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Amitriptyline

Amitriptyline is an antidepressant medication prescribed for the treatment of depression among adults.

6 Minute Read | Published Oct 02 2023 | Updated Feb 28 2024 Expert Verified
Emma Collins
Written by
Ashley Bayliss
Reviewed by
Emma Collins
Written by
Ashley Bayliss
Reviewed by

Common Brand Names: Elavil, Vanatrip

Amitriptyline’s Clinical Uses

Amitriptyline is an antidepressant medication belonging to the drug class called tricyclic antidepressants (TCAs). It is FDA-approved for the treatment of depression among adults, but is also widely used off-label for various psychiatric disorders including anxiety, post-traumatic stress disorder (PTSD), and depression among pediatric patients.Amitriptyline is not generally considered a substance of significant abuse potential. However, chronic use of amitriptyline can eventually lead to dependence.

Common Ways People Abuse Amitriptyline

Though amitriptyline is not commonly considered an addictive substance, some people misuse the drug by:

  • Increasing their dosages to amplify its effects
  • Using the medication more often than needed
  • Taking it with other substances, such as alcohol

Amitriptyline Drug Interactions

When combined with certain drugs, amitriptyline may increase your risk of experiencing side effects. Examples of these drugs include:

  • Anticholinergic drugs: These drugs include olanzapine, oxybutynin, diphenhydramine, and solifenacin. They can worsen amitriptyline’s anticholinergic side effects.
  • Selective serotonin reuptake inhibitors (SSRIs). Taking SSRIs with TCAs like amitriptyline can amplify tricyclic side effects.
  • Monoamine oxidase inhibitors (MAOIs). MAOIs include drugs such as ​​phenelzine, selegiline, isocarboxazid, or tranylcypromine.If switching from an MAOI to amitriptyline, it is best to wait at least 2 weeks before starting the latter medication.
  • Drugs that increase serotonin levels. These drugs include the above-mentioned MAOIs, SSRIs, as well as safinamide, procarbazine, and sertraline. Combining any of these drugs with amitriptyline can lead to the development of serotonin syndrome.
  • Opioid-based medication. Opioids include substances such as morphine, codeine, and oxycodone. Combining amitriptyline with these can cause a person to experience extreme drowsiness or difficulty breathing.
  • Medications that prolong QT intervals. These drugs include cisapride, pentamidine, astemizole, and quinidine. Because amitriptyline can cause QT prolongation, combining it with any of these drugs can cause a person to develop arrhythmia.

Side Effects of Amitriptyline

Some of the most common adverse effects associated with amitriptyline use include:

  • Constipation
  • Dry mouth
  • Dizziness or drowsiness
  • Weight gain
  • Headache

Because amitriptyline is also an alpha-adrenergic receptor blocker, some who take it may experience:

  • Dizziness
  • Sedation
  • Postural hypotension
  • Cardiac disturbances such as heart rate variability, arrhythmias, QT prolongation, and slow cardiac conduction

Secondary to its anticholinergic properties, amitriptyline may cause:

  • Dry mouth
  • Urinary retention
  • Increased heart rate
  • Blurred vision
  • Confusion
  • Delirium

In contrast, amitriptyline may cause the following side effects secondary to its antihistamine properties:

  • Increased appetite and weight gain
  • Sedation
  • Confusion
  • Delirium

In addition to the abovementioned, amitriptyline can also lower seizure threshold, and thus must be used with caution by patients with any seizure disorder.

Amitriptyline can also cause transient abnormalities in liver function tests. However, these abnormalities are mild and easily reversible upon discontinuation of the medication.

Much like other antidepressants, amitriptyline can increase the incidence of suicidal ideation, particularly among adolescents and young adults. Physicians are advised to educate patients and their families regarding this risk.

Amitriptyline’s Long-Term Effects

When taken as intended, amitriptyline rarely causes negative effects. However, amitriptyline use of between 4 to 8 weeks has also associated with sexual dysfunction among depressive males patients, expressing primarily as erectile dysfunction and lowered libido.

Liver test abnormalities have also been reported to occur to up to 12% of patients using amitriptyline at therapeutic doses, although the serum enzyme elevations it causes are typically mild and transient, while cases of acute liver injury are rare.

Signs of Amitriptyline Overdose

Amitriptyline toxicity can result in life-threatening conditions. It can occur at a dose of 5 mg/kg and above.Patients and their families are advised to seek immediate medical attention when symptoms such as the following are observed:

  • Sedation
  • Seizure
  • Coma
  • Increased heart rate
  • Decreased blood pressure
  • Dilated pupils
  • Dry mouth

How to Identify Amitriptyline Addiction

Amitriptyline is not generally considered a substance with abusive or addictive properties, although some scientific literature point at the drug having such an effect on susceptible individuals, particularly those who have a history of abusing another psychoactive substance.

