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Vicky Davis

Reviewed by Vicky Davis, FNP

Written by Geoffrey Whittaker

Published 05/05/2022

Updated 05/06/2022

Amitriptyline is a name you might struggle to pronounce. However, it’s also a versatile, effective medication that’s used to treat a diverse range of medical issues, from mental illnesses such as clinical depression to neuropathic pain conditions. 

There are several common uses for amitriptyline. As such, your dosage and the experience you have with this medication can vary based on why your healthcare provider prescribes it to you.

Below, we’ve explained what amitriptyline is, as well as the specific conditions it’s often used to treat. 

We’ve also shared some alternatives to amitriptyline that you may want to consider if you suffer from a mental health issue, such as depression

What is Amitriptyline?

Amitriptyline is a prescription antidepressant. It belongs to a class of medications referred to as  tricyclic antidepressants, or TCAs.

Tricyclic antidepressants like amitriptyline work by increasing the levels of natural chemicals in your brain and body, which are referred to as neurotransmitters. These chemicals allow nerve cells, or neurons, to communicate with each other throughout your brain and body.

Proper neurotransmitter function is important for just about every aspect of your life, from your ability to think and feel to many of your essential bodily functions.

More specifically, amitriptyline works by increasing levels of serotonin and norepinephrine, two important neurotransmitters that are responsible for regulating certain aspects of your thinking, moods and behavior.

Serotonin is involved in managing your feelings of happiness and anxiety. It also plays a major role in stimulating the parts of your brain that control your ability to fall asleep and wake up at a consistent, regular time each day.

Maintaining normal serotonin levels is important for emotional stability. Research suggests that low levels of serotonin could play a part in several mood disorders, including major depressive disorder (MDD), obsessive-compulsive disorder (OCD) and anxiety.

Norepinephrine plays a critical role in increasing your heart rate, managing blood sugar levels, increasing blood pressure and providing your body with a consistent source of energy.

Like serotonin, it also has an effect on your brain function. Research shows that norepinephrine helps to regulate your sleep-wake cycle, allows you to concentrate on specific tasks and helps with the formation of memories.

Low levels of norepinephrine are also linked with health issues and psychiatric disorders, such depression, anxiety and attention deficit hyperactivity disorder (ADHD). 

As a tricyclic antidepressant, amitriptyline helps to increase levels of these neurotransmitters in your brain by preventing them from being reabsorbed.

When your brain isn’t able to reabsorb the surplus of these neurotransmitters, this means that there’s a larger supply on standby for what your brain actually needs them for: regulating your moods and feelings. 

Tricyclic antidepressants have been available since the late 1950s, and they’ve been used for the treatment of depression fairly frequently since then.

Most research suggests that they’re very effective as treatments for depression. In fact, a 2001 systematic review published in the British Journal of Psychiatry found that amitriptyline worked more effectively than other antidepressants in people with symptoms of depression.

However, it also noted that amitriptyline was less well tolerated (meaning it was more likely to lead to side effects) than more modern medicines for depression, such as selective serotonin reuptake inhibitors (SSRIs).

Common Amitriptyline Uses

Amitriptyline is used to treat a diverse range of mental and physical conditions, from clinical depression to certain forms of chronic pain in adults, such as fibromyalgia. It’s also used to treat conditions such as irritable bowel syndrome and to prevent migraines.

Depressive Disorders

As with other antidepressant drugs, amitriptyline is primarily used to treat depressive disorders, such as major depressive disorder). In fact, treating depression is the only use for amitriptyline that’s approved by the FDA.

Although amitriptyline is effective at treating most depressed patients, it generally isn’t used as the first form of treatment for people with depression. This is because it’s more likely to cause side effects than other, newer drugs used in antidepressant therapy.

However, if you have depression that doesn’t improve with the use of an SSRI, your healthcare provider may suggest switching to amitriptyline. 

Our guide to tricyclic antidepressants goes into more detail about how amitriptyline and similar medications work as depression treatments.

Anxiety Disorders

Although amitriptyline is currently only approved by the FDA for the treatment of depression, it’s also used as an off-label treatment for several other mental health conditions, including anxiety and post-traumatic stress disorder (PTSD).

Neuropathic Pain 

Neuropathic pain is a type of pain that’s caused by nerve damage. It can develop as a result of certain infections, alcohol abuse, central nervous system disorders and diseases like diabetes, which can harm your nervous system and prevent it from functioning properly.

Amitriptyline is one of several tricyclic antidepressants used to treat neuropathic pain disorders, such as diabetic neuropathy and fibromyalgia.

Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is a digestive condition that can cause bloating, stomach cramps, gas, diarrhea and constipation.

Amitriptyline is sometimes prescribed off-label as a treatment for irritable bowel syndrome. In a clinical trial published in 2008, researchers found that it may help to reduce IBS-related diarrhea when used at a low daily dose.

Migraines

Amitriptyline is also used off-label as a treatment for migraines -- severe headaches that often involve throbbing, pulsing pain. It’s typically used as a prophylaxis, meaning a medication used preemptively to prevent migraine headaches from occurring. 

In a study published in the journal Headache in 2011, researchers found that amitriptyline was more effective than a placebo treatment for eight weeks of treatment. However, the effects of amitriptyline were not as significant after eight weeks of use.

Insomnia

One of the most well-known side effects of amitriptyline is drowsiness. After using amitriptyline, many people feel sleepy. In fact, healthcare providers are typically advised to warn people who are prescribed amitriptyline to avoid driving until they know how the medication affects them.

Because of its ability to cause drowsiness, amitriptyline is sometimes prescribed at a low dose to treat sleep issues such as insomnia (difficulty falling asleep or staying asleep).

Interstitial Cystitis

Interstitial cystitis is a chronic health condition that can involve pain and pressure in the bladder and pelvis. It’s sometimes referred to as painful bladder syndrome, as it tends to produce pain that affects the lower abdomen.

Amitriptyline is occasionally used as a second-line treatment for interstitial cystitis when options such as behavioral modification aren’t effective.

Sialorrhea (Excessive Saliva Flow)

Sialorrhea is a condition that can develop when you have excessive saliva production, resulting in drooling. It can develop on its own or as a symptom of certain neurologic disorders, such as Parkinson’s disease and cerebral palsy. 

Many antidepressants, including amitriptyline, can cause dry mouth as a side effect. Because of this, amitriptyline is sometimes prescribed off-label to reduce saliva production and treat issues such as sialorrhea.

Most Effective Uses of Amitriptyline

Amitriptyline is commonly used for mood disorders, and it’s especially effective as an alternative to newer antidepressant drugs, such as SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs).

These antidepressants have a lower risk of causing side effects than amitriptyline, but may not always provide complete relief from depression symptoms.

If you’re prescribed amitriptyline, it may take two to four weeks before you begin to experience improvements in your mood and other symptoms of depression. It’s important to keep taking amitriptyline consistently, as these effects may gradually become more noticeable. 

Amitriptyline comes as an oral tablet. As a treatment for depression, it’s usually prescribed at a starting dosage of 25mg per day, taken before bedtime. Your healthcare provider might adjust this to a maximum dose of 150 to 300mg per day based on the severity of your symptoms.

You can read more about amitriptyline dosage in our guide.

If you’re prescribed amitriptyline, make sure to closely follow your healthcare provider’s advice and use your medication exactly as directed. Do not adjust your dose of amitriptyline or modify the way you use your medication without first talking to your healthcare provider.

Can Amitriptyline Cause Side Effects?

Amitriptyline can cause side effects. In fact, as an older tricyclic antidepressant, it generally has a higher risk of causing adverse effects than newer medications for depression, such as SSRIs and SNRIs. 

Most side effects of amitriptyline are mild and transient, meaning they gradually improve as you use this medication. However, some adverse reactions may be persistent and/or bothersome.

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

Like other antidepressants, amitriptyline can affect your sexual function. Sexual side effects of amitriptyline include changes in your libido and, for some men, erectile dysfunction (ED). 

Amitriptyline can also cause more serious side effects, such as irregular heartbeat, chest pain, slowed speech, eye pain, rash, orthostatic hypotension (low blood pressure while standing up), fainting and swelling that affects your face or tongue.

It’s important to contact your healthcare provider as soon as possible if you notice any of these side effects while using amitriptyline to treat depression or any other condition. 

Amitriptyline can also cause drug interactions, including serotonin syndrome. To reduce your risk of experiencing interactions or other adverse effects, make sure to inform your healthcare provider about any medications or substances you currently use or have recently used.

It’s also important to let your healthcare provider know about any underlying health conditions you have, such as an irregular heart rhythm, heart disease, or a previous cardiovascular event such as a heart attack or stroke.

They’ll be able to inform you about whether it’s safe for you to use amitriptyline, as well as how you can keep yourself healthy and avoid any unwanted issues during treatment. 

Alternatives to Amitriptyline

As we explained above, amitriptyline generally isn’t used as a first-line treatment for depression these days due to its significant risk of side effects.

