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.
Danish dan iwan Adventure
November 17, 2025 AT 02:47Amoxapine is a monoaminergic modulator with dual serotonin-norepinephrine reuptake inhibition plus D2 antagonism via 7-hydroxyamoxapine-this pharmacodynamic profile makes it uniquely suited for anergic, anhedonic depression phenotypes. SSRIs lack dopaminergic modulation, hence their limited efficacy in motivational deficits. The risk-benefit calculus favors TCAs only in treatment-resistant cases with documented SSRI/SNRI failure.
Ankit Right-hand for this but 2 qty HK 21
November 17, 2025 AT 04:33Why the hell are we even talking about this relic? In India we’ve got cheaper, safer, and more effective options-why are UK docs still playing doctor with 1980s junk? This is pharmaceutical colonialism disguised as medicine.
Oyejobi Olufemi
November 18, 2025 AT 11:54Let’s be clear: amoxapine isn’t a drug-it’s a metaphysical experiment in neurochemical imbalance. The dopamine blockade? That’s not pharmacology, that’s existential engineering. You’re not treating depression-you’re recalibrating the soul’s neurotransmitter dial. And yes, the side effects? They’re not side effects-they’re the universe screaming back at you for tampering with the sacred chemistry of being. Who are we to play god with 5-HT, NE, and DA? We’re not just prescribing pills-we’re rewriting the ontological code of human affect.
Daniel Stewart
November 20, 2025 AT 01:22It’s fascinating how we romanticize these older agents as ‘last resorts’ while ignoring the structural reasons they fell out of favor-pharmaceutical industry lobbying, risk-averse guidelines, and the slow erosion of psychopharmacological literacy among GPs. The real tragedy isn’t amoxapine’s decline-it’s that we’ve lost the clinical courage to use nuanced tools when they’re needed.
Latrisha M.
November 20, 2025 AT 05:33If you’ve tried multiple antidepressants and still feel stuck, amoxapine might be worth discussing with a psychiatrist who’s willing to monitor you closely. But don’t rush it. Get your ECG, check your BP, and track your symptoms. This isn’t a quick fix-it’s a careful, intentional step.
Jamie Watts
November 21, 2025 AT 11:38SSRIs are for people who want to feel okay not great. Amoxapine? That’s for when you’ve been hollow for years and your brain just won’t reboot. I was on sertraline for 18 months and felt like a ghost. Switched to amoxapine-2 weeks later I actually wanted to get out of bed. Yeah the dry mouth sucks and I gained 10 lbs but at least I’m alive again. People who say it’s too risky have never been this far gone.
John Mwalwala
November 22, 2025 AT 09:57Did you know amoxapine was developed during the Cold War as part of a secret military program to create soldiers who could function without sleep or emotion? The dopamine blockade was meant to suppress fear responses. Now it’s just prescribed to accountants with burnout. The pharmaceutical industry repurposed a weapon for mass compliance. They don’t want you to know this. They want you to think it’s just another pill. But the truth? It’s a psychological scalpel-and they’re afraid of what happens when people start using it right.
Deepak Mishra
November 23, 2025 AT 04:35OMG I tried amoxapine last year and it was like my brain finally woke up from a 5 year nap?? I cried the first time I felt joy again like wtf is this magic?? But then I got the tremors and my doc yanked me off it and now I’m back on escitalopram and I feel like a zombie again 😭😭😭 someone pls help I just wanna feel human again
Rachel Wusowicz
November 24, 2025 AT 18:01They say amoxapine is dangerous-but have you ever noticed how the FDA only flags drugs that are *too* effective? The real reason it’s not prescribed is because it works too well for people who don’t respond to corporate-approved antidepressants. It’s not about safety-it’s about control. Who profits from 6 months of SSRIs versus one 8-week course of amoxapine? The system doesn’t want you to know the truth: sometimes the oldest medicine is the one they tried hardest to bury.
Jennifer Walton
November 25, 2025 AT 05:17Amoxapine’s dopamine effect is interesting but overhyped. Most patients who respond do so because of norepinephrine, not D2 blockade. The literature is thin. And the side effect burden? Still too high for routine use. SNRIs and bupropion offer similar energy boosts without the cardiac risks.
Kihya Beitz
November 25, 2025 AT 12:51So let me get this straight-we’re praising a drug that can kill you if you sneeze wrong, just because some guy on Reddit said it ‘brought him back to life’? Wow. I miss the days when doctors didn’t treat depression like a video game where you unlock the secret boss item after failing 4 times.
Diane Tomaszewski
November 25, 2025 AT 16:38I think the real question is not whether amoxapine works but why we’ve forgotten how to listen to patients who say nothing else helped. Sometimes the answer isn’t a new drug-it’s giving old ones a fair shot when the system says no.