1. About amitriptyline for depression
Amitriptyline is an antidepressant medicine. It's used to treat low mood and depression.
This medicine is only available on prescription. It comes as tablets and as a liquid.
2. Key facts
- Amitriptyline is an antidepressant medicine. It works by increasing levels of a chemical called serotonin in your brain. This can improve your mood.
- You may start to feel better after 1 to 2 weeks but it can take 4 to 6 weeks for amitriptyline to work fully.
- Side effects such as a dry mouth and constipation are common. They're usually mild and go away after a couple of weeks.
- It's best to take amitriptyline in the evening or before you go to bed. This is because it can make you feel sleepy.
- Amitriptyline can cause side effects if you stop taking it suddenly. Talk to your doctor if you want to stop taking it.
3. Who can and cannot take amitriptyline
Most adults can take amitriptyline. It can also be taken by young people aged 16 to 17 years for depression or low mood.
Amitriptyline is not suitable for some people. To make sure it's safe for you, check with your doctor if you:
- have ever had an allergic reaction to amitriptyline or any other medicine
- have a heart problem – amitriptyline can make some heart problems worse
- have a rare blood disorder called porphyria
- have liver problems
- have epilepsy or are having electroconvulsive treatment (ECT) – amitriptyline may increase your risk of having a fit or seizure
- are pregnant, trying to get pregnant or breastfeeding
- have glaucoma – amitriptyline can increase the pressure in your eye
- have thoughts about harming yourself or ending your life
- have problems emptying your bladder
- have type 1 or type 2 diabetes
If you have diabetes, amitriptyline can make it more difficult to keep your blood sugar stable. Monitor your blood sugar more often for the first few weeks of treatment with amitriptyline and adjust your diabetes treatment if necessary. Speak to your doctor if your blood sugar levels are causing you concern.
4. How and when to take amitriptyline for depression
You'll usually take amitriptyline once a day. It's best to take it before bedtime because it can make you feel sleepy. If you find that you are still feeling drowsy in the morning you could try taking it earlier in the evening.
Dosage and strength
Amitriptyline tablets come in different strengths of 10mg, 25mg or 50mg.
Amitriptyline liquid also comes in 3 different strengths containing 10mg, 25mg or 50mg of amitriptyline in a 5ml spoonful.
The usual dose of amitriptyline for depression in adults is 50mg to 100mg a day. This may go up to 150mg to 200mg a day if you need a stronger dose, but only under the supervision of a specialist.
Young people aged 16 to 17 years and older people sometimes start on a lower dose of 25mg to 50mg a day to reduce the chance of side effects.
The maximum dose of amitriptyline is 200mg per day.
Sometimes, when you're just starting treatment, you may be told to take a lower dose, 2 or 3 times a day, until you get used to the medicine. This is because taking a smaller dose 2 or 3 times a day for a while can reduce the chance of you having side effects.
How to take it
Amitriptyline does not usually upset your stomach, so you can take it with or without food.
Swallow the tablets whole with a drink of water. If you chew them, they taste bitter.
The liquid comes with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.
What if I forget to take it?
If you take amitriptyline once a day and forget a dose, leave your missed dose and take your next one the next day at the usual time.
If you take amitriptyline 2 or 3 times a day and forget a dose, take it as soon as you remember unless it's close to the time for your next dose.
Never take 2 doses at the same time to make up for a forgotten dose.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
What if I take too much?
The amount of amitriptyline that can lead to an overdose varies from person to person.
Taking more than your prescribed dose of amitriptyline can:
- make you feel agitated
- make you sick (vomiting)
- cause shaking
- cause a fast heart rate
- cause fits or seizures (shaking and jerking uncontrollably)
If you need to go to A&E do not drive yourself. Get someone else to drive you or call for an ambulance.
Take the amitriptyline packet, or the leaflet inside it, plus any remaining medicine with you.
5. Side effects
Like all medicines, amitriptyline can cause side effects in some people, but many people have no side effects or only minor ones. Some of the common side effects of amitriptyline will gradually improve as your body gets used to the medicine.
Common side effects
Keep taking the medicine but talk to your doctor or pharmacist if these common side effects bother you or do not go away:
- dry mouth
- feeling sleepy, tired or weak
- difficulty peeing
Serious side effects
It happens rarely, but some people have a serious side effect after taking amitriptyline.
