Treating depression with Amitriptyline

Amitriptyline is a common tricyclic antidepressant that is used to manage symptoms of depression. It works by influencing chemicals present in brain as these chemicals get unbalanced in people who are in state of depression. The generic name is Amitriptyline and the brand name is Elavil and Vanatrip.

Important Information

Avoid using this medicine if you recently suffered from a heart attack. Also avoid using Amitriptyline if you were on MAO inhibitor in last 14 day like methylene (blue injection), linezolid, isocarboxazid, rasagiline, phenelzine or tranylcypromine.

Before you start using Amitriptyline, let your doctor know if you have used an SSRI antidepressant in last 5 weeks like fluoxetine, escitalopram, citalopram, Sarafrem, fluvoxamine, sertraline and paroxetine.

You may get suicidal thoughts, when you start using an antidepressant like Amitriptyline, especially if you are below 24 years of age. Your doctor will ask you to come for regular checkups at least for the first twelve weeks of Amitriptyline treatment.

If any worsening symptoms persist, discuss with your doctor like anxiety, changes in mood or behaviour, panic attacks, feel agitated, impulsive, restless, irritable, aggressive, hostile hyperactive, more depressed or getting suicidal thoughts or hurting yourself.

Do not use Amitriptyline if you are allergic to the medicine or had a heart attack recently. To know if Amitriptyline is a safe medication for you, tell your health care provider if you have

  1. liver disease
  2. glaucoma
  3. urinating problems
  4. heart disease
  5. schizophrenia or bipolar disorder
  6. history of seizures, heart stroke or attack
  7. diabetes
  8. history of psychosis or mental illness

 

Some young patients get suicidal thoughts when they start using antidepressant. His/her family members should be alert to check for mood changes or related symptoms. The patient should be checked regularly by his/her physician.

Use Amitriptyline as directed by the physician. Also read the directions on the label and follow them carefully. Do not use the medication for a longer period or take high doses. Do not stop using Amitriptyline suddenly without consulting your doctor as it can lead to unwanted withdrawal symptoms. Speak to your doctor to know how to stop Amitriptyline consumption safely.

Store the medicine at room temperature away from light, heat and moisture.

Is Amitriptyline an Addictive Antidepressant?

Amitriptyline is not at all addictive, but when you stop taking it, it should be done slowly over 2-3 weeks to avoid serious withdrawal symptoms like malaise and headache. Some reports say that using Amitriptyline in large doses can result in hallucinations or high in some people.

If a person is trying to get high through Amitriptyline, it can be dangerous and result in life threatening effects or overdose.

Keep this drug away from teenagers and children or anyone who is trying to use Amitriptyline without prescription.

Amitriptyline should not be taken for a longer period as you may face serious side effects. Avoid taking in excess as it can lead to severe effects that can be fatal too. If you want to stop using Amitriptyline, speak to your doctor before you stop using Amitriptyline completely.

Side effects that can bother you while using Amitriptyline

In addition to the desired effects, some unwanted side effects occur as a result of Amitriptyline consumption. These side effects can be mild which do not need medical attention and go with time, but some other side effects can bother you while you are using Amitriptyline. You should contact your doctor if the side effects continue to exist for a long period or bother you.

Major Side effects

Occurrence not known

  • agitation
  • bleeding gums
  • chills
  • cold sweats
  • coma
  • tarry, black stools
  • stomach or abdominal pain
  • confusion
  • discomfort or chest pain
  • change in rhythms and pattern of speech
  • numbness, prickling, crawling, itching or tingling feelings
  • convulsions
  • dark urine
  • pale, cool skin
  • hoarseness or cough
  • breathing problems
  • speech problem
  • drooling
  • dry mouth
  • excitement
  • difficulty in concentrating
  • decreased volume of urine
  • double vision
  • fainting
  • nervousness or fear
  • dry, flushed skin
  • fever without or with chills
  • hearing loss
  • headache
  • hostility
  • inability to move facial, legs, arms muscles
  • increased sweating
  • increased hunger
  • lethargy
  • appetite loss
  • lip puckering or smacking
  • overactive reflexes
  • vomiting and nausea
  • poor coordination
  • restlessness
  • seizures
  • fast weight gain
  • shivering
  • shuffling walk
  • unsteady or shaky walk
  • slow speech
  • stupor
  • sore throat
  • sweating
  • swollen glands

Symptoms of overdose that need immediate medical help are

  • muscle aches
  • drowsiness
  • sleepiness
  • feeble pulse
  • tiredness
  • feeble or weak pulse
  • reduced body temperature
  • muscle weakness
  • clumsiness

Minor Side effects

Some minor side effects will not bother you and will vanish with time. Once your body gets used to the medication, the minor side effects disappear. If you still notice that some side effects lasts for a longer period, contact your doctor immediately.

