1. About amitriptyline for depression
2. Key facts
- It can take 4 to 6 weeks for amitriptyline to work.
- Side effects such as a dry mouth and constipation are common. They're usually mild and go away after a couple of weeks.
- Amitriptyline can make you feel sleepy so it's best to take it in the evening or before you go to bed.
- If you and your doctor decide to take you off amitriptyline, your doctor will probably recommend reducing your dose gradually to help prevent extra side effects.
- Amitriptyline is an antidepressant, but at lower doses it's also very good for treating pain and migraine.
3. Who can and cannot take amitriptyline
Amitriptyline can be taken by most adults. It can also be taken by children aged 16 to 17 years for depression or low mood.
Check with your doctor before starting to take amitriptyline if you:
- have had an allergic reaction to amitriptyline or any other medicine in the past
- have a heart problem – amitriptyline can make some heart problems worse
- have a rare illness called porphyria
- have liver or kidney problems
- have epilepsy or are having electroconvulsive treatment – amitriptyline may increase your risk of having a seizure
- have ever taken any other medicines for depression – some rarely-used antidepressants can interfere with amitriptyline
- are trying to become pregnant, are already pregnant or you are breastfeeding
- have an eye problem called glaucoma – amitriptyline can increase the pressure in your eye
- have thoughts about harming yourself or ending your life
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 it
It's usual to take amitriptyline once a day 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.
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.
Amitriptyline doesn't usually upset the stomach so you can take it with or without food.
Swallow the tablet with a drink of water. If you chew it, it tastes bitter.
How much will I take?
Amitriptyline tablets come in different strengths of 10mg, 25mg or 50mg.
Amitriptyline liquid 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 hospital specialist.
Children 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.
What if I forