Amitriptyline

What Does Amitriptyline Do?

Amitriptyline is a tricyclic antidepressant (TCA) originally used to treat mental health disorders such as depression, anxiety, and panic attacks. However, these days, it seems rarely used for treating depression as other drugs are more favoured. Instead, it is commonly used to treat migraines, nerve pain, joint pains, irritable bowel syndrome and chronic pain.

How Does Amitriptyline Work? (the complicated stuff)

Its function lies in enhancing the presence of certain neurotransmitters, namely norepinephrine and serotonin, in the brain. Amitriptyline works by inhibiting the reuptake of these neurotransmitters, thereby promoting their activity in the synaptic cleft. This action improves mood stability and minimises pain perception, making the drug effective for mental health treatment and nerve pain conditions.

Drug Type and Category of Amitriptyline

Amitriptyline is categorised as a tricyclic antidepressant (TCA).

What dosage of Amitriptyline should you be taking?

NHS Recommendations ¹

Amitriptyline tablets come in different strengths of 10mg, 25mg or 50mg.

The liquid also comes in 3 different strengths containing 10mg, 25mg or 50mg of amitriptyline in a 5ml spoonful.

Depression

• The usual dose of amitriptyline for depression in adults is 50mg to 100mg a day. This may go up to 150mg a day if you need a stronger dose, but only under the supervision of a specialist.
• Young people aged 16 to 17 years and older people sometimes start on a lower dose of 25mg to 50mg a day to reduce the chance of side effects.
• The maximum dose of amitriptyline is 150mg per day.

Pain ²

• The usual starting dose for adults and children aged 12 to 17 years old is 10mg a day. 
• The starting dose for children aged 11 years old and under depends on their weight and symptoms. 
• The maximum dose of amitriptyline for treating pain is 75mg a day. 

What are the side-effects of Amitriptyline?

Common Side Effects

• Constipation
• Dizziness
• Dry mouth
• Drowsiness, fatigue, or weakness
• Difficulty urinating
• Headaches

Serious Side Effects

• Fast or irregular heartbeat
• Yellowing of skin or eyes (liver problems)
• Frequent muscle cramps, confusion, or weakness (low sodium levels)
• Thoughts of self-harm or suicide
• Eye pain, vision changes, or swelling around the eyes
• Severe constipation or urination problems

Rare but Serious Allergic Reaction

• Swelling of lips, mouth, tongue, or throat
• Trouble breathing or choking
• Skin turning blue, grey or pale
• Sudden confusion, drowsiness or dizziness
• Fainting or unresponsiveness

Drug Interactions

One of the most concerning interactions is with other antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs), which can lead to a potentially life-threatening condition called serotonin syndrome. Amitriptyline also interacts with sedatives like opioid painkillers, increasing the risk of central nervous system depression, respiratory distress, and even coma.

Cardiovascular drugs, such as certain antiarrhythmic medications, can interact with amitriptyline, prolonging the QT interval and increasing the risk of cardiac arrhythmias. Antibiotics, particularly macrolides and quinolones, can also interact with amitriptyline, potentially leading to increased blood levels and enhanced anticholinergic effects. Anti-seizure medications, on the other hand, may decrease the seizure threshold in patients taking amitriptyline.

Amitriptyline can also inhibit the metabolism of certain drugs, such as abacavir and abiraterone, leading to increased blood levels and an increased risk of adverse effects. Additionally, amitriptyline has interactions with certain foods and supplements, such as alcohol and St. John's Wort, which can enhance its sedative effects and alter its metabolism, respectively.

Natural Alternatives to Amitriptyline

Lifestyle Interventions

• Exercise, fresh air, and sunshine can help improve mood and sleep. ^3,4
• Stress management techniques like meditation, yoga, and deep breathing. ³
• Walk in nature, resolve conflict, be positive about life. 

Supplements ⁴

• SAM-e (S-adenosylmethionine) - May help alleviate depression symptoms
• St. John's Wort - Can be as effective as antidepressants for mild-to-moderate depression, but may interact with other medications
• Omega-3 fatty acids - May help reduce inflammation and improve mood
• Lavender - May improve sleep quality
• 5-HTP (5-Hydroxytryptophan) - May help modulate serotonin levels
• DHEA (Dehydroepiandrosterone) - May help with certain mental health symptoms, but use caution due to potential side effects

Therapy

Talking therapy, such as cognitive behavioral therapy, can be an effective alternative or complement to medication. ³ 

Other recommended therapies include counselling, psychotherapy and hypnotherapy. 

A holistic approach combining lifestyle changes, therapy, and carefully selected supplements may be the most effective strategy for managing conditions like depression and chronic pain. ^3,4

Interesting facts about Amitriptyline

Stopping amitriptyline suddenly can lead to withdrawal symptoms such as nausea, headache, and malaise.

Amitriptyline is recommended on the WHO pain ladder for nerve-related pain that is unresponsive to opioid-like drugs.

Disclaimer

This article is generated for informational purposes only. It was created in December 2024. Medications and medical guidance can change over time. Therefore, it is essential to consult with your general practitioner or healthcare provider before making any decisions regarding medications or treatment plans. Your GP can provide personalised advice based on your specific health needs and conditions.

References

1. https://www.nhs.uk/medicines/amitriptyline-for-depression/
2. https://www.nhs.uk/medicines/amitriptyline-for-pain/how-and-when-to-take-amitriptyline-for-pain-and-migraine/
3. https://www.alternativetomeds.com/blog/amitriptyline-alternatives/
4. https://www.medicalnewstoday.com/articles/6-natural-antidepressants