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Among TCAs, doxepin (sinequan) appears to be best suited for managing insomnia in healthy adults. Doxepin works as a selective antagonist to H(1) receptors, which promote the initiation and maintenance of sleep (Owen, 2009) (Table 2). Ultra-low doses of this drug (< 6 mg per day) significantly improve and sustain both maintenance and duration of sleep (Rojas-Fernandez and Chen, 2014; Weber et al., 2010). Another frequently prescribed TCA is amitriptyline, which as a long-term option is found to be effective for patients with ongoing sleep problems (Everitt et al., 2014; Pagel and Parnes, 2001).
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