Amitriptyline Dosage Guide

If you’ve been diagnosed with depression, anxiety or a chronic pain disorder, your healthcare provider may prescribe amitriptyline to help you treat your symptoms. 

If there’s one thing we can say with certainty, it’s that amitriptyline didn’t win the “catchy names” lottery. This tricyclic antidepressant’s name is hard to pronounce, but thankfully, using it to treat depression and other conditions isn’t so challenging.

If you’re reading this, we’re guessing you're probably pretty familiar with depression and how it can affect you.

Depression is a common mental illness, as well as one of the most well-known mood disorders out there. There’s a reason so many people know about it -- it affects a truly staggering number of people, with an estimated 21 million US adults affected every year.

Many medications have been developed in the hope of treating depression over the years, and while not all of them have worked effectively, many have indeed helped people with depression live more normal lives.

Amitriptyline is one of these effective medications. However, like all medications, it needs to be used at the proper dosage for you to experience its benefits while reducing your risk of adverse effects. 

Below, we’ve explained what amitriptyline is, as well as how it works as a form of antidepressant treatment. We’ve also shared dosage information for amitriptyline as a treatment for depression, neuropathic pain and other conditions.

Finally, we’ve shared a few alternatives to amitriptyline that you may want to consider if you feel like this antidepressant medication isn’t quite suitable for you.

What is amitriptyline used for? Amitriptyline is a tricyclic antidepressant, or TCA. It’s been in use as a treatment for depression in adults for more than 60 years, with the medication first gaining approval from the FDA in the early 1960s.

Tricyclic antidepressants like amitriptyline work by preventing the reuptake of naturally-occurring chemicals called neurotransmitters, which are used to manage your moods, thoughts, behaviors and other biological processes.

More specifically, tricyclic antidepressants such as amitriptyline work by blocking the reuptake of serotonin and norepinephrine. This increases levels of these neurotransmitters in your brain and body, which may help to reduce severity of the symptoms of depression.

Serotonin is involved in regulating your moods, anxiety levels and feelings of happiness. It also plays an important role in allowing you to sleep on a consistent schedule by stimulating parts of your brain responsible for feelings of tiredness at night and alertness in the morning.

Research suggests that low levels of serotonin may play a role in the development of psychiatric disorders such as depression and anxiety.

Norepinephrine helps to increase your heart rate, blood pressure and blood sugar levels, giving you a consistent source of energy. It also plays a major role in your sleep and wake cycle, your ability to concentrate on specific tasks and your memory storage capabilities.

Like serotonin, low levels of norepinephrine are associated with mood disorders, including some forms of depression.

By blocking the reuptake of these neurotransmitters, amitriptyline increases norepinephrine and serotonin levels -- something that experts believe may provide antidepressant effects.

Although amitriptyline is approved by the FDA as a treatment for major depressive disorders, it’s rarely used as a first-line treatment for depression (meaning the first type of medication that you will be prescribed).

This is because tricyclic antidepressants such as amitriptyline have a higher risk of causing side effects than newer medications for depression.

Instead of prescribing amitriptyline, your healthcare provider will usually recommend a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) if you have been diagnosed with a form of depression. 

These medications have a lower risk of causing intolerable side effects, meaning they’re usually easier for people with depression to take on an ongoing basis. 

However, medications like amitriptyline are still used to treat depression, especially when newer medications aren’t fully effective.

Your healthcare provider may recommend using amitriptyline if you don’t feel any improvements from an SSRI or SNRI, or if you have a condition other than depression for which amitriptyline is used as an off-label treatment.

Common off-label uses for amitriptyline include:

• Anxiety

• Insomnia

• Post-traumatic stress disorder (PTSD)

• Interstitial cystitis (bladder pain syndrome)

• Irritable bowel syndrome (IBS)

• Sialorrhea (excessive saliva flow)

• Postherpetic neuralgia

• Diabetic neuropathy

• Fibromyalgia

• Migraines

Like other antidepressants, amitriptyline can require some time to work effectively. You may start to notice improvements in your symptoms after using amitriptyline for two to four weeks, with the full effects becoming more noticeable after one month or longer.

For depression, amitriptyline is typically prescribed at a recommended dosage of 25 to 300mg per day, taken just before bedtime. 

If you’re prescribed amitriptyline for depression, your healthcare provider will likely suggest an initial dose of 25mg per day. This may be increased in 25mg increments every few days to a maintenance dose of approximately 50 to 100mg per day.

Your healthcare provider may make further dose adjustments if you have severe symptoms of depression that don’t improve with a moderate dose of amitriptyline. The maximum dosage of amitriptyline for depression is 150 to 300mg per day.

It’s common and normal to take amitriptyline for several months in order to properly treat your depression symptoms. If you want to stop taking amitriptyline, it’s important to tell your mental health provider ahead of time.

They’ll help you slowly taper your dosage to avoid withdrawal symptoms and limit your risk of experiencing a relapse of your depression. 

Although amitriptyline isn’t approved by the FDA as an anti-anxiety medication, it’s sometimes prescribed off-label to treat certain forms of anxiety.

