Antidepressants increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (18-24 years of age) with major depressive disorder and other psychiatric disorders. Doxepin is approved for treatment of depression in adolescents. May unmask bipolar disorder. Doxepin is not approved for use in treating bipolar depression. Possible activation of mania and hypomania, particularly in bipolar disorder. Possible exacerbation of psychosis in schizophrenia. May cause anticholinergic effects (use with caution in decreased GI motility, paralytic ileus, urinary retention, benign prostatic hyperplasia, xerostomia, or visual problems). May cause orthostatic hypotension (use with caution in patients at risk of this effect or in those who would not tolerate transient hypotensive episodes, e.g. cerebrovascular disease, cardiovascular disease, hypovolemia, or concurrent medication use which may predispose to hypotension/bradycardia). May cause sedation (degree of sedation is very high relative to other antidepressants). Use with caution in history of cardiovascular disease (including previous MI, stroke, tachycardia, or conduction abnormalities). Use with caution in hepatic or renal impairment. Use with caution in patients at risk of seizures, including those with history of seizures, head trauma, brain damage, alcoholism, or concurrent therapy with medications which may lower seizure threshold. Use with caution in patients with hyperthyroidism or those receiving thyroid supplementation. Effects may be potentiated when used with other sedative drugs or ethanol. Use with caution in the elderly. Used topically for >8 days, may increase risk of contact sensitization. Therapy should not be abruptly discontinued in patients receiving high doses for prolonged periods. May increase the risks associated with electroconvulsive therapy.