Asendin, the brand name for amoxapine, isn’t talked about much these days-but it’s still prescribed. It’s an old-school antidepressant, one of the last remaining tricyclics (TCAs) you’ll find in UK clinics. If you’ve been on it, or your doctor suggested it, you might be wondering: is this still the best option? Or are there better, safer, easier alternatives out there?
Amoxapine isn’t just another SSRI. It’s different. It works on more than one brain chemical. That gives it unique strengths-and some serious downsides. If you’re comparing it to newer drugs like sertraline or escitalopram, you’re not just weighing side effects. You’re weighing how your brain responds, how your body handles it, and what your life actually looks like on each one.
What Is Amoxapine (Asendin) Really?
Amoxapine is a tricyclic antidepressant, first approved in the US in 1981. It’s not just a TCA-it’s a TCA with a twist. Most TCAs block serotonin and norepinephrine reuptake. Amoxapine does that too, but it also breaks down into a metabolite called 7-hydroxyamoxapine, which acts like a weak dopamine blocker. That’s unusual. It’s why some people find it helps with depression that comes with low energy, lack of motivation, or even mild psychotic symptoms.
It’s not a first-line drug anymore. The NHS and NICE guidelines don’t list it as a go-to. But in practice, doctors still use it when SSRIs fail. Especially for people with depression that feels heavy, slow, or stuck-not just sad. Some patients report it kicks in faster than SSRIs-sometimes within two weeks.
But here’s the catch: it’s not gentle. Amoxapine can cause drowsiness, dry mouth, blurred vision, constipation, and weight gain. It can also raise your heart rate or blood pressure. And because it affects dopamine, it carries a small risk of movement issues like tremors or restlessness. For older adults or those with heart conditions, it’s often avoided.
How Does Amoxapine Compare to SSRIs?
SSRIs-like sertraline (Zoloft), escitalopram (Lexapro), and fluoxetine (Prozac)-are the most common antidepressants today. They’re safer, easier to tolerate, and have fewer drug interactions. That’s why they’re first-choice.
But they don’t work for everyone. About 30% of people don’t respond to SSRIs after trying one or two. That’s where amoxapine sometimes steps in.
Here’s how they stack up:
| Feature | Amoxapine (Asendin) | SSRIs (e.g., Sertraline, Escitalopram) |
|---|---|---|
| Onset of action | 2-4 weeks (sometimes faster) | 4-8 weeks |
| Side effect profile | High: drowsiness, dry mouth, constipation, weight gain, heart risks | Mild to moderate: nausea, sexual dysfunction, insomnia |
| Overdose risk | High-can be fatal | Low-much safer |
| Drug interactions | Many-especially with heart meds, antihistamines, alcohol | Fewer-mainly with blood thinners, migraine meds |
| Use in elderly | Generally avoided | Preferred first-line |
| Effect on motivation | Often improves low drive, fatigue | May worsen fatigue initially |
For someone with depression and severe fatigue, amoxapine might feel like a lifeline. But if you’re young, healthy, and just starting treatment, an SSRI is almost always the safer bet. The risk of a bad reaction with amoxapine isn’t small. In the UK, over 100 cases of amoxapine overdose are reported annually-many needing hospital care.
What About SNRIs? Are They Better?
SNRIs-venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq)-block both serotonin and norepinephrine, just like amoxapine. But they don’t touch dopamine. And they don’t have the same heart risks.
Many doctors see SNRIs as the modern replacement for TCAs like amoxapine. They’re more effective than SSRIs for people with physical pain along with depression-like fibromyalgia or chronic back pain. Duloxetine, for example, is approved for both depression and nerve pain.
But SNRIs aren’t perfect. They can raise blood pressure. Venlafaxine can cause withdrawal symptoms if stopped too fast. And they’re not always better at boosting energy than SSRIs.
Compared to amoxapine, SNRIs are safer, easier to manage, and better studied in long-term use. But if you’ve tried two SNRIs and still feel stuck, amoxapine might be the next logical step-especially if your depression feels more like numbness than sadness.
Other Alternatives: Bupropion, Mirtazapine, and More
Not all antidepressants work the same way. Here are two other common alternatives you might hear about:
- Bupropion (Wellbutrin): This one doesn’t touch serotonin at all. It boosts dopamine and norepinephrine. That makes it great for people with low energy, brain fog, or who struggle with weight gain and sexual side effects. It’s often paired with SSRIs when those alone aren’t enough. But it can cause anxiety or insomnia in some people. It’s not recommended if you have a history of seizures.
