 degrees C 2.1 X 10(10)M-1. Doxepin was a competitive inhibitor of [3H]-mepyramine binding to guinea-pig cerebellar homogenates. The affinity constant derived for doxepin at 30 degrees C was 1.12 +/- 0.45 X 10(10)M-1. Hill coefficients for curves of doxepin or mepyramine inhibition of [3H]-mepyramine binding in guinea-pig cerebellum, cerebral cortex and hippocampus did not differ significantly from unity. The mean affinity of mepyramine for histamine H1-receptors in rat brain homogenates at 30 degrees C was 3.5 X 10(8)M-1. Hill coefficients for curves of doxepin or mepyramine inhibition of [3H]-mepyramine binding to homogenates of rat cerebral cortex or rat whole brain were near unity. These studies provide no evidence that doxepin binds preferentially to a sub-class of histamine H1-receptors in rat brain.

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The knowledge of cross-reactivity among aromatic anticonvulsant agents mainly emerged from clinical experience and observations because diagnostic challenge tests are not advisable. Thirty-six patients with the diagnosis of AHS were instructed to contact our unit if the symptoms relapsed.

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The effects of doxepin hydrochloride (Adapin) on sleep and depression were evaluated in nine depressed patients with documented sleep difficulties. All subjects were screened for depression on the Hamilton Psychiatric Rating Scale. Sleep disturbance was measured by all-night polysomnography. Doxepin in doses of 75 and 150 mg/day significantly improved sleep efficiency, as evidenced by decreased sleep latency and increased total sleep time. After 2 weeks of treatment, REM latency and percent REM time were dramatically changed. Maximal improvement in depression occurred after 2 weeks of doxepin therapy and at the 150 mg dose.

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The therapeutic efficacy, plasma levels, and psychomotor effects of tryptophan (L-tryptophan), clomipramine hydrochloride, and doxepin were investigate in "neurotically" depressed outpatients. The tricyclic antidepressants were significantly more efficacious than tryptophan in inducing remission. The alleviation of depression was preceded by an improvement of the initially slow information-processing rates in the depressed patients. The plasma levels of the tricyclics that were associated with a therapeutic response were significantly lower than those reported in "endogenously" depressed inpatients.

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The effects of tricyclic antidepressants; imipramine and doxepin, and of new antidepressants; mianserin, danitracen, trazodone, viloxazine and zimelidine, on seizures kindled from the rabbit amygdala were examined. Behavioral and bioelectrical seizures were kindled by a repeated daily stimulation of unilateral amygdala with a low intensity electric current (120 microamperemeter, 1 msec, 50Hz). The following parameters of kindled seizures were analyzed: 1-intensity of behavioral seizures according to a 6-point scale, 2-duration of behavioral seizures, 3-duration of bioelectrical (EEG) seizure activity. Only imipramine inhibited all parameters of kindled seizures. Doxepin, mianserin, danitracen and trazodone affected only two parameters. Zimelidine did not induce any changes of kindled seizure, and viloxazine prolonged duration of the bioelectrical seizure activity. It is likely that inhibition of seizures kindled from the rabbit amygdala is due to noradrenaline stimulating or serotonin inhibiting properties of the drugs, but independent of the antidepressive activity.

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The theromdynamic pKa values for doxepin and its metabolite desmethyldoxepin were determined by the solubility method to be 8.96 and 9.75, respectively at 25 degrees. The intrinsic solubilities for doxepin and desmethyldoxepin were linearly dependent upon ionic strength. The intrinsic solubilities at zero ionic strength and 25 degrees were determined to be 1,13 x 10(-4) M for doxepin and 3.95 x 10(-4) M for desmethyldoxepin. The solubility experiment was repeated at different temperatures and a constant ionic strength of 0.167 M. The change in enthalpy (6.71 kcal/mole) and entropy (-4.16 cal/mole degrees K) of solution for doxepin was determined from a van't Hoff plot for this nonideal system. The apparent partition coefficient between hexane and water for the doxepin free base was determined to be 13,615 at an ionic strength of 0.067 M.

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We identified 314 members of a health maintenance organization (HMO) who were diagnosed with epithelial ovarian cancer between 1981 and 1997, were aged 35-79 years at diagnosis, and had at least 4 years of HMO membership. Up to four controls were selected for each case (n = 790), matched on age, calendar year, and length of HMO membership. Information concerning past medication use was obtained from the computerized pharmacy database, established in 1977.

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DAR antagonists represent a putative new insecticide class with activity against C. quinquefasciatus and Ae. aegypti, the two most important mosquito vectors of NTDs. There has been limited change in the sequence and pharmacological properties of the DOP2 DARs of these species since divergence of the tribes Culicini and Aedini. We identified antagonists selective for mosquito versus human DARs and observed a correlation between DAR pharmacology and the in vivo larval toxicity of antagonists. These data demonstrate that sequence similarity can be predictive of target potential. On this basis, we propose expanded insecticide discovery around orthologous DOP2 targets from additional dipteran vectors.

