Amitriptyline belongs to the group of drugs tricyclic antidepressants (TCAs) and is mainly used to manage depression. It can also help treat bipolar disorder, insomnia, and chronic pain.

The newer antidepressants are more commonly used as they have fewer side effects, but TCAs still play a significant role in managing these disorders. They are named so as the molecule consists of three rings of atoms.

It is a prescription medicine and available as a liquid and tablets.

Let’s understand more about Amitriptyline, how it can help treat depression, and its use, dosage, precautions, interactions, and side effects.

Amitriptyline and Treating Depression

Depression is caused by a chemical imbalance that results in abnormal communications between nerve cells in the brain. The chemical delivering these messages are known as neurotransmitters.

The neurotransmitters pass a message from one cell to the other. How you feel and react to the message depends on the type of neurotransmitter.

When the brain cells pass signals to one another, they also release the chemicals to deliver the message. They have to take back the chemical so that they can pass the next message. This process of taking the chemical back is known as “reuptake.”

Amitriptyline prevents the reabsorption of neurotransmitters serotonin and norepinephrine. Serotonin mainly regulates your mood, and norepinephrine aids in the fight-or-flight reaction.

By preventing reuptake, Amitriptyline increases the levels of these chemicals, improving the symptoms of depression.

Along with depression, Amitriptyline can also help manage the following conditions:

• Insomnia
• Chronic pain
• Migraine
• Post-traumatic stress disorder
• Anxiety
• Excessive saliva production
• Irritable bowel syndrome
• Shingle’s pain
• Interstitial cystitis

Prescription and Use

Use

Read the patient information leaflet carefully and follow all the instructions given by your doctor.

Here are some instructions on its use:

• Take it once a day before bedtime as it may cause sleepiness. If you feel it makes you drowsy in the morning, try taking it in the evening.
• It may be possible that your doctor may advise taking low doses twice or thrice a day to avoid the risk of side effects.
• It usually does not upset digestion, and thus you can take it with or without food.
• The tablet is to be taken orally with water.
• Try and take medicine at the same time every day.
• If you happen to miss a dose, take the missed dose as soon as you remember. However, if it is almost time for the next dose, do not take the missed dose and continue with your next scheduled dose. 
• Do not take a double dose to compensate for the missed dose. 

Dose

Amitriptyline tablets are available in the strengths of 10mg, 25mg, or 50mg.

Amitriptyline liquid is available in different strengths containing 10mg, 25mg, or 50mg of Amitriptyline.

The usual dose of Amitriptyline for depression in adults is 50mg to 100mg a day. In some cases, it can go up to 150mg to 200mg a day.

In children between the age of 16-17, the usual dose is 25 mg to 50 mg a day.

Symptoms of Overdose

Here are some common symptoms:

• Seizures
• Confusion
• Hallucinations
• Drowsiness
• Vomiting
• Cold body temperature
• Irregular heartbeat
• Difficulty in concentration
• Rigid muscles
• Fever

Precautions

Amitriptyline is safe for use in most adults and children aged 16 to 17 years.

Inform your physician if you have the following conditions before starting Amitriptyline:

• Heart disorders
• Porphyria
• Severe liver or kidney disorders
• Epilepsy
• Suicidal thoughts
• Thoughts of harming yourself
• Diabetes

Talk to your doctor before taking Amitriptyline if:

• You are taking any other medication, are pregnant, breastfeeding, or planning a pregnancy. 
• You are allergic to Amitriptyline or any of its ingredients or have any other allergies.
• You are allergic to any other medication.
• You are taking any other drugs, over-the-counter medicines, herbal products, or nutritional supplements.

Interactions

Besides, certain medicines may interfere with its working and thus might not be safe to take them together. Some of them are:

• Disulfiram
• Arbutamine
• Cimetidine
• Terbinafine
• NSAIDs such as ibuprofen
• Antiplatelet drugs such as clopidogrel
• Blood thinners such as warfarin
• High blood pressure medicines such as clonidine, guanabenz
• Anticholinergic drugs such as belladonna alkaloids
• MAO inhibitors such as linezolid, isocarboxazid, phenelzine, procarbazine, methylene blue, rasagiline, tranylcypromine, safinamide, selegiline
• Medications to treat irregular heart rate such as quinidine, flecainide, propafenone
• Other antidepressants such as fluoxetine, paroxetine, fluvoxamine

This may not be a comprehensive list, and other drugs may interact with Amitriptyline. Please inform your doctor if you are taking any of the medicines listed above.

Progress of Treatment

The doctor will increase or decrease the dose based on your condition.

It is important to taper its dose gradually to prevent discontinuation symptoms.

Some common symptoms include:

• Headache
• Nausea
• General discomfort

This tapering schedule is not fixed and the doctor will decide it based on your response to  the dose. Each person has a different reaction.

Common Side Effects to Expect

Like all other medications, Amitriptyline may cause side effects, although it is unlikely to happen to everyone. However, it is important that you are aware of what could be the possible side effects.

Common side effects

• Dizziness
• Feeling sleepy
• Fatigue
• Headaches
• Dryness of mouth
• Constipation
• Difficulty peeing
• Excessive sweating
• Change in sex drive
• Change in weight and appetite
• Nightmares

Serious side effects

• Irregular or fast heartbeat
• Signs of liver problem such as yellow sclera and skin
• Long-lasting confusion
• Constant headaches
• Frequent muscle cramps
• Suicidal thoughts or thoughts of ending your life
• Change in your eyesight, eye pain, redness, or swelling in or around the eye
• Severe abdominal pain and constipation
• Inability to pee
• Blurred eyesight
• Loss of balance
• Weakness of one side of your body
• Severe allergic reaction with symptoms such as itching, blister, peeling of skin
• Wheezing or tightness of chest
• Trouble breathing or talking
• Swelling of face, tongue, throat, mouth, or lips

Here is what you can do to manage side effects:

• Dizziness: It is mainly caused by low blood pressure. To manage this, consume enough water or other non-alcoholic fluids. Also, avoid stranding quickly from sleeping or standing position.
• Constipation: Include high-fiber foods such as fruits, vegetables, and cereals. You can also increase the consumption of water and exercise daily.
• Dryness of mouth: You can chew sugar-free sweets or sugar-free gum.
• Difficulty peeing: Try and relax while peeing and not force the flow of urine. Try this again. However, if you are not able to pee at all, consult your doctor immediately. 
• Headaches: Have enough fluids and get adequate rest. Avoid excess consumption of alcohol. If the headaches are severe or last longer than a week, consult your physician. 
• Fatigue: Cut down the amount of alcohol you consume and take Amitriptyline in the evening. Also, avoid operating machines or driving if you are feeling sleepy.

Final Thoughts

Amitriptyline belongs to the group of drugs tricyclic antidepressants (TCAs), and doctors usually prescribe it to manage depression. However, it can also help manage IBS, anxiety, and chronic pain.

People on this medicine may usually experience side effects such as headaches, drowsiness, and dizziness. But these effects usually subside in a few days.

If you are on Amitriptyline, it is recommended to monitor your symptoms and remain watchful for worsening symptoms. This is especially true if you get thoughts of harming yourself or suicidal thoughts. Consult your doctor immediately if this is the case.

Lastly, some drugs can interact with this medicine. So, carefully discuss all the medications you are taking, including supplements and herbs.