Licensed providers on Klarity provide personalized treatment. Find a provider that matches your needs and preferences.
Depression
22 min read
Written by Klarity Editorial Team
Published: Dec 21, 2022
Medically Reviewed by Dr. Zoe Russell
Navigating depression can feel overwhelming, especially when first-line depression treatment hasn’t worked. Searching for effective antidepressant medicine takes some time, but…
You’re not alone, and you deserve to get the treatment you need when you need it! Not weeks later.
In this article, we’ll review Silenor and Tofranil, two antidepressant drugs that can be prescribed to treat major depressive disorder when first-line antidepressants like selective serotonin reuptake inhibitors (SSRIs) are not effective in reducing depression symptoms.
We’ll discuss—
Klarity connects people with board-certified mental health providers who can diagnose and prescribe treatment for a variety of mental health issues, including depression.
If you want to talk to a medical provider about your treatment-resistant depression and are exploring different antidepressants, then schedule an appointment, and we’ll match you with a licensed provider in your state within 48 hours.
This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the Suicide Prevention Lifeline immediately at 800-273-8255.
Tofranil | Silenor | |
Drug Class | Tricyclic antidepressant | Tricyclic antidepressant |
Brand / Generic Status | Generic (Brand name: Silenor) | Brand name for Silenor |
Form(s) of the Drug | Immediate-release tablets • Shapes indicate dosage | • Immediate-release capsules • Immediate-release tablets • Clear, blueberry-mint flavored liquid suspension • Topical cream (for itching) |
Standard Dosage | Immediate-release tablets: • 10mg triangular tablet • 25mg small round tablet • 50mg large round tablet | Immediate-release capsule: • 10mg • 25mg • 50mg • 75mg • 100mg • 150mg Immediate-release tablets: • 3mg • 6mg Liquid suspension: • 10mg per dose Topical cream: • 5% formula |
Conditions Treated | FDA-approved uses: • Major depressive disorder Off-label uses: • Bulimia • Nerve Pain • Panic Disorder • Irritable bowel syndrome (IBS) • ADHD • Enuresis in children | FDA-approved uses: • Major depressive disorder • Anxiety disorder • OCD Off-label uses: • Itchiness due to atopic dermatitis, pruritus, or lichen simplex chronicus • Topical neuropathic pain |
Cost | Generic form (imipramine): • $10 for a 30-day supply Brand name: • $430 for a 30-day supply | Generic form (doxepin) • $36 to $90 for a 30-day supply • $8 for a 30-day supply (with coupons or discounts) Brand name: • $93 to $240 for a 30-day supply |
Side-Effects | Common side effects: • Mood/behavior changes • Anxiety • Difficulty sleeping • Agitation, hostility, and aggression • Increased depression and suicidal thoughts • Blurred vision • Lightheadedness • Fever • Hallucinations • Confusion • Pain or difficulty urinating • Seizures • Difficulties with sex • Constipation • Nausea and vomiting • Diarrhea | Common side effects: • Agitation, confusion • Black, tarry stools, bleeding gums, blood in urine or stool • Blurred vision • A sensation of burning, itching, or “pins and needles” on the skin • Chest pain or tightness, fast or irregular heartbeat • Chills, cold sweats • Urinary retention • Dizziness upon standing, loss of consciousness • Headache • Hearing loss • Muscle spasms, stiffness, twitching • Seizures Serious side effects: • Unusual thoughts or behavior • Hallucinations • Depression • Suicidal ideation • Seizures • Lightheadedness • Eye or chest pain |
Warnings For Use | Drug interactions: • MAOIs • SSRIs • SNRIs • Blood pressure medication • Anticholinergics • Digoxin • Disopyramide • Valproic acid • Thyroid supplements | Drug interactions: • Thyroid supplements • Anticholinergic drugs • Some blood pressure medications • MAOIs • SSRIs • St. John's Wort • Cimetidine • Terbinafine • Drugs to treat irregular heart rate |
Tofranil (Imipramine) and Silenor (Doxepin) are tricyclics, a class of antidepressants developed in the 1950s. These medications are primarily prescribed to treat major depressive disorder (MDD) but also have other off-label uses, such as treating anxiety disorders or managing chronic pain.
Tricyclics are nonselective antidepressants meaning they affect much more serotonin receptors than other antidepressants like SSRIs or SNRIs, which are newer antidepressants that are selective.
Tricyclics work by blocking the reuptake of certain neurotransmitters in the brain, which can help improve mood and reduce symptoms of depression. Tricyclics don’t work for everyone, but they can be an effective means of treatment for some people based on their health history and current diagnosis, such as treatment-resistant depression.
Tofranil and Silenor are prescription medications used to treat major depressive disorder. Each drug has its own forms, doses, and side effects, and you should always consult your mental health provider before taking a new medication.
Though Tofranil and Doxepin are in the same class of medication, it’s important to understand that they are different antidepressants and each will affect your mind and body differently.
Let’s compare these two antidepressant medications—
Tofranil is primarily used to treat symptoms of MDD, but it may also be used off-label to treat other conditions. The FDA has an approval system where a series of tests determines whether or not a medication will be an effective treatment for a particular issue. Off-label use is when a medication isn’t approved for a certain issue, but it’s proven to be an effective treatment.
Tofranil is FDA-approved to treat major depressive disorder. Off-label uses may include:
Silenor is also primarily prescribed to treat MDD and anxiety. Since it increases the levels of certain chemicals in the brain responsible for regulating mood, it’s also used off-label to treat other conditions.
Off-label uses for Silenor may include:
Silenor comes in different doses and forms that contribute to the overall cost of the medication. Depending on your recommended dose, you may experience common side effects, and it’s important to know how your body might respond. Additionally, silenor interacts with several drugs, so you should tell your care provider about any other medications you take.
Silenor is available in oral capsule, oral solution, and topical form. The recommended starting dose for adults is 75 mg daily, divided into three smaller doses and taken at bedtime. Your dose may increase gradually, up to a maximum of 300 mg per day.
Silenor can cause several common side effects. These side effects are usually mild and may disappear as your body adjusts to the medication.
Common Silenor side effects include:
However, if these side effects persist or if you experience any severe side effects, such as worsening depression, suicidal ideation, difficulty breathing, or swelling of the face, lips, tongue, or throat, you should contact your care provider right away.
Silenor can interact with other medications and substances, such as alcohol and certain herbal supplements. There are also 661 drugs that Silenor interacts with, including 134 major interactions, 502 moderate interactions, and 25 minor interactions.
Of the most frequently checked medications, Silenor has major interactions with Cymbalta, Flexeril, Lexapro, Topamax, and Zoloft.
Moderate interactions include:
The cost of Silenor depends on the pharmacy you use, your recommended dose, and if you have insurance. You can expect to pay anywhere from $4.26 to $42.15 monthly for 30 capsules of 75 mg. Talk to your provider about using the generic form Silenor to save money.
Like Silenor, Tofranil also comes in several doses and forms and has its own set of side effects. It also interacts with a series of other medications, so you must tell your care provider about any other medicines you’re taking.
There are several doses and forms of Tofranil available, including tablets, capsules, and a liquid form. Common doses are between 10 and 200 mg daily, with the typical dose starting at 75 mg. Your care provider will determine the right dose based on your symptoms and other factors, like your health history.
Tofranil can cause some side effects. You must contact your mental health provider if these side effects persist or become severe.
Common side effects include:
If you experience any of the following serious side effects, contact your healthcare provider immediately.
Tofranil interacts with 690 drugs, with 134 major interactions, 529 moderate interactions, and 27 minor interactions. Major interactions occur with
Moderate interactions include:
The cost of Tofranil varies depending on your dose, pharmacy, and insurance coverage. The price ranges from $12.22 to $53.60 for 90 tablets at 25 mg. You should also consider asking about Imipramine, the generic form of Tofranil, as it’s often less expensive.
While they can be effective for many people, tricyclic antidepressants can have other potentially harmful side effects. These adverse effects could include serotonin syndrome, pregnancy and breastfeeding complications.An increased risk of bleeding could also occur due to taking blood thinner medication like Warfarin
One potential side effect of tricyclic antidepressants is serotonin syndrome, which occurs when there’s too much serotonin in the body. Symptoms of serotonin syndrome include agitation, hallucinations, and rapid heartbeat. If you experience these symptoms, contact your care provider immediately.