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Mirtazapine is a novel antidepressant with a unique mode of action, which can be best summarized as a noradrenaline and specific serotonin antidepressant. Its unique mode of action, involving both the noradrenergic and serotonergic neurotransmitter systems, results in strong clinical efficacy. A comprehensive clinical trial programme in Europe and the United States has demonstrated that mirtazapine has clear clinical benefits in a broad range of patients treated across different therapeutic settings. The individual placebo-controlled trials and a meta-analysis on pooled efficacy data from all available placebo-controlled studies have shown that mirtazapine has sustained antidepressant efficacy, as assessed by changes from baseline in group mean scores on the Hamilton Rating Scale for Depression (HAMD) and in the depressed mood item, from week 1 throughout the whole study period. Corroborative evidence on the clinical efficacy of mirtazapine has been obtained in comparative studies with antidepressant drugs of well established efficacy, such as amitriptyline, clomipramine, doxepin and trazodone. As with the placebo-controlled studies, a meta-analysis was performed on data from all the randomized, double-blind, comparative studies of mirtazapine and amitriptyline. Data from 732 patients were available (364 patients taking mirtazapine and 368 taking amitriptyline) for efficacy analysis. Equivalent improvements in total 17-item HAMD scores from baseline were observed in both treatment groups at all scheduled assessments and at the end of the study period, and similarly high percentages of patients responded to treatment with either mirtazapine (70%) or amitriptyline (73%). The efficacy of mirtazapine was also assessed in the treatment of moderately (baseline 17-item HAMD score 18-24) or severely depressed patients (baseline 17-item HAMD score > or = 25). A meta-analysis was performed on the pooled data from the moderately or severely depressed patients in the comparative studies of mirtazapine and placebo or mirtazapine and amitriptyline. Statistically and clinically significant improvements from baseline were seen in both moderately and severely depressed patients treated with mirtazapine compared with placebo, while an equivalent extent of improvement was present with mirtazapine and amitriptyline. A similar pattern was observed in the improvement of depressed mood (HAMD item 1) and other clinically important symptoms of depression: mirtazapine was significantly more efficacious than placebo, and of equivalent efficacy to amitriptyline. Therefore, it can be concluded that the new antidepressant mirtazapine offers distinct therapeutic benefits for a variety of depressed patients in either in- or outpatient settings.

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To establish the efficacy of a multidrug oral treatment with the tricyclic antidepressant agent doxepin and the cyclooxygenase (COX) inhibitor piroxicam in patients with interstitial cystitis (IC), who had failed standard therapy in an open, prospective, nonrandomized study.

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To report a serious drug interaction possibly occurring with the monoamine oxidase inhibitor phenelzine and the selective serotonin reuptake inhibitor sertraline.

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The capillary isotachophoresis (cITP) separation of the isomers of the tricyclic antidepressant doxepin using β-cyclodextrin (β-CD) as a buffer additive is investigated by online microcoil NMR detection. Capillary electrophoresis (CE) is also used to determine the binding constant between the doxepin E and Z geometric isomers and β-CD. Although the doxepin isomers could be easily baseline resolved by CE, their separation by cITP was more challenging due in part to the high concentration of doxepin after cITP-focusing. The use of online (1)H NMR detection allows observation of changes in doxepin dynamics due to formation of the β-CD inclusion complex, changes in the fraction complexed and the intracapillary pH. It also provides novel experimental evidence that a weak complex between β-CD and acetate contributes to its active transport from the leading electrolyte through the sample band to the trailing electrolyte in this cationic cITP separation. The results of these cITP-NMR experiments provide new mechanistic details about the interactions of the buffer counterion acetate with various components of the separation system and have important implications for other analyses based on formation of cyclodextrin inclusion complexes.

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In adults with primary insomnia, doxepin 1 mg, 3 mg, and 6 mg was well-tolerated and produced improvement in objective and subjective sleep maintenance and duration endpoints that persisted into the final hour of the night. The side-effect profile was comparable to placebo, with no reported anticholinergic effects, no memory impairment, and no significant hangover/next-day residual effects. These data demonstrate that doxepin 1 mg, 3 mg, and 6 mg is efficacious in improving the sleep of patients with chronic primary insomnia.

