Amitriptyline – Tricyclic antidepressant for depression and chronic pain.
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What is Amitriptyline?
Amitriptyline is a tricyclic antidepressant that’s widely used not only for depression but also for chronic pain conditions and migraine prevention. While it has more side effects than newer antidepressants, it remains valuable for specific conditions where other treatments haven’t been effective.
Book an online consultation if you’re experiencing chronic pain, frequent migraines, or depression that hasn’t responded to other treatments. Our GPs can assess whether Amitriptyline is appropriate for your specific condition and provide proper monitoring for side effects.
What is Amitriptyline used for?
- Major depressive disorder (when SSRIs unsuitable)
- Chronic pain conditions (neuropathic pain)
- Migraine prevention
- Tension headache prevention
- Fibromyalgia
- Chronic fatigue syndrome
- Sleep disorders (low dose)
- Irritable bowel syndrome (some cases)
How does Amitriptyline work?
A tricyclic antidepressant that blocks reuptake of serotonin and noradrenaline, and also has antihistamine and anticholinergic effects. For pain, it modulates pain pathways in the nervous system.
Dosage and Administration
Adults
Depression: 75-150mg daily. Pain/migraine prevention: 10-75mg daily, usually taken at bedtime.
Children
Not recommended for depression in under-18s. Occasionally used for other conditions under specialist supervision.
Important Notes
- Usually taken as a single dose at bedtime due to sedating effects.
- Start with low dose and increase gradually.
- For pain relief, benefits may be seen at lower doses than for depression.
- May take 2-4 weeks to see full benefits for depression.
Side Effects
Common Side Effects
- Drowsiness and sedation
- Dry mouth
- Constipation
- Blurred vision
- Weight gain
- Dizziness
- Difficulty urinating
- Increased sweating
Serious Side Effects
Seek immediate medical attention if you experience:
- Heart rhythm changes
- Severe low blood pressure
- Seizures (in overdose)
- Suicidal thoughts (especially when starting)
- Severe allergic reactions
- Glaucoma worsening
- Severe confusion (especially in elderly)
Important Warnings
- May increase suicidal thoughts in young adults—close monitoring required when starting.
- Dangerous in overdose—keep safely stored away from children.
- Tell your GP if you have heart disease, glaucoma, enlarged prostate, or epilepsy.
- Do not stop suddenly—gradual dose reduction required.
- May cause drowsiness—avoid driving until you know how it affects you.
Drug Interactions
Tell your GP if you're taking any of the following medications:
- MAOIs—dangerous interaction, must avoid completely.
- Other antidepressants—risk of serotonin syndrome.
- Alcohol—increases sedation and may be dangerous.
- Anticholinergic drugs—additive effects (dry mouth, confusion).
- Heart rhythm medications—may interact dangerously.
- Tramadol—increased risk of seizures.
Frequently Asked Questions
Why is Amitriptyline used for pain when it's an antidepressant?
At lower doses, Amitriptyline affects pain pathways in the nervous system independently of its antidepressant effects, making it effective for chronic pain conditions.
How is it different from modern antidepressants like SSRIs?
Amitriptyline affects multiple neurotransmitters and has more side effects, but it can be more effective for certain types of pain and when SSRIs haven't worked.
Why does it make me so drowsy?
Amitriptyline has strong antihistamine effects that cause sedation. This is why it's usually taken at bedtime and can help with sleep problems.
Can I stop taking it if my pain improves?
Don't stop suddenly as this can cause withdrawal symptoms. Your GP will help you reduce the dose gradually if discontinuation is appropriate.
Medically Reviewed by: Mohammed Hassan - Independent Prescriber
Last Updated: 2025-01-14