Instead, it’s generally only prescribed when newer medications don’t seem to be totally effective, and as an off-label treatment for conditions other than depression. 

If you have been diagnosed with depression, your healthcare provider will likely suggest using a different type of medication to control your depression symptoms, such as an SSRI or SNRI.

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 serotonin-norepinephrine reuptake inhibitors (SNRIs), including duloxetine (Cymbalta®) and venlafaxine (Effexor®).

These medications are available following a consultation with a licensed psychiatry provider via our online psychiatry service

In addition to going on medication, your mental health provider may suggest participating in talk therapy, or psychotherapy. 

This form of treatment involves working with a mental health provider to identify and change the thoughts and behaviors that contribute to depression. One common form of therapy is cognitive behavioral therapy, or CBT.

We offer talk therapy online, allowing you to connect with a licensed therapist and learn more about dealing with depression without having to drive to appointments in person. 

The Bottom Line on Amitriptyline

Amitriptyline is approved by the FDA to treat depression. However, it’s used off-label to treat a diverse range of different conditions, from neuropathic pain to anxiety, digestive problems and even migraines. 

If you’re prescribed amitriptyline, it’s important to listen closely to your mental health provider’s instructions and follow their advice. 

It’s also important to let them know if you develop any side effects, allergic reactions or simply wish to stop taking amitriptyline.

If you’re just starting to look into mental health treatment, it’s always best to talk with a mental health professional to find out what’s best for you.

You can do this online by using our mental health services to connect with a licensed therapist or psychiatry provider, or learn more about your options for dealing with depression or anxiety with our free mental health resources and content. 

14 Sources

  1. Thour, A. & Marwaha, R. (2022, May 15). Amitriptyline. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537225/
  2. Moraczewski, J. & Aedma, K.K. (2022, May 2). Tricyclic Antidepressants. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557791/
  3. Sheffler, Z.M., Reddy, V. & Pillarisetty, L.S. (2022, May 8). Physiology, Neurotransmitters. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK539894/
  4. Brain Hormones. (2022, January 24). Retrieved from https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/brain-hormones
  5. Adrenal Hormones. (2022, January 24). Retrieved from https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/adrenal-hormones
  6. Barbui, C. & Hotopf, M. (2001). Amitriptyline v. the rest: still the leading antidepressant after 40 years of randomised controlled trials. British Journal of Psychiatry. 178 (2), 129-144. Retrieved from https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/amitriptyline-v-the-rest-still-the-leading-antidepressant-after-40-years-of-randomised-controlled-trials/149B8AB17D99C548445A9E40986FADF3
  7. Neuropathic Pain. (2020, December 7). Retrieved from https://my.clevelandclinic.org/health/diseases/15833-neuropathic-pain
  8. Vahedi, H., et al. (2008, April). Clinical trial: the effect of amitriptyline in patients with diarrhoea-predominant irritable bowel syndrome. Alimentary Pharmacology & Therapeutics. 27 (8), 678-684. Retrieved from https://pubmed.ncbi.nlm.nih.gov/18248658/
  9. Couch, J.R., et al. (2011, January). Amitriptyline in the prophylactic treatment of migraine and chronic daily headache. Headache. 51 (1), 33-51. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21070231/
  10. Amitriptyline. (2017, July 15). Retrieved from https://medlineplus.gov/druginfo/meds/a682388.html
  11. Everitt, H., et al. (2014, February). GPs’ management strategies for patients with insomnia: a survey and qualitative interview study. British Journal of General Practice. 64 (619), e112-e119. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905408/
  12. Interstitial Cystitis (Painful Bladder Syndrome). (n.d.). Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrome
  13. Generali, J.A. & Cada, D.J. (2014, October). Amitriptyline: Interstitial Cystitis (Painful Bladder Syndrome). Hospital Pharmacy. 49 (9), 809-810. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4252183/
  14. Lakraj, A.A., Moghimi, N. & Jabbari, B. (2013, May). Sialorrhea: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins. Toxins. 5 (5), 1010-1031. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709276/
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Vicky Davis, FNP

Dr. Vicky Davis is a board-certified Family Nurse Practitioner with over 20 years of experience in clinical practice, leadership and education. 

Dr. Davis' expertise include direct patient care and many years working in clinical research to bring evidence-based care to patients and their families. 

She is a Florida native who obtained her master’s degree from the University of Florida and completed her Doctor of Nursing Practice in 2020 from Chamberlain College of Nursing

She is also an active member of the American Academy of Nurse Practitioners.

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