Hi everyone, looking for medical insight or guidance regarding my father’s recent medication changes and acute GI symptoms.
Age/Sex: 47M
Diagnoses on current slip: Recurrent Depressive Disorder (ICD-11: 6A71), chronic insomnia, history of severe headaches/migraine
Relevant history: Heavy smoker (20+ years), no prior history of peptic ulcers
Timeline & Background:
April 2026: Suffered from severe chronic migraines and was treated by a neurologist for 3–4 months with good relief.
August 2026: Developed severe sleep onset insomnia (could not fall asleep naturally on his own).
September 2026: Consulted a neuro-psychiatrist (a different doctor from the initial neurologist). The psychiatrist diagnosed him with Recurrent Depressive Disorder and started him on:
Amisulpride (Joykem ODT) 50 mg (morning)
Dothiepin (Dothip) 25 mg (night)
Clonazepam (Zapiz/Epitril) 0.5 mg (night)
October 11, 2026: Follow-up consultation with the neuro-psychiatrist. Dosage was adjusted to:
Dothiepin increased to 50 mg (night)
Clonazepam reduced to 0.25 mg (night)
Amisulpride maintained at 50 mg (morning)
The Issue:
Following the October 11 dose increase of Dothiepin, he has been feeling ill and complaining of severe, persistent burning pain in his stomach and intestines, describing it as feeling like raw, open sores ("chaale").
He has no vomiting or black/tarry stools, but the burning and abdominal discomfort are significant and distressing.
Questions:
Given his 20+ year smoking history, could the anticholinergic, gut-slowing effects of Dothiepin 50 mg (especially combined with Amisulpride) be causing severe gastric irritation or delayed gastric emptying?
Is a tricyclic antidepressant (TCA) like Dothiepin still an appropriate first-line choice here for insomnia/depression, or are there gentler modern alternatives (like an SSRI/SNRI/Mirtazapine) that carry less GI and anticholinergic burden?
What is the best next step: take him to a gastroenterologist to check for active gastritis/ulcers, or seek a second opinion from a different psychiatrist to overhaul this regimen?
Any guidance on whether this symptom profile warrants an urgent medication review would be deeply appreciated. Thank you.
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