Call a doctor straight away if:
- your heartbeat becomes fast or irregular
- the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin, or you have dark pee – these can be signs of a liver problem
- you have constant headaches, long lasting confusion or weakness, and frequent muscle cramps – together, these can be a sign of low sodium levels in your blood. In severe cases low sodium levels can lead to a fit or seizure
- you have thoughts about harming yourself or ending your life
- you have eye pain, a change in your eyesight, or swelling or redness in or around your eye
- you have constipation that lasts a long time, or problems peeing which are causing stomach ache
Immediate action required: Call 999 and ask for an ambulance if:
- you have weakness on one side of your body
- you have trouble speaking or thinking
- you lose your balance or have blurred eyesight
These can be signs of a stroke.
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to amitriptyline.
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of amitriptyline. For a full list see the leaflet inside your medicines packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. How to cope with side effects of amitriptyline
What to do about:
- constipation – eat more high-fibre foods such as fresh fruit and vegetables and cereals. Try to drink several glasses of water or other non-alcoholic drinks every day. If you can, it may also help to increase your level of exercise.
- feeling dizzy – this is probably due to low blood pressure. Drink plenty of water or other non-alcoholic drinks. Do not stand up too quickly after you have been sitting or lying down. Do not drive until you stop feeling dizzy.
- dry mouth – try sugar-free gum or sugar-free sweets.
- feeling sleepy or tired – take amitriptyline in the evening and try to cut down the amount of alcohol you drink. Do not drive, cycle or use tools or machinery if you're feeling sleepy. Talk to your doctor if this does not help.
- difficulty peeing – try to relax when you pee. Do not try to force the flow of urine. If you still cannot go, try again later. Talk to your doctor urgently if you cannot pee at all.
- headaches – make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. Paracetamol and ibuprofen may help if you need pain relief. Talk to your doctor if the headaches last longer than a week or are severe.
7. Pregnancy and breastfeeding
Amitriptyline and pregnancy
If you are already taking amitriptyline, you may be advised to continue taking it during pregnancy, especially if you take it to treat depression.
If you become pregnant while taking amitriptyline, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.
Your doctor can explain how taking amitriptyline can help you and how it might affect you. They will also help you choose the best treatment for you and your baby.
Amitriptyline and breastfeeding
If your doctor or health visitor says your baby is healthy, you can take amitriptyline while breastfeeding.
Amitriptyline passes into breast milk in very small amounts, so it's unlikely to cause any harm to your baby.
It's important to keep taking amitriptyline to keep you well. Breastfeeding will also benefit both you and your baby.
If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your midwife, health visitor or doctor as soon as possible.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
For more information about how amitriptyline can affect you and your baby during pregnancy, find out more on the Best Use of Medicines in Pregnancy (BUMPS) website.
8. Cautions with other medicines
Many medicines and amitriptyline can affect each other and increase the chances of side effects.
Always check with your doctor or a pharmacist before starting any new medicine while you are taking amitriptyline.
Taking amitriptyline with opioid medicines can increase your risk of becoming very drowsy and having breathing problems. Opioid medicines include:
Tell your doctor if you have ever taken any other medicines for depression. Some antidepressants can affect the way amitriptyline works and cause very high blood pressure. This can happen even after you have stopped taking them.
Mixing amitriptyline with herbal remedies and supplements
Do not take St John's wort, a herbal remedy for depression, while you're taking amitriptyline as this will increase your risk of side effects.
There's very little information about taking amitriptyline with other herbal remedies and supplements. They are not tested in the same way as medicines.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about amitriptyline
How does amitriptyline work in depression?
Amitriptyline is from a group of medicines called tricyclic antidepressants. They are thought to work by increasing levels of a chemical called serotonin in your brain. This can improve your mood.
When will I feel better?
You may find you are feeling better after a couple of weeks, although it usually takes between 4 and 6 weeks before you feel the full benefit of the medicine.
Do not stop taking amitriptyline after 1 or 2 weeks just because you feel it is not helping your symptoms. Give the medicine at least 6 weeks to work.
How will it make me feel?
Antidepressants like amitriptyline help to gradually lift your mood so you feel better. You may notice that you sleep better and get on with people more easily because you're less anxious. Hopefully you'll take little things that used to worry you in your stride.
Amitriptyline will not change your personality or make you feel euphorically happy. It will simply help you feel like yourself again.