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A new type of dispersive liquid-liquid microextraction is used for the determination of doxepin, citalopram, and fluvoxamine in aqueous matrices. This method is based upon the tandem utilization of dispersive liquid-liquid microextraction, and by providing a high sample clean-up, it efficiently improves the applicability of the method in complicated matrices. For this purpose, in the first step, the analytes contained in an aqueous sample solution (8.0 mL) were extracted into an organic solvent, and then these analytes were simply back-extracted into an aqueous acceptor phase (50 μL). The overall extraction time was 7 min, and very simple tools were required for this aim. Optimization of the variables affecting the method such as the type and volume of the organic solvent used and effect of ionic strength was carried out to achieve the best extraction efficiency. Under the optimized experimental conditions, tandem dispersive liquid-liquid microextraction with high-performance liquid chromatography and UV detection showed a good linearity in the range of 10-5000 ng/mL. The limits of detection were in the range of 3-10 ng/mL. The Intra-day precisions (relative standard deviation) were 9.2, 4.5, and 4.8, and the recoveries were 58.5, 52.9, and 39.3% for citalopram, doxepin, and fluvoxamine, respectively.

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Male rats were divided randomly into three groups: Control, doxepin 1 mg/kg, and doxepin 5 mg/kg. Rats received an i.p injection of doxepin for 21 days. Then the hippocampi were dissected for the measurement of the expression of BDNF, TNF-α, MAPK14, and AKT1 genes.

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The common use of potentially inappropriate drugs should serve as a reminder to monitor their use closely. Pharmaceutical claims databases can be important tools for accomplishing this task, though clinical and laboratory data are needed to improve the sensitivity and specificity of patient-specific alerts.

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Helping oncologists to identify and treat depression is an important step in improving the overall care of people with cancer. In previous work performed in our community-based, ambulatory oncology outreach network, we validated a depression screening tool, put into place depression screening programs, and taught oncologists how to follow up on screening with brief, reliable clinical interviews. Subsequently, we provided these oncologists with a fluoxetine-based antidepressant algorithm to follow for the treatment of their depressed patients. In this article, we report on the initial experience identifying and treating 35 ambulatory oncology patients who were screened with the Zung Self-rating Depression Scale (ZSDS). Structured follow-up interviews by their oncologist determined whether the patients qualified for a diagnosis of a major depressive episode. These patients then received 1 of 4 treatments based on the algorithm (no treatment, fluoxetine alone, fluoxetine plus bedtime doxepin, or fluoxetine plus methylphenidate). Patients were matched by their oncologist to a prototype patient for each treatment arm based on their symptomatic presentation (i.e., patients requiring a side effect minimization approach were to be placed on fluoxetine alone; patients who had significant insomnia, weight loss, or neuropathic pain were placed on the fluoxetine plus doxepin regimen; those with prominent fatigue were to receive fluoxetine plus methylphenidate). Patients were followed weekly for one month, and then every two weeks for two more months, with telephone assessments of their depression, associated symptoms and overall quality of life. Results suggested that oncologists most often chose the simplest regimen (fluoxetine alone) but that patients uniformly benefited in terms of improved mood and overall quality of life throughout the 12 weeks of follow-up. Our initial experience suggests that oncologists can be empowered to recognize and treat depression in their patients with a screen-and-intervene approach. Such an approach may benefit patients, and, if kept simple, can be incorporated into day-to-day care of people with cancer.

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A sensitive method suitable for the determination of tricyclic and other antidepressants in postmortem and clinical specimens is presented. The procedure, which utilizes reversed-phase HPLC combined with dual ultraviolet wavelength detection, enables the separation of 17 commonly prescribed antidepressants and some selected metabolites in a single extraction. Peak purity was confirmed using absorbance ratios at 220 nm and 254 nm wavelengths and revealed little interference from other eluting analytes. The blood detection limit for most antidepressants was 50 ng/ml. The most commonly observed antidepressants in 281 forensic cases analysed over a two-year period with the described method were dothiepin, amitriptyline, nortriptyline and doxepin.

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sinequan 25 mg 2016-02-16

Complete resolution of pruritus was reported in 14 patients (58.3%) with doxepin and 2 (8.3%) with placebo ( buy sinequan online P < .001). Relative improvement was observed in 7 (29.2%) and 4 (16.7%), respectively. Overall, the improving effect of doxepin on pruritus was seen in 87.5% of the patients. Twelve patients (50.0%) complained of drowsiness that alleviated in all cases after 2 days in average. One patient refused to continue the treatment due to its sedative effect.

sinequan generic name 2017-11-10

Doxepin and desipramine at final doses of 188 and 173 mg/day, respectively, were compared in 36 volunteers with major affective or dysthymic disorder and chronic back pain. Both drugs produced significant decreases in depression, with an overall response buy sinequan online rate of 70%; no significant difference was seen between groups. Pain ratings also decreased significantly in both groups (overall response rate = 50%); pain severity showed a better response to doxepin than to desipramine. While baseline pain, depression, and anxiety were correlated, treatment changes in these measures did not correlate. CSF beta-endorphin levels did not change with treatment. The usefulness of an antidepressant with anxiolytic properties, such as doxepin, is discussed.