Occurrence not known

  • welts or hives
  • hair thinning or hair loss
  • diarrhoea
  • constipation
  • bloating
  • black tongue
  • enlarged, bigger and dilated pupils
  • decreased interest in intercourse(sex)
  • change in taste sense
  • skin rash
  • severe sunburn
  • discoloration or redness of skin
  • swollen breast and breast soreness (in males)
  • swollen parotid glands
  • inflammation or swelling of mouth
  • excess flow of milk from breasts
  • inability to have erection or keep erection
  • loss in sexual desire, ability, performance or drive

The above side effects can be severe and if you notice any unusual symptoms ask for medical help immediately as timely medical attention can help you avoid fatal complications. Consult your doctor before you stop taking the medication as there are many withdrawal symptoms and side effects that occur after you stop the medication. Your doctor will lower the dose of Amitriptyline gradually and you can stop taking medicine accordingly. Withdrawal symptoms are life threatening too so seek your doctor’s advice before taking any decision.

Possible Drug Interactions – Amitriptyline

Amitriptyline is an active ingredient present in different types of antidepressants, which is prescribed in case of chronic lower back pain. The Amitriptyline dose is quite low as compared to the dose recommended for depression. If you are using other medications apart from Amitriptyline, you should speak to your doctor in detail with the prescription. There are more than 2000 drugs that can interact with Amitriptyline resulting in mild to severe side effects.

The list given below can help you talk to your doctor in detail about medications you are taking.

  1. Tell your doctor if you consume alcohol. Alcohol when taken with Amitriptyline can result in side effects like blurred vision, confusion, seizures, irregular heartbeats, drowsiness, vomiting etc.,
  2. Also do not hide anything from your doctor even if you are using illegal drug as Amitriptyline interacts with illegal drugs and can harm your health.
  3. Also let your doctor know if you have used an MAO inhibitor as MAO inhibitors are not recommended to be taken with Amitriptyline.
  4. Discuss about any other drugs that you have stopped using now.
  5. Other things that you should not forget to discuss with your doctor is to tell your doctor if you are taking antacids, sleeping pills, birth control pills, grapefruit or juice, antihistamines or other medications for weight loss, flu or cold medications, appetite suppressants etc.,

Drug Interactions responsible for Increasing Amitriptyline Blood levels

Some interactions between some other drugs and Amitriptyline can increase the level of Amitriptyline in your blood resulting in additional side effects. Here is the list of drugs that can interact with Amitriptyline

  1. Drugs used for an irregular heartbeat or any other heart medications.
  2. blood thinners like Warfarin
  3. chemotherapy drugs like procarbazine and imatinib
  4. Parkinson’s drugs like levodopa
  5. diarrhoea medication like diphenoxylate
  6. some antibiotics
  7. thyroid hormones like levothyroxine
  8. SSRI medications
  9. seizure and epilepsy medications
  10. drugs used to treat HIV – delavirdine
  11. bromocriptine
  12. cimetidine – ulcer/heartburn medication
  13. Phenobarbital or atropine
  14. disulfiram – a drug used to help people quit drinking

 

Anticholinergic agents and Amitriptyline

When Amitriptyline is taken with Anticholinergic agents or other sympathomimetic drugs like epinephrine with local anaesthetics need careful dose adjustment as needed and close monitoring.

Hyperpyrexia is noticed in case anticholinergic agents and Amitriptyline are combined together or combined with neuroleptic drugs especially in hot weather.

Paralytic ileus is also reported in patients taking Amitriptyline and anticholinergic agents together.

Some common drugs that interact with Amitriptyline and lead to major side effects are

  • Fluxoetine
  • Tramadol
  • Sertraline
  • Duloxetine
  • Citalopram
  • Cyclobenzaprine
  • Trazodone
  • Topamax

Speak to your doctor before you start using Amitriptyline as if you are using any other drugs currently, you should discuss the list of prescription or non prescription drugs with your doctor to avoid the harmful side effects of drug interactions. As stated above there are around 2000 drugs that interact with Amitriptyline and your doctor is the right person to tell you the risks/benefits of using Amitriptyline.

Can I take Amitriptyline during pregnancy or breastfeeding?

Well, the answer to this question is ideally no because the safety of using Amitriptyline during breastfeeding or pregnancy is still not been completely established. The reality is that depression can occur in women during pregnancy and women using antidepressants can also become pregnant.

Amitriptyline and Pregnancy

Amitriptyline is sometimes used during pregnancy, provided the doctor has calculated the risks/benefits of this drug when compared with other treatments or stopping treatment. Amitriptyline is believed to have harmful effects on your baby during first and third trimester of your pregnancy. Symptoms that match the withdrawal symptoms and side effects of Amitriptyline were seen in new born whose mothers used Amitriptyline in third trimester of their pregnancy.

