Low dose Doxepin and Fluoxetine with Duloxetine, is it safe?

[Jwright1984]

I was recently switched from Paroxetine to Fluoxetine. It was one of the best decisions I have ever made. When on Paroxetine and I was tired ALL the time. I was literally falling asleep at my desk. It was hard to stay awake. I do have obstructive sleep apnea however I use a CPAP every night. According to the readout on the machine I usually stay between 2 and 4 events an hour. My problem is, since I switched to Fluoxetine I had been having difficult falling asleep at night, one extreme to another lol. Clearly I have some mental health issues, hence the Fluoxetine but I also take Duloxetine for pain/anxiety. This combo seems to work great. My head is clear and I have energy I haven't had in years. I wouldn't want to stop either medication but I NEED to be able to sleep at night. I've tried everything. Ambien doesn't work. Trazodone doesn't work. Hydroxyzine and diphenhydramine doesn't work. Doxylamine doesn't work. I've even taken some of my Oxycodone (for my chronic pain) at night and that doesn't work. I've gone natural and tried lemon balm, chammomile and valerian with no luck. I've been doing some research and found out that the FDA has approved low doses of Doxepin for use in insomnia. My father used Doxepin years ago and it greatly helped him with sleep. In my research I also see that taking it with anything that inhibits liver enzyme CYP2D6 (which both Fluoxetine and Duloxetine do) can cause the levels of the medication to build up in the body essentially behaving like you have taken more than you have. My question is, would it be safe to add a very tiny dose, say, 3 mg as a sleep aid to my medications. If it builds up enough to mimic say 6 mg or 10 mg that wouldn't be too bad. I am just really desperate right now and I need to know how safe this would be so I can bring it up with my doctor. Sorry for the long winded and confusing post and thanks to anyone who can help me.

My current medications/supplements:

Fluoxetine 20 mg
Duloxetine 60 mg
Lamotrigine 200 mg
Modafinil 200 mg
Lansoprazole 15 mg delayed release
Oxycodone 15 mg once a day (will be tapering off in the next few weeks)
Omega-3 3000 mg
Vitamin D3 5000 IU
Whole Food Multivitamin
Methylcobalamin
Probiotic
Magnesium 300 mg

[Morpheus1517]

Wow, that's quite the pharmacology you've got going there.  Given your underlying medical/psychiatric conditions, your best and most credible answer will come from a medical professional who examines you and knows your complete medical history.

That said, I'm wondering if you've tried any nondrug sleep improvement methods, particularly CBT adult sleep training methods.  Those are proven effective and help most who try them.  Might be a better solution for you.

[Jwright1984]

Unfortunately yes, I have tried CBT for both sleep and my anxiety disorders as well as my OCD and never had any success. As far as asking my doctor's, I've come to realize they know very little about the medications they prescribe. I recently found out the average doctor only has to take a 3 month course on medications (not sure exactly how true this is, my therapist claims this is true. He has 4 phd's and a masters. Of course that doesn't necessarily mean to he knows what he is talking about) whereas a pharmacist trains for 5 years. In retrospect I could ask a pharmacist but I was hoping someone here might have some experience with using doxepine in combo with some of my meds. Part of my extensive med list comes from numerous mental health issues including generalized anxiety disorder, panic disorder, ptsd and major depressive disorder, I also have ADD-I, lol. It's hard to find a balance that works with very few serious side effects but when I do I prefer to keep it. Oddly enough this isn't nearly as extensive as it used to be. I've cut quite a few meds out. I am also not too concerned about serotonin syndrome. It is pretty rare but I have personally been on 4-5 serotonergic medications many times with no problems. Either my body tolerates the excess serotonin very well or I am very, VERY low on serotonin which could actually explain a lot, lol. Insomnia, while certainly not the worst possible side effect, is pretty annoying. With that said, I may call my local pharmacist today and ask him. I am still hoping someone on here may have experience using doxepin with fluoxetine and or duloxetine. I like to read people's personal experiences when it comes to meds, it gives me a better idea of the experience may be like and what to watch out for. It's easy for someone to say, "ok yeah, it will be safe you" when they haven't used the med themselves. I have a love and a deep interest in pharmacology and would like to one day go to school for it (if I can get my mental health issues manageable) but in all my research I find very little personl experiences of doxepine with my meds.

[Morpheus1517]

If you're not satisfied with your docs responses you might ask for a referral to an MD who specializes in sleep.  And I do know docs as part of med school have to know everything there is to know about literally hundreds of classes of drugs, they are tested on this and must pass in order to get into a residency program.  Then in residency they get specific experience in those drugs most commonly used in their area of practice.  A sleep doc might be able to shed more light on your sleep issues if nothing else.

[Jwright1984]

I actually do see a sleep specialist however they don't prescribe psych meds for sleep assistance. I should note I decided against pursuing the Doxpin. After doing some research I've discovered it antagonizes the dopamine D2 receptor which blocks the effect of Modafinil. Ironically if I didn't have my modafinil I wouldn't be able to stay awake during the day. It's sort of a double edged sword for me.