sinequan drug test 2016-10-04

We extracted data in duplicate on the type of study population, the nature of the pharmacotherapy, the outcome measures, method of randomization, and completeness of follow up. The main outcome measure was abstinence from smoking after at least six months follow up in patients smoking at baseline, expressed as an odds ratio (OR). We used the most rigorous definition of abstinence available in buy sinequan online each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed-effect model.

sinequan 6 mg 2016-05-07

To provide an effective continuum of the relief of severe carcinomatous pain buy sinequan online with minimal side reactions, we initiated treatment with piroxicam (60 to 120 mg per day) and doxepin hydrochloride (25 to 225 mg per day). Of 30 patients presenting with severe pain of cancer of various origins, 7 continued to death with piroxicam and doxepin therapy. An additional 17 were successfully treated for 6 to 66 weeks with therapy reported here but, as disease progressed, required supplemental narcotics. The remaining six abandoned the use of piroxicam due to complications of therapy, which ranged from diarrhea to gastric perforation; serious complications were associated with patients' failure to adhere to a prescribed regimen of sucralfate. Therapy with piroxicam and doxepin proved to be safe and efficacious.

buy sinequan online 2016-01-15

Non-viral gene transfer efficiency can be increased significantly using new buy sinequan online transfection enhancers that are identified by a novel, semi-automated two-stage screening system employing yeast cells in the first and specific human target cells in the second round.

sinequan lethal dose 2015-06-09

Cases of profound hypoglycemia after the initiation of tricyclic antidepressant therapy in two patients taking sulfonylureas are described. To the authors' knowledge, this is the first report of a potential drug buy sinequan online interaction between tricyclic antidepressants and sulfonylureas.

cost of sinequan 2016-03-29

A buy sinequan online systematic literature search generated 37 randomised controlled trials of TCAs and SSRIs of which 11 were entered into a meta analysis comparing withdrawal rates and side effect profiles.

sinequan drug interactions 2017-06-24

Forty consecutively hospitalized patients who had overdosed primarily with a tricyclic antidepressant (TCA) were observed until discharge. The severity of the overdose was documented by serial measurements of plasma TCA levels. Nineteen of the patients became comatose, 16 required supportive respiration, and 2 died. Individual symptoms in the 13 patients having plasma TCA levels greater than 1,000 ng/ml are shown. Plasma TCA measurements more reliably define patients who are at risk for major medical complications following overdose than does the amount of drug buy sinequan online ingested by history. In the absence of plasma measurements, a QRS duration of 100 msec or more on a routine ECG within the first 24 hours defined all patients with major TCA overdoses.

sinequan drug 2015-04-01

In a double-blind study, 49 elderly patients with primary major depression, with or without cardiovascular disease, were treated with maprotiline or doxepin. Holter monitors, 12-lead ECGs, and orthostatic blood pressure measurements were used. Maprotiline was associated with decreased PVCs in patients with a "high" baseline rate, while doxepin was associated with increased PVCs in this group. There were no significant differences in orthostatic blood pressure changes between treatment and nontreatment phases or between the two drugs. Small but significant increases in heart rate and prolonged PR interval were noted with both drugs. QRS interval was prolonged by maprotiline but decreased by doxepin. Neither drug produced untoward effects in patients with stable angina or an old myocardial infarction. Maprotiline may have an antiarrhythmic effect which could be beneficial in the treatment of depression with concomitant PVCs. Conversely, doxepin may be more appropriate for depressed patients with buy sinequan online heart block or intracardiac conduction delays. Further research is necessary to confirm these suggestions.

sinequan dose 2015-11-12

Antidepressants belong to a variety of chemical and pharmacologic classes. Most require therapeutic drug monitoring, at least in certain circumstances, such as unexplained inefficacy or suspected toxicity. Several types of chromatographic methods have generally been used. This paper presents a fully automated, sensitive, and specific method for the therapeutic drug monitoring of 13 buy sinequan online antidepressants of all classes (amoxapine, amitriptyline, citalopram, clomipramine, dothiepin, doxepin, fluoxetine, imipramine, maprotiline, mianserin, paroxetine, sertraline, trimipramine) and some of their respective active metabolites (nortriptyline, monodesmethylcitalopram, desmethylclomipramine, desipramine, norfluoxetine, desmethylmianserin, N-desmethylsertraline), based on the innovative turbulent-flow liquid chromatography (TFC) technology, coupled to tandem-mass spectrometry (MS/MS). The antidepressants were divided in two groups depending on their chromatographic properties, so that two injections would be necessary to screen all compounds (which is infrequent for therapeutic drug monitoring). Calibration curves ranged from 10 to 500 ng/mL. No significant memory effect was observed after the injection of a blank serum sample spiked at 500 ng/mL. The intra-assay and inter-assay precision CVs ranged from 0.4% to 12% and from 1% to 16%, respectively. The method was further validated by blindly analyzing Heathcontrol-Therapeutic Drugs Scheme samples (Cardiff Bioanalytical Services Ltd.) containing several antidepressants.