The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists 11 criteria that point toward pathological behavioral patterns associated with substance use disorder. Applied to amitriptyline, these include the following:

  1. Taking amitriptyline in excessive amounts or for a longer period than initially intended
  2. Trying to cut back on or stop using amitriptyline but not managing to
  3. Spending plenty of time getting, using, or recovering from the use of amitriptyline
  4. Craving to use amitriptyline
  5. Failing to manage commitments at school, work, family, or elsewhere because of amitriptyline use
  6. Continuing to use amitriptyline even when it causes interpersonal or relationship problems
  7. Letting go of important personal activities because of amitriptyline use
  8. Continued use of the amitriptyline despite being put in danger
  9. Continued use of the amitriptyline despite the risk of worsening physical or psychological problems
  10. Increasing tolerance to amitriptyline such that more of it is needed to achieve the desired effects
  11. Exhibiting withdrawal symptoms after abrupt cessation of amitriptyline use

Amitriptyline Withdrawal Symptoms

Abrupt cessation of amitriptyline use can also lead to the development of withdrawal syndrome. Some symptoms linked to amitriptyline withdrawal include:

  • Nausea
  • Headache
  • Malaise
  • Irritability and restlessness
  • Sleep disturbances
  • Mania or hypomania (rare)

Amitriptyline Detox

If you’ve begun experiencing withdrawal symptoms, that may be a sign that you may have developed dependence on amitriptyline. Note that while you may be dependent on the drug, this doesn’t necessarily mean that you’ve also become addicted to amitriptyline. However, it is not recommended to abruptly stop using amitriptyline if you’ve been taking it for a while, and if you’ve been taking amounts greater than is clinically appropriate. Instead, make sure to consult your doctor, who can design a tapering schedule for you. Gradual dose reduction can help you safely and comfortably detoxify your body of amitriptyline.

Getting Treatment for Amitriptyline Addiction

If you are facing an addiction problem, getting help from professionals is the first big step you can take to bring your life back on track and start your journey to sobriety. The right amitriptyline addiction treatment program can help you safely quit using amitriptyline, either in an inpatient or in an outpatient setting.

  • Inpatient amitriptyline addiction treatment: In an inpatient setting, you will be made to live in an environment where you will receive various treatment modalities that may be deemed appropriate by those responsible for your care. These may include medication-assisted treatment as well as psychotherapeutic treatment that are designed to equip you with coping skills, substance refusal skills, and impulse control strategies to help you stay on track of your goal and prevent relapse.
  • Outpatient amitriptyline addiction treatment: In this setup, you get to continue living in your home as usual, but you may be asked to attend treatment sessions at a facility. This option is ideal if your condition is determined to be low-risk and you desire the normalcy of being able to go to school or work or to attend to other everyday activities.

Get the Help You Deserve

If you or anyone you know is struggling with amitriptyline use disorder, do not hesitate to ask for help. There are suitable programs that will likely be covered by your insurance. And even if you don’t have insurance, you can rest assured that there are other ways to finance your treatment. You can also talk to our advisors to verify your insurance and help find a suitable treatment facility for your needs.

To learn more, give us a call at (800) 429-7690. One of our recovery support advisors will be taking your call, and they can help you find a recovery facility and program that suits your requirements.

A Short History of Amitriptyline

Imipramine, the first tricyclic antidepressant, was synthesized in the 1950s. Scientists discovered that imipramine was beneficial among patients with endogenous depression associated with mental and motor retardation. In the course of exploring imipramine’s uses, scientists accidentally discovered amitriptyline by substituting imipramine’s diamine structure of an N-CH2 group with a C=CH group. Amitriptyline soon became available in the market and was widely accepted among medical practitioners. The Food and Drug Administration approved it for the treatment of depression in 1961.

Resources

bullet Thour, A & Marwaha R. (2021)
"Amitriptyline. StatPearls"
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bullet Alpert, Jonathan E. (2008)
"Massachusetts General Hospital Comprehensive Clinical Psychiatry"
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bullet Dunner, D. L. (2014)
"Combining Antidepressants. Shanghai Archives of Psychiatry, 26(6): 363–364"
Retrieved on May 17, 2021
bullet U.K. National Health Service (2020)
"Amitriptyline for Depression"
Retrieved on May 17, 2021
bullet U.K. National Health Service (2020)
"Amitriptyline for Pain and Migraine"
Retrieved on May 17, 2021
bullet U.S. National Library of Medicine, MedlinePlus (2017)
"Amitriptyline"
Retrieved on May 17, 2021
bullet Chen, L.W. et al. (2018)
"Amitriptyline and Sexual Function: A Systematic Review Updated for Sexual Health Practice. American Journal of Men’s Health"
Retrieved on May 17, 2021
bullet U.S. National Institute of Diabetes and Digestive and Kidney Diseases (2012)
"Amitriptyline. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury"
Retrieved on May 17, 2021
bullet U.S. National Center for Biotechnology Information, PubChem (2021)
"Amitriptyline"
Retrieved on May 17, 2021
bullet Umaharan, T., Sivayoka, S. & Sivansuthan S. (2021)
"Amitriptyline Dependence and Its Associations: A Case Report and Literature Review. Case Reports in Psychiatry"
Retrieved on May 17, 2021
bullet American Psychiatric Association (2013)
"Diagnostic and Statistical Manual of Mental Disorders (5th ed.)."
Retrieved on May 17, 2021
bullet Henssler, J., Heinz, A., Brandt, L. and Bschor, T. (2019)
"Antidepressant Withdrawal and Rebound Phenomena. Deutsches Arzteblatt International, 116(20): 355-361"
Retrieved on May 17, 2021
bullet U.S. Food and Drug Administration (2014)
"Amitriptyline Hydrochloride Tablets, USP"
Retrieved on May 17, 2021
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