Do not expect to feel better overnight though. Some people feel worse during the first few weeks of treatment before they begin to feel better.
How long will I take it for?
Once you're feeling better it's likely that you will keep taking amitriptyline for several more months. Most doctors recommend that you take antidepressants for 6 months to a year after you've stopped feeling depressed. Stopping before then can make depression come back.
Talk to your doctor about the risks and benefits of taking amitriptyline for longer than a few months. It will depend on:
- how bad your symptoms are
- whether it's a one-off problem or it keeps coming back
- how well amitriptyline works for you
- any bad side effects you've had
Is it safe to take for a long time?
Amitriptyline is safe to take for a long time. There do not seem to be any lasting harmful effects from taking it for many months or years.
Is it addictive?
Amitriptyline is not addictive but you can get withdrawal side effects if you stop taking it suddenly.
Do not stop taking it without talking to your doctor first.
What will happen when I stop taking it?
If you've been feeling better for 6 months or more, your doctor may suggest coming off amitriptyline.
Your doctor may recommend reducing your dose gradually over several weeks, or longer if you have been taking amitriptyline for a long time.
This is to help prevent any withdrawal side effects you might get as a reaction to coming off the medicine. These include:
- feeling dizzy
- feeling sick
- numbness or tingling in the hands or feet
- trouble sleeping
- feeling agitated or anxious
Do not stop taking amitriptyline suddenly, or without talking to your doctor first.
Will I gain or lose weight?
Amitriptyline can change how hungry you feel. Some people feel more hungry when they're taking it, while others feel less hungry. So your weight may change when you first start taking it.
If you start to have problems with your weight while taking amitriptyline, talk to your doctor or a pharmacist.
Can I drive or ride a bike?
Some people feel sleepy while they're taking amitriptyline. It's best to stop driving and cycling for the first few days of treatment until you know how this medicine makes you feel.
It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.
Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking amitryptyline. GOV.UK has more information on the law on drugs and driving.
Is amitriptyline better than other antidepressants?
Amitriptyline does not work any better or worse than other antidepressants. However, for some people, the side effects are a problem and they may have fewer side effects with another antidepressant. Sometimes people respond better to one antidepressant than to another.
Talk to your doctor if you are not feeling any better after taking amitriptyline for 6 weeks, or sooner if the side effects are still a problem.
Are there other treatments that will help?
Antidepressants, including amitriptyline, are just one of several approaches to treating depression. Other potential treatments include:
- talking therapy (such as cognitive behavioural therapy (CBT))
- exercise programmes
- help to get a good night's sleep
Choosing a treatment that's most suitable for you depends on:
- how long you've had depression
- your symptoms
- whether you've had depression before
- whether previous treatment has worked
- how likely you are to stick with your treatment
- the potential side effects
- your preferences and priorities
Can I drink alcohol with it?
You can drink alcohol while taking amitriptyline but it may make you feel sleepy. It might be best to stop drinking alcohol until you see how the medicine makes you feel.
Is there any food or drink I need to avoid?
You can eat and drink normally while taking amitriptyline. However, it might be best to stop drinking alcohol until you see how the medicine makes you feel.
Will it affect my sex life?
The good effects of amitriptyline may, after a while, improve your sex life as your mood lifts and you become interested in life and relationships again.
Some of the possible negative effects include:
- having problems with getting an erection and problems ejaculating
- having some vaginal bleeding
Sexual side effects are not common and should pass after the first couple of weeks. If they do not, and this is a problem for you, go back to your doctor to see if there's another antidepressant you can try.
If you get vaginal bleeding after the menopause make an appointment to see your doctor as soon as possible.
Will it affect my fertility?
There's no evidence that amitriptyline affects either male or female fertility.
Will recreational drugs affect it?
Cannabis with amitriptyline can give you a fast heartbeat. Cannabis can also make drowsiness worse, especially if you've just started taking amitriptyline.
Methadone and other opiates (for example, heroin) can increase the risk of severe drowsiness if you're taking amitriptyline.
It can be dangerous to take amitriptyline with:
- stimulants like MDMA (ecstasy) or cocaine
- hallucinogens like LSD
- novel psychoactive substances (previously called legal highs), like mephedrone
Find out more the side effects of some recreational drugs on the Frank website.
Amitriptyline has not been properly tested with recreational drugs. Talk to your doctor if you think you might use recreational drugs while taking amitriptyline.