sinequan 60 mg 2017-03-23

In all, 155 patients were randomly allocated to a doxepin oral rinse or a placebo for the treatment of radiotherapy-related OM pain. Patients received a single dose of doxepin or placebo on day 1 and then crossed over to receive the opposite agent on a subsequent day. Pain questionnaires were administered at baseline and at 5, 15, 30, 60, 120, and 240 minutes. Patients were then given the option to continue doxepin. The primary end point was pain reduction as measured by the area under the curve (AUC) of the pain scale buy sinequan online using data from day 1.

sinequan pill identifier 2017-11-21

We studied central mechanisms of antidepressants that affect feeding behavior in rats. The tricyclic compounds amitriptyline, doxepin and imipramine significantly induced feeding after their infusion into the third cerebral ventricle in the light phase, but the tricyclic, desipramine, and the dicyclic zimelidine, did not. Drinking was not affected by any compound tested. The relative order of potency in eliciting feeding was: amitriptyline and doxepin greater than imipramine greater than desipramine and zimelidine. To clarify the involvement of neuronal histamine in antidepressant- buy sinequan online induced feeding, alpha-fluoromethylhistidine (FMH), a "suicide" inhibitor of histidine decarboxylase, was intraperitoneally administered before infusion of amitriptyline. FMH attenuated the amitriptyline's effect. Bilateral microinfusion of amitriptyline into the ventromedial hypothalamus or the paraventricular nucleus verfied that these are loci for the modulation of feeding by amitriptyline. In the lateral hypothalamus, amitriptyline was less effective. These findings indicate that tricyclic antidepressants directly facilitate feeding, which is, at least in part, mediated by histamine in the hypothalamus.

sinequan sleeping pill 2017-07-31

Functional gastrointestinal disorders are common, accounting for up to 50% of gastroenterology referrals, and several randomized buy sinequan online controlled trials have evaluated antidepressant therapy for their treatment.

sinequan medication uses 2016-04-05

This study assessed the effectiveness of oral doxepin rinse for mucositis-related pain management in patients following 1 week of repeated dosing. Patients with oral mucositis due to head and neck radiation therapy or hematopoietic stem cell transplant (HSCT) were recruited to participate in a 1-week follow-up study. Subjects who gave informed consent rinsed with doxepin (5 ml) during the initial visit and were then told to use doxepin rinse over the next week as needed, three to six times per day, and return for a buy sinequan online follow-up visit. At each visit, mucositis was scored using the Oral Mucositis Assessment Scale and oral pain was assessed using a visual analogue scale before and after rinsing. The use of a systemic analgesic was recorded, and side effects were documented. At the follow-up visit, subjects were also asked to retrospectively report average pain scores they experienced over the past week, 5 and 15 minutes following rinse. Nine subjects were enrolled in the study. Statistically significant reductions in pain scores were reported for 2 hours following doxepin rinse during the initial visit (p < .05). Patients recalled that their pain significantly dropped within 5 minutes of rinsing over the week of repeated dosing (p < .05). At the follow-up visit, subjects reported statistically significant pain reduction 5 minutes after doxepin rinsing (p < .05). These results indicate that doxepin rinsing continues to produce reduced intensity of pain levels over a 1-week span of repeated dosing.

sinequan 75 mg 2016-12-07

Stress is one of the effective factors in the development of depressive disorders that performs some parts of its effects by affecting hippocampus. Since doxepin has been shown to have neuroprotective effects, in this study, we focused on the effects of doxepin on the expression of involved genes in neuronal survival and plasticity in the rat hippocampus following chronic stress. Male Wistar rats were divided into four groups, the control, the stress, the stress-doxepin 1 mg/kg and the stress-doxepin 5 mg/kg, respectively. To induce stress, the rats were placed within adjustable restraint chambers for 6 h/day, for 21 days. Before daily induction of the stress, rats received an i.p. injection of doxepin. At the end of experiments, expression of Bax, Bad, Bcl-2, tumor necrosis factor alpha (TNF-α), mitogen-activated protein kinase 14 (MAPK14) and serine-threonine protein kinase AKT1 genes were detected by reverse transcription polymerase chain reaction (RT-PCR) in the hippocampus. Results showed significant enhancements in expression of Bax, Bad and Bcl-2 genes in the stressed rats, whereas expression of TNF-α, MAPK14, and AKT1 genes didn't show significant differences. Doxepin could decrease the expression Lexapro Alcohol of Bax and Bad genes in the stress group, but had no significant effects on the expression of other genes. The present findings indicated that doxepin can probably change the pattern of gene expression in the hippocampus to maintain neurons against destructive effects of stress.

