Amitriptyline for Depression

What is amitriptyline?

Amitriptyline is a tricyclic antidepressant (TCA) originally developed to treat depression that is only available on prescription. While it's more often used at lower doses for conditions like chronic pain or migraines, it remains an effective treatment for depression at higher doses. It works by restoring the balance of certain natural chemicals in the brain involved in mood regulation[1].

What is amitriptyline used to treat?

It is prescribed for a range of depressive disorders and other conditions, including[1]: 

• Major depressive disorder (MDD) 

• Persistent depressive disorder (dysthymia) 

• Depression with anxiety 

• Treatment-resistant depression 

• Chronic nerve pain 

• Migraines 

It may also be used for other mood disorders under specialist care.

How does amitriptyline work?

Amitriptyline increases the levels of serotonin and noradrenaline in the brain by blocking their reuptake into nerve cells. These chemicals help regulate mood, and increasing their availability can help relieve symptoms of depression[1].

Who can take amitriptyline?

Most adults can take it, but speak to your doctor or pharmacist first, especially as it may not be suitable for people who[1]: 

• Have had a recent heart attack 

• Have certain heart rhythm problems 

• Have liver disease, glaucoma, or epilepsy 

• Have suicidal thoughts 

• Have bladder emptying problems 

• Have type 1 or type 2 diabetes 

• Have taken other depression medicines 

• Are pregnant or breastfeeding 

• Are taking monoamine oxidase inhibitors (MAOIs) 

• Have had an allergic reaction to amitriptyline 

It’s generally not prescribed to children or adolescents unless under specialist supervision. 

Please tell your doctor or pharmacist about any conditions you may have or medication you take before you start treatment, and always follow the instructions in the Patient Information Leaflet[2]. 

What is the typical dosage of amitriptyline?

Amitriptyline tablets come in different strengths of 10mg, 25mg or 50mg, while the liquid comes in 3 different strengths too, 10mg, 25mg or 50mg in a 5ml spoonful. The usual amitriptyline dose for depression in adults is 50mg a day (25mg twice a day). The dose may gradually be increased if necessary until you find a dose that suits you[1]. 

A lower dose of 10mg to 25m may be recommended for some people to reduce the chance of side effects, particularly for older people and anyone with heart problems. The maximum dose is 150mg a day, but this should only be under specialist supervision[1].

How do you take amitriptyline?

To take it correctly and reduce side effects[1]: 

• Swallow the tablets whole with water 

• Take the liquid using the syringe or spoon that comes with the medicine, not a kitchen teaspoon as this may not give you the correct dose 

• You can take it with or without food as it doesn’t usually cause an upset stomach 

• Avoid alcohol while taking this medication 

• Follow the instructions from your doctor and on the medicine packaging 

Can you stop taking amitriptyline?

Do not stop taking amitriptyline suddenly. Withdrawal symptoms such as headache, nausea, irritability, and sleep problems can occur as well as a rebound of your low mood. Your doctor or pharmacist will guide you in tapering the dose gradually[1]. 

What do you do if you take too much amitriptyline?

Taking too much amitriptyline can be dangerous. Symptoms of overdose include confusion, seizures, hallucinations, irregular heartbeat, and unconsciousness. Call 999 or go to A&E immediately if this happens[1]. 

What do you do if you forget to take amitriptyline?

If you forget a dose, take it as soon as you remember unless it’s nearly time for your next dose. Do not take two doses at once to make up for a missed one[1].

How do you store amitriptyline?

Store in a cool, dry place away from sunlight. Keep out of reach of children. Do not use it after the expiry date[1]. 

What medicines can’t you take with amitriptyline?

Some medicines, supplements, substances can interact with amitriptyline and should be avoided or used with caution. These include[1][3]: 

• MAOIs (e.g. phenelzine, tranylcypromine) 

• SSRIs (e.g. fluoxetine, sertraline) without medical advice 

• Opioid medicines (e.g. codeine, morphine, oxycodone) 

• Sleeping pills or sedating antihistamines 

• Heart rhythm medications 

• St John’s Wort 

• Alcohol 

Always inform your doctor or pharmacist about all medications and supplements you take before you start a new medicine, and follow the instructions in the Patient Information Leaflet[2]. 

What are the side effects of amitriptyline?

Common side effects include[1]: 

• Drowsiness 

• Dry mouth 

• Constipation 

• Blurred vision 

• Sleepiness 

• Difficulty urinating 

Serious side effects requiring urgent medical attention include[1]: 

• Suicidal thoughts, especially in young people 

• Seizures 

• Irregular heartbeat 

• Yellowing of eyes or skin 

• Constant headaches with nausea, muscle cramps, and weakness as a sign of low sodium in your blood 

• Eye pain or changes in eyesight 

• Constipation that lasts a long time 

• A complete inability to pee 

• A high temperature with chills and a sore throat 

You should contact your GP if you experience any of these symptoms. In rare cases, the medicine may cause a serious allergic reaction (anaphylaxis). You should call 999 or visit A&E immediately if you believe this is happening[1]. 

Symptoms of anaphylaxis include[1]:  

• Difficulty breathing  

• Tightness in throat and chest  

• Swelling of the tongue or throat  

• Feeling faint or dizzy  

• Blue/grey skin or lips  

• Loss of consciousness 

If you experience any side effects, including those not listed, you are encouraged to report them via the Yellow Card Scheme or contact your doctor, pharmacist, or nurse. This information is intended as a summary for general awareness and does not replace professional medical advice. 

The information provided in the side effects section is not a comprehensive list of all possible side effects associated with this medication. For a complete list of side effects, please refer to the Patient Information Leaflet (PIL) provided with your medication or consult your healthcare professional[2].

Frequently asked questions about amitriptyline

How long does it take to work? 
It may take 2 to 4 weeks to feel a noticeable improvement in mood[1]. 

Can I drink alcohol with amitriptyline? 
Avoid alcohol, as it can increase drowsiness and the risk of side effects[1]. 

Will amitriptyline make me sleepy? 
Yes, drowsiness is a common side effect, especially at first[1]. 

Can I drive while taking amitriptyline? 
Avoid driving until you know how it affects you. If you feel drowsy and unable to concentrate, avoid driving[1]. 

Is amitriptyline addictive? 
No, but stopping suddenly can lead to withdrawal symptoms or may cause your low mood to return[1]. 

Can I take amitriptyline long-term? 
Yes, if it continues to help and is monitored by your doctor[1]. 

Can I take amitriptyline with painkillers? 
Usually yes but check with your pharmacist or GP[1]. 

Can I take amitriptyline during pregnancy? 
Only if clearly advised by your doctor[1]. 

What if amitriptyline doesn’t work? 
Your doctor may adjust the dose or suggest a different treatment[1]. 

Do I need regular check-ups while taking amitriptyline? 
Yes, especially during the first few weeks or if your dose changes[1]. 

For the official NHS guide to amitriptyline, visit their website.