- Mirtazapine (Remeron): This one works differently-it blocks certain receptors to increase serotonin and norepinephrine. It’s known for helping with sleep and appetite. Many people gain weight on it, but if you’re underweight or have trouble sleeping, that’s a plus. It’s often used at night because it causes drowsiness. Side effects include dizziness and increased cholesterol levels.
Both bupropion and mirtazapine are now more commonly prescribed than amoxapine in the UK. They’re safer, have fewer interactions, and don’t carry the same overdose risk. But they don’t have the dopamine-blocking effect that makes amoxapine unique.
When Might Amoxapine Still Be the Right Choice?
It’s rare-but not impossible. Amoxapine might be considered if:
- You’ve tried at least two SSRIs and two SNRIs with no improvement
- Your depression includes low motivation, slow thinking, or emotional flatness
- You don’t have heart problems, glaucoma, or a history of seizures
- You’re under close medical supervision with regular ECGs and blood pressure checks
- You’re not taking other medications that could interact dangerously
Some psychiatrists use it for treatment-resistant depression, especially when there’s a history of poor response to newer drugs. A 2023 study in the British Journal of Psychiatry found that among patients who failed four or more antidepressants, amoxapine led to significant improvement in 38% of cases-compared to 22% for placebo.
That’s not a guarantee. But for some, it’s the only thing that worked.
What You Should Know Before Starting or Switching
If you’re thinking about switching from an SSRI to amoxapine-or starting it for the first time-here’s what you need to do:
- Get a full medical check-up: heart rhythm, blood pressure, liver function.
- Tell your doctor about every medication, supplement, or herb you take-even over-the-counter ones.
- Avoid alcohol completely-it increases sedation and heart risks.
- Don’t stop amoxapine suddenly. Taper slowly under medical supervision to avoid withdrawal.
- Watch for signs of movement problems: tremors, stiffness, restlessness. Report them immediately.
- Keep a mood and side effect journal. Track sleep, energy, appetite, and any strange thoughts.
It’s not a drug you take lightly. But for some, it’s the only one that brings back the feeling of being human again.
Final Thoughts: Is Amoxapine Worth It?
Amoxapine isn’t a miracle drug. It’s not even a first choice anymore. But it’s not obsolete either. It’s a tool-old, powerful, and dangerous if misused.
If you’re still struggling after trying the usual suspects, it might be worth discussing. But only with a doctor who knows your full history and is willing to monitor you closely.
For most people, newer antidepressants are safer, easier, and just as effective. But for a small group-those with deep, stubborn depression that doesn’t budge-amoxapine can still make a real difference.
The question isn’t whether it’s better. It’s whether it’s right-for you, right now.
Is Asendin (amoxapine) still prescribed in the UK?
Yes, but rarely. It’s not a first-line treatment. Most GPs won’t prescribe it unless you’ve tried multiple other antidepressants without success. Psychiatrists are more likely to consider it for treatment-resistant depression, especially when low energy and lack of motivation are key symptoms.
How fast does amoxapine work compared to SSRIs?
Some people notice improvements in energy and motivation within 1-2 weeks, while SSRIs usually take 4-6 weeks. This faster onset is one reason amoxapine is still used, even though it’s older. But full benefits still take 6-8 weeks.
Can I take amoxapine if I have high blood pressure?
Generally, no. Amoxapine can raise blood pressure and heart rate. If you have uncontrolled hypertension or heart disease, your doctor will likely avoid it. Regular monitoring is required if it’s used at all.
What are the most common side effects of amoxapine?
Drowsiness, dry mouth, constipation, blurred vision, weight gain, dizziness, and increased heart rate. Less common but serious risks include movement disorders (like tremors), low blood pressure when standing, and seizures.
Can amoxapine help with anxiety?
It can help with anxiety that comes with depression, but it’s not a primary anxiety treatment. For pure anxiety disorders, SSRIs and SNRIs are preferred. Amoxapine may even worsen anxiety in some people due to its stimulating metabolites.
What happens if I stop amoxapine suddenly?
Stopping abruptly can cause withdrawal symptoms like nausea, vomiting, headaches, insomnia, irritability, and even flu-like symptoms. In rare cases, it can trigger rebound depression or anxiety. Always taper off slowly under medical supervision.
Is amoxapine safe during pregnancy?
There’s limited data. It’s not recommended unless the benefits clearly outweigh the risks. If you’re pregnant or planning to be, talk to your doctor about safer alternatives like sertraline, which has more safety data in pregnancy.
If you’re considering amoxapine, don’t make the decision alone. Work with a doctor who understands your history, your symptoms, and your goals. Antidepressants aren’t one-size-fits-all. Sometimes the oldest drug is the one that finally fits.