sinequan 100 mg 2016-01-13

More than half the formulations (55.0%) contained at least 1 member of the 10 allergen families assessed. Most brompheniramine and doxepin preparations included potentially allergenic excipients, whereas fexofenadine was most often free of them. Sorbitan group members, azo dyes, and propylene glycol were the allergens found most frequently in the antihistamines, each present Zantac 450 Mg in over 25% of the products. Elixirs, liquids, solutions, suspensions, and syrups were more likely than nonchewable caplets, capsules, and tablets to contain the allergens tabulated (100% vs 39.3%, respectively). Chewable pills frequently contained azo dyes.

sinequan overdose 2016-11-11

Both drugs were equally effective in relieving symptoms of depression and anxiety. The cardiovascular effects of both drugs were minimal. Trimipramine did lower blood pressure but this was without clinical significance. Three trimipramine patients and five doxepin patients developed occasional premature ventricular or atrial contractions. Of these, two trimipramine patients and one doxepin patient were among those with abnormal ECG's at entry. The doxepin patient was withdrawn from Plavix 225 Mg the study after 21 days of treatment when the PVC's became increasingly frequent.

sinequan 10 mg 2015-06-07

There are at least three reasons to believe antidepressants might help in smoking cessation. Firstly, nicotine withdrawal may produce depressive symptoms or precipitate a major depressive episode and antidepressants may relieve these. Secondly, nicotine may have antidepressant effects that maintain smoking, and antidepressants may substitute for this effect Lasix Pill . Finally, some antidepressants may have a specific effect on neural pathways (e.g. inhibiting monoamine oxidase) or receptors (e.g. blockade of nicotinic-cholinergic receptors) underlying nicotine addiction.

sinequan dosage 2015-12-05

A simplified and reliable fully automated production of (11) C-doxepin for clinical use was developed, allowing the synthesis of the tracer with high yield using a cGMP-compliant module and procedure. The success of this approach could make Aldactone Dosage Bodybuilding the PET tracer (11) C-doxepin more accessible for clinical studies.

sinequan max dose 2017-06-18

Two concurrent studies of geriatric outpatients who received diagnoses of depression were conducted. In the first, patients were treated with one of two tricyclic antidepressants or with a placebo. In the second, patients were assigned to groups receiving either psychodynamic group therapy or cognitive-behavioral group therapy. Patients in the placebo group showed the least improvement; most patients receiving group psychotherapy showed some improvement, but only 12% had full remissions; by contrast, 45% of patients receiving imipramine or doxepin had full remissions, while 36% of them experienced little or no benefit. An Medication Zofran Classification early response to tricyclic antidepressant drugs was a reliable predictor of continued improvement.

sinequan and alcohol 2015-06-24

Atopic eczema (AE) is a chronic inflammatory skin disease with strong itching as the prominent symptom. The pathology of itch is still in discussion, but acetylcholine (ACH) seems to be a relevant pruritogenic mediator in AE. Since efficient benefit on pruritus and excoriations has been demonstrated with tricyclic agents, we investigated how the topical treatment with doxepin (5%, Boehringer Standard, Mannheim, Germany), a tricyclic compound with anticholinergic properties, may influence ACH induced itch and cutaneous sensations (erythema, wheal, axonreflex flare).

sinequan 150 mg 2016-06-27

Patients placed on indomethacin obtained relief more consistently and more completely. Patients on pentoxifylline had the fewest side effects of all oral therapies. Patients on antihistamines with or without doxepin had the highest incidence of side effects, although more of these patients reported a greater degree of relief than patients on pentoxifylline. All patients on oral therapy overall had greater relief than patients using topical steroids.

sinequan generic 2017-03-25

The chromatographic behavior of six calix[n]arene phases (n=4, 6, 8) and one calix[4]resorcinarene phase is described for the separation of cis- and trans-isomers of three thioxanthene (flupentixol, clopenthixol, chlorprothixene) and one benz[b,e]oxepin derivative (doxepin). The influences of two different organic modifiers (MeOH, MeCN) for the separation of the isomers on every column are described. Different selectivities of the stationary phases exist as a function of the ring size of the calixarenes and their substitution at the "upper rim" with p-tert.-butyl groups. Furthermore, the influence of free phenol groups on the resorcinarene phase is discussed. Relations between structural elements of the analytes and the retention behavior on the stationary phases are found. The selectivity of the calixarene and resorcinarene stationary phases is compared with a RP-C18 phase containing the same base silica. Advantages of the resorcinarene as well as of the calixarene columns exist for the separation of cis- and trans-isomers of three compounds dependent from the substitution in position 2 of the thioxanthenes, respectively the kind of the basic side chain of all substances.