It is always better to consult your doctor before taking Amitriptyline during pregnancy. If you are pregnant and plan to stop using Amitriptyline, speak to your doctor to know how you can stop taking the drug safely instead of stopping suddenly.

If you have taken Amitriptyline during pregnancy, make sure your doctor knows about it. You can talk to your doctor and tell him that you need the medicine. He can advice the lowest dose that works well for you accordingly.

There is still no evidence available to prove that using Amitriptyline during pregnancy is harmful or lead to birth defects, but looking at the side effects of Amitriptyline and developmental stages of baby during third trimester of pregnancy, Amitriptyline is not recommended.

Amitriptyline and breastfeeding

Amitriptyline is secreted in breast milk in small amounts and can affect your baby. You should consult your paediatrician if you are planning to breastfeed your baby while using Amitriptyline. There are some important factors that need to be considered for example whether premature delivery took place. In some cases it is safe to use Amitriptyline during breastfeeding provided the baby is monitored closely for possible side effects.

Amitriptyline use during breastfeeding shows no adverse effects in infants, especially in infants above 2 months old. Effect of Amitriptyline on infants is still not known. It is always better to consult your doctor before you take any decision.

Some women looking at the adverse effect of tricyclic antidepressants either discontinue breastfeeding or discontinue use of Amitriptyline. Some mothers experience depression post delivery and when it becomes difficult to manage depression through other medications, they opt for Amitriptyline. If you feel it is necessary for you to take antidepressants to manage depression, then ask your doctor if it is suitable for you and your baby while breastfeeding.

Sometimes doctors recommend you to take Amitriptyline in low doses while breastfeeding to manage the symptoms of depression. Make sure you monitor your baby’s health closely if you are breastfeeding, and if you find any unusual symptoms in your baby, contact your paediatrician immediately so that you can avoid further complications.

In general any drug can affect your health and your baby’s health in some or the other way and if you could manage the symptoms of depression through alternative treatment methods, you can easily continue with medications and breastfeeding.

Amitriptyline – General Dosage to treat depression

Amitriptyline is used to manage symptoms of depression. It can prove to be an effective antidepressant if taken in right dosages and as per your doctor’s directions. Let us have a look at general dosage information of Amitriptyline used to symptoms of depression.

For Depression- Normal Adult Dose

Normal dose

75 mg to be taken orally in split doses. This can go up to maximum dose of 150mg/day if required.

Alternate dose

40-100mg to be taken orally as a single dose while going to bed, this can be increased from 25-50mg as required at bedtime to a maximum dose of 150mg/day.

Maximum dose

150 mg to be taken orally per day

Inpatients

Initial dose

75 mg/day- taken orally

Maintenance dose

40-100mg to be taken orally as a single dose while going to bed

Maximum dose

300mg to be taken orally per day

Note: Dosage needs to be reduced to lowest possible amount that can help manage relief of depression symptoms, when satisfactory results are attained.

Increment in dosage should be made late in the afternoon or during bedtime because of its sedative effect.

The complete healing effect can take minimum 30 days to progress.

Maintenance therapy should be carried out for three months or more to reduce the possibility of failure.

Normal Geriatric dose – depression

10mg to be taken orally –thrice a day with 20mg while going to bed

Note: The complete healing effect can take minimum 30 days to progress. Elderly patients need to be monitored very carefully. Dose adjustments can be made as per the clinical response.

Normal paediatric dose – depression

12 years and above

10mg – to be taken orally thrice a day with 20mg while going to bed

Amitriptyline – Overdose treatment

Deaths can occur from Amitriptyline over dosage. Some of the overdose symptoms are as follows

  1. Lungs and Airways- laboured or slow breathing
  2. Kidneys and Bladder- Unable to urinate, weak urine flow
  3.  blurred vision
  4. dry mouth
  5. irregular heart beat
  6. shock

In case of overdose, call nearest poison control centre immediately. In an emergency room, the patient can be treated with

  1. activated charcoal
  2. urine and blood tests
  3. Laxative
  4. Chest X-ray
  5. EKG
  6. Fluids via vein
  7. Gastric lavage
  8. medicine known as antidote to reduce the effects of poison and treat related symptoms

Amitriptyline overdose can be quite serious. People who consume this drug in excess need immediate hospitalization.

How well a person responds to the overdose treatment depends on the amount of drug swallowed and how soon a person receives treatment. There are better chances of speedy recovery if the person gets immediate medical help. Complications like pneumonia, brain damage due to lack of oxygen, muscle damage and even death can occur.

The first thing that should be done in case of an overdose is to call poison control centre or medical help. The patient should get immediate treatment so that the poison is flushed out from the body soon before its effects are accelerated.

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