Another potential concern with tricyclic antidepressants is using them during pregnancy and breastfeeding. Taking tricyclics while pregnant can lead to preterm birth, respiratory distress, neonatal convulsions, or low birth weight. It’s important to talk to your healthcare provider about the potential risks and benefits of taking a tricyclic antidepressant during pregnancy.
Tricyclic antidepressants can also increase the risk of bleeding if you’re taking a blood thinner like Warfarin. If you are taking a tricyclic antidepressant and planning surgery or dental work, let your care provider know beforehand. You may need to stop taking the medication for a period of time before and after the procedure.
The Food and Drug Administration (FDA) requires a black box warning on all antidepressants, including tricyclic antidepressants. This warning states that antidepressants may increase the risk of suicidal thoughts and behaviors in children, teenagers, and young adults. Monitor any changes in mood or behavior while taking a tricyclic antidepressant.
Silenor is a tricyclic antidepressant prescription medication commonly used to treat symptoms of depression and anxiety.
Tofranil is another tricyclic antidepressant medication that treats symptoms of depression.
Yes, Silenor and Tofranil are tricyclic antidepressants, meaning they belong to the same class of drugs. While they are within the same drug class, they have their own unique side effects and warnings, and you should consult with a licensed professional before taking either one.
Silenor is FDA-approved to treat anxiety, while Tofranil is not. Tofranil is used to treat some panic disorders in an off-label capacity, but that’s not its primary intended use. The right medication depends on your current symptoms and your care provider’s recommendations.
Both Silenor and Tofranil are tricyclic antidepressant medications commonly used to treat MDD. Tofranil is a first-choice medication when it comes to treating symptoms of depression, while Silenor is a second-choice medication due to its many side effects. Your mental health provider will recommend the best option for you.
It is generally safe to drive while taking Silenor or Tofranil as long as you do not experience any side effects that could impair your ability to operate a vehicle. Before getting behind the wheel, you should wait until you’ve taken a few doses to understand how your body responds.
You should not drink alcohol while taking Silenor or Tofranil. Alcohol can interact with these medications, increasing the risk of adverse side effects and worsening symptoms of depression and anxiety. If you do choose to drink while taking Silenor or Tofranil, only do so in moderation and talk to your healthcare provider about any potential risks.
It is generally recommended that you take Silenor or Tofranil at the same time each day to help maintain a consistent level of the medication in your body. Both drugs can make you tired, so it’s best to take them before bed.
If you have treatment-resistant depression and are looking to try new antidepressants like Silenor and Tofranil, Klarity can help. We make accessing online depression treatment easy!
Get started with online depression treatment in as little as 48 hours when you book an appointment on Klarity.
Sources:
Mayo Clinic Staff. “Tricyclic antidepressants and tetracyclic antidepressants” Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983
“Doxepin Side Effects” Drugs.com
https://www.drugs.com/sfx/doxepin-side-effects.html
Femi Aremu. “Doxepin, Oral Capsule” Healthline
https://www.healthline.com/health/drugs/doxepin-oral-capsule#side-effects
“Doxepin Interactions” Drugs.com
https://www.drugs.com/drug-interactions/doxepin.html
“Doxepin” GoodRx
https://www.goodrx.com/doxepin
John P. Cunha. “Side Effects Center” RxList
https://www.rxlist.com/tofranil-side-effects-drug-center.htm
“Tofranil Interactions” Drugs.com
https://www.drugs.com/drug-interactions/imipramine,tofranil.html
“Tofranil” RxList
https://www.rxlist.com/tofranil-drug.htm
IBM Micromedex. “Imipramine (Oral Route)” Mayo Clinic
https://www.mayoclinic.org/drugs-supplements/imipramine-oral-route/proper-use/drg-20072148
“Generic Tofranil” GoodRx
“Serotonin Syndrome” Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758
Kelly A. Cochran, Larisa H. Cavallari, Nancy L. Shapiro, Jeffrey R. Bishop. “Bleeding Incidence with Concomittant Use of Antidepressants and Warfarin” National Library of Medicine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3212440/
Patricia Weisser. “Imipramine (Tofranil): dosage, uses, side effects” ro
https://ro.co/health-guide/imipramine-tofranil-dosage-uses-side-effects/
“Compare Tofranil-PM vs. doxepin” Iodine
Get free, credible health and wellness tips from Klarity
Subscribe to our blog for the latest insights and advice—totally free! No spam, and you can unsubscribe at any time.