sinequan reviews 2017-08-24

In summary, the results suggest that when amitriptyline (but not doxepin or venlafaxine) is locally co-administered with morphine the effectiveness under neuropathic pain is enhanced, although additional studies are necessary to explain differential mechanisms of interaction of antidepressant drugs with morphine after local administration.

sinequan 50 mg 2016-12-26

Several new chemical entities with improved efficacy in allergic disease have been pursued. Addition of multiple antagonist activities in single compounds has been the focus of current research. Involvement of the H(1) receptor in sleep has led to the evaluation of new compounds as sedative hypnotics.

sinequan mg 2017-11-25

A neural-network analysis has been applied to predict adverse or side effects of drugs using a database of antidepressant agents with known effects as well as input from a database with both patient parameters and drug information. A NeuralWork software package was implemented on a Macintosh Quadra 700 and trained on a database of ten drugs with known adverse effects. Another agent (not in the database) was used to test the ability of the network to predict the relative incidence of its side effects. Despite the small number of drugs used for training, the adverse effects of some drugs, such as doxepin, were predicted with 90-100% accuracy. These results indicate that neural-network analysis can be used to predict adverse drug effects for drugs within a given class and ultimately can be extended to include patient parameters to predict the mechanisms of action of drugs from relatively large databases.

sinequan 200 mg 2015-09-17

Twenty-four subjects with atopic dermatitis received either doxepin or doxepin/TAC cream 4 times daily for 7 days in a randomized, double-blind, controlled trial. Serum samples were obtained and pharmacokinetic parameters estimated from the dose-normalized serum concentrations of doxepin and desmethyldoxepin. Efficacy and adverse experiences were determined by physician and subject evaluations.

sinequan drug class 2017-06-08

In this model of transient insomnia, DXP 6mg demonstrated significant improvements in sleep onset, sleep maintenance, sleep duration and sleep quality, and also appeared to reduce early morning awakenings. These data suggest that DXP 6mg may be effective and well tolerated in adults experiencing transient insomnia.

sinequan pill 2015-04-13

Cenesthesia is portrayed as a rare differential diagnosis to persistent idiopathic facial pain, including the resulting therapy with antipsychotics. In this case report a female patient developed persistent facial pain 2 years after manifestation of a depressive disorder. The symptoms appeared as a bizarre pain phenomenon closely resembling the psychotic phenomenon of cenesthesia (body hallucinations). Treatment with imipramine and doxepin or a combination of venlafaxin, carbamazepine, and tilidine N had not been successful. Based on diagnostic classification of the complaint as cenesthesia in the context of a depressive disorder, add-on therapy of the atypical antipsychotic ziprasidone was administered. This led to clear improvements in mood and pain symptoms after 4 weeks of treatment.

sinequan capsules 2016-10-07

Doxepin, a tricyclic antidepressant, was recently found to be effective in the treatment of various acute and chronic painful conditions. However, the mechanism of its actions was not clear, especially when involving the spine. The aim of our study was to evaluate the spinal anesthetic effect of doxepin. Two commonly used traditional local anesthetics, bupivacaine and lidocaine, were used as controls. The potencies and durations of the drugs' action were evaluated in male Sprague-Dawley rats. We found that intrathecally administered doxepin, like bupivacaine and lidocaine, produced dose-related spinal anesthetic effects on motor activity, proprioception, and nociception. Among the three drugs, doxepin produced spinal anesthetic effects in rats more potent than that of lidocaine (p < 0.001, in each comparison) and longer than that of bupivacaine and lidocaine (p < 0.001, in each comparison). The spinal activity of doxepin may provide some explanation of its clinical effect in pain management.