Since anxiety is an off-label indication, there’s no standardized dosage range for amitriptyline when it’s used for this purpose. Your healthcare provider will generally suggest a dosage that offers relief from your anxiety symptoms while limiting your risk of common side effects. 

Mostresearch into amitriptyline as a medication for anxiety involves a dosage range of 25 to 250mg per day. Research suggests that people often experience improvements in anxiety symptoms after taking 50mg of amitriptyline on a daily basis.

If you’re prescribed amitriptyline to treat anxiety, panic attacks or a similar issue, make sure to inform your healthcare provider if you feel like your medication isn’t totally effective, or if you’re starting to develop any side effects.

If you’re prescribed amitriptyline for another off-label use, such as chronic pain relief or issues related to sleeping, your healthcare provider will inform you about how to take your medication and what dosage to use.

For off-label uses, amitriptyline is generally prescribed at a relatively low starting dose, such as 10 to 20mg per day. Your healthcare provider might adjust your dose of amitriptyline over time if the lowest dose doesn’t provide effective relief from your symptoms.

Make sure to closely follow your healthcare provider’s instructions and inform them if you notice any bothersome or persistent side effects while using amitriptyline.

Amitriptyline is generally a safe and effective medication when it’s used as prescribed. However, as an older tricyclic antidepressant, it has a higher risk of causing side effects than newer drugs for depression, such as SSRIs and SNRIs.

Common side effects of amitriptyline include:

• Nausea

• Vomiting

• Drowsiness

• Confusion

• Dry mouth

• Headaches

• Physical weakness

• Unsteadiness

• Tiredness

• Confusion

• Nightmares

• Blurred vision

• Constipation

• Urinary retention

• Excessive sweating

• Changes in appetite 

• Changes in weight

Amitriptyline can also cause sexual side effects, including changes in your sex drive and sexual performance issues such as erectile dysfunction (ED). 

Amitriptyline may also cause more serious side effects, including swelling that affects your face, fainting, slow or slurred speech, seizures, yellowing of the eyes or skin, muscle spasms, tremor, hallucinations, chest pain, irregular heartbeat, eye pain, unusual bleeding and/or bruising. 

If you experience any of these side effects, it’s important to seek medical advice as soon as you can by contacting a medical professional. 

It’s important not to use amitriptyline if you have ever had a heart attack (myocardial infarction), have heart failure or if you have an eye condition such as glaucoma.

It’s also important to inform your healthcare provider about all medications you currently take or have recently taken before using amitriptyline, especially if you’ve recently been prescribed any type of monoamine oxidase inhibitor (MAOI) medication.

This type of medication may interact with amitriptyline, increasing your risk of potentially severe issues such as serotonin syndrome. 

Although amitriptyline is generally safe when it’s used at the prescribed dosage, it’s important not to take too much of this medication. Taking too little amitriptyline or skipping a dose is not necessarily dangerous, but taking too much may cause heart and brain issues.

Signs of an amitriptyline overdose include:

• Confusion

• Drowsiness

• Hallucinations

• Agitation

• Difficulty concentrating

• Loss of consciousness

• Cold body temperature

• Irregular heartbeat

• Rigid muscles

• Vomiting

• Seizures

• Fever

Amitriptyline overdose is a serious medical emergency. If you, a friend or a family member has taken too much amitriptyline and is displaying overdose symptoms, you should call emergency services on 911 as soon as you can. 

Although amitriptyline is effective for many people, its risk of side effects means it typically isn’t used as a first-line treatment for depression.

If you’re prescribed amitriptyline to treat depression, you may benefit from changing to a more modern antidepressant, such as an SSRI or SNRI.

These medications provide many of the same benefits as older antidepressant drugs such as amitriptyline, but have a lower risk of causing side effects, making them a better option from a quality of life standpoint.

We offer several SSRis online, including fluoxetine (the active ingredient in Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®) and escitalopram (Lexapro®).

We also offer several SNRIs that are used to treat depression, such as duloxetine (Cymbalta®) and venlafaxine (Effexor®).

These medications are available via our online psychiatry service, following an evaluation with a licensed psychiatry provider who will determine if a prescription is appropriate. 

As a medication for treating depression, amitriptyline can offer real benefits. However, it’s vital to use this medication at the correct dosage to maximize its benefits while limiting your risk of side effects, interactions and other issues. 

If you’re prescribed amitriptyline for depression or an off-label use, make sure that you follow the dosage instructions given to you by your healthcare provider.

It’s also important to alert your healthcare provider as soon as possible if you have any adverse effects from amitriptyline.

Although medication is one part of managing depression, it isn’t the entire puzzle. Other options for treating depression include talk therapy, as well as changes that you can make to your habits and lifestyle. 

We offer individual therapy and anonymous support groups as part of our range of online mental health services, allowing you to connect with a mental health expert and get help from your own home. 

You can also learn more about successfully managing depression, anxiety, bipolar disorder and other mental health concerns with our free mental health resources and content.