Starting treatment with antidepressants can often be an apprehensive and challenging prospect, and as such, it’s important to be well-educated on the matter so that you know what to expect.
What is amitriptyline and what is it used for?
Amitriptyline is an antidepressant medication primarily prescribed for the treatment of clinical depression and low mood. This medication also possesses some analgesic (anti-pain) properties, and for this reason it is also often prescribed to treat migraines and certain kinds of pain.
Originally created in the 1960’s, amitriptyline remains widely used today due to its efficacy against depression. In contrast to newer antidepressants such as sertraline and venlafaxine, amitriptyline is less well tolerated across the population, and as such is seldom considered as a first choice in the treatment of depression. Instead, amitriptyline is mostly prescribed to people that have either failed to respond or had an inadequate response to one or two newer antidepressant medications.
How does amitriptyline work?
Amitriptyline belongs to a class of antidepressants called tricyclic antidepressants, named after their distinct chemical structure consisting of three rings. Tricyclic antidepressants work in a similar way to SSRIs and SNRIs, by increasing the availability of certain mood-related neurotransmitters in the brain, specifically serotonin and noradrenaline.
For more general information on how antidepressants work, check out our article Taking antidepressants: What should I know?
Unlike SSRIs and SNRIs, tricyclics such as amitriptyline can interact with other processes and chemicals in the body not immediately related to depression, thus increasing the chances that patients can experience unpleasant side effects. This is the reason why drugs such as amitriptyline are less well tolerated and not considered as first-line options for the treatment of depression.
How long does amitriptyline take to work?
Most antidepressants take a few weeks until they begin to work, and amitriptyline is no exception to this rule. Amitriptyline generally begins to work within 2 to 4 weeks and may take up to 6 weeks to reach a full effect.
This is called a “therapeutic lag” and highlights the importance of adhering to your medication regimen. If you’ve been prescribed amitriptyline, it’s important to give it a full 6 weeks to take full effect.
How to take amitriptyline
Amitriptyline formulations can come in various forms, though the most common ones are oral and liquid preparations. If you’ve been prescribed amitriptyline, it’s likely that you’ll be given oral tablets.
For depression, treatment generally starts at 50 to 100mg per day, a dosage that can be increased up to a maximum of 200mg if needed.
Your doctor will provide more detailed instructions on how and when to take amitriptyline, and you can also ask your pharmacist for more information. Generally, amitriptyline is simply taken with water at the same time every day – usually before bed, as the medication tends to produce a drowsy or sleepy effect. It can be taken with or without food, as it’s not known to cause stomach issues.
It’s essential that you strictly adhere to the treatment regimen prescribed to you. If you forget to take a dosage, take it as soon as you remember, unless it’s close to the next dosage. Never take more amitriptyline than indicated and avoid taking two doses at the same time to make up for a forgotten dose. If you have any questions or concerns regarding this, please contact our pharmacy team or your GP directly.
Side effects of amitriptyline
Like most other medicines, amitriptyline can produce unpleasant side effects, particularly in the initial period of treatment as your body gets adjusted to the medicine. After a few weeks, the intensity of the side effects will start to diminish, and your side effects may go away completely.
Common side effects include:
You may also experience rarer and more serious side effects. Call your doctor as soon as you can if you experience any of the serious side effects on this list.
Amitriptyline cautions and contraindications
It’s important to inform your doctor about any medicines that you’re taking, including herbal remedies such as St. John’s Wort.
In particular, amitriptyline interacts with opioid medications such as codeine, morphine, dihydrocodeine, buprenorphine, fentanyl and oxycodone. Such interactions can be dangerous and may lead to excessive drowsiness and difficulty breathing.
To learn more about amitriptyline, please refer to the official NHS article.
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