sinequan tablets 2016-07-23

In this work, a novel polythiophene/graphene oxide (PTh/GO) nanostructured coating was introduced for on-line electrochemically-controlled in-tube solid phase microextraction of amitriptyline (AMI) and doxepin (DOX) as antidepressant drugs. The PTh/GO coating was prepared on the inner surface of a stainless steel tube by a facile in-situ electro-deposition method and it was used as a working electrode for electrochemically control in-tube solid phase microextraction. In the PTh/GO coating, GO acts as an anion dopant and sorbent. The PTh/GO coating, compared to PTh and GO coatings, exhibited enhanced long lifetime, good mechanical stability and a large specific surface area. Regarding the in-tube SPME, some important factors such as the extraction and desorption voltage, extraction and desorption times and flow rates of the sample solution and eluent, which could affect the extraction and separation efficiency of the analytes, were optimized. Total analysis time of this method including the online extraction and desorption time was about 21min for each sample. AMI and DOX were extracted, separated and determined with limits of detection as small as 0.3μgL(-1) and 0.5μgL(-1), respectively. This method showed good linearity in the range of 0.7-200μgL(-1), 2.3-200μgL(-1) and 2.9-200μgL(-1) for AMI, and in the range 0.9-200μgL(-1), 2.5-200μgL(-1) and 3.0-200μgL(-1) for DOX in water, urine and plasma samples, respectively; the coefficients of determination were also equal to or higher than 0.9976. The inter- and intra-assay precisions (RSD%, n=3) were in the range of 2.8-3.4% and 2.9-3.9% at the three concentration levels of 5, 25 and 50μgL(-1), respectively. Finally, under the optimal conditions, the method was applied for the analysis of the drugs in human urine and plasma pretreated samples and good results were obtained.

sinequan medicine 2016-03-02

In 92 patients (22 females and 70 males) with unipolar affective disorder hemodynamic studies using a radiocardiographic method were performed during treatment of a depressed phase of illness with amitriptyline or doxepin or mianserin. Frequent presentation of hemodynamic disturbances (increased heart rate and increased blood pressure) in the course of endogenous depression was noticed. Thymoleptic treatment causes the disturbances to alter in a statistically significant manner which allows to predict the final treatment outcome. Total Peripheral Resistance Index (TPRI) reveals the highest prognostic potential.

sinequan buy 2015-04-19

A 4-week randomized, double-blind safety and efficacy study was conducted to compare the safety and efficacy of cetirizine, doxepine, and hydroxyzine 5 in the treatment of chronic pruritus due to sulfur mustard. Patients were treated in the Dermatology Clinic of Baqiyatallah Hospital. The study population consisted of 75 patients with chronic pruritus due to sulfur mustard exposure. Patients were given either cetirizine 10 mg, doxepine 10 mg, or hydroxyzine 25 mg/day, for 4 weeks. A calculated pruritic score for each patient was taken before and 1 month after treatment. Mean before-treatment pruritic scores were 38.2 +/- 4.8, 37.2 +/- 4.9, and 37.3 +/- 5.1 in the cetirizine, doxepine, and hydroxyzine groups, respectively. After treatment, the mean pruritic scores were 24.8 +/- 3.1, 17.8 +/- 2.5, and 16.7 +/- 2.3 in the cetirizine, doxepine, and hydroxyzine groups, respectively. In addition, 65%, 75%, and 80% of patients in the cetirizine, doxepine, and hydroxyzine groups were downgraded in the severity of pruritus (P 1/4 0.465). Sedation effects were reported in 6, 14, and 18 patients in the cetirizine, doxepine, and hydroxyzine groups, respectively. Hydroxyzine 25 mg/day has equal results compared to doxepine 10 mg once daily; but greater than cetirizine 10 mg once a day in controlling the symptoms of patients with chronic pruritus.

sinequan doxepin reviews 2017-08-11

Helping oncologists to identify and treat depression is an important step in improving the overall care of people with cancer. In previous work performed in our community-based, ambulatory oncology outreach network, we validated a depression screening tool, put into place depression screening programs, and taught oncologists how to follow up on screening with brief, reliable clinical interviews. Subsequently, we provided these oncologists with a fluoxetine-based antidepressant algorithm to follow for the treatment of their depressed patients. In this article, we report on the initial experience identifying and treating 35 ambulatory oncology patients who were screened with the Zung Self-rating Depression Scale (ZSDS). Structured follow-up interviews by their oncologist determined whether the patients qualified for a diagnosis of a major depressive episode. These patients then received 1 of 4 treatments based on the algorithm (no treatment, fluoxetine alone, fluoxetine plus bedtime doxepin, or fluoxetine plus methylphenidate). Patients were matched by their oncologist to a prototype patient for each treatment arm based on their symptomatic presentation (i.e., patients requiring a side effect minimization approach were to be placed on fluoxetine alone; patients who had significant insomnia, weight loss, or neuropathic pain were placed on the fluoxetine plus doxepin regimen; those with prominent fatigue were to receive fluoxetine plus methylphenidate). Patients were followed weekly for one month, and then every two weeks for two more months, with telephone assessments of their depression, associated symptoms and overall quality of life. Results suggested that oncologists most often chose the simplest regimen (fluoxetine alone) but that patients uniformly benefited in terms of improved mood and overall quality of life throughout the 12 weeks of follow-up. Our initial experience suggests that oncologists can be empowered to recognize and treat depression in their patients with a screen-and-intervene approach. Such an approach may benefit patients, and, if kept simple, can be incorporated into day-to-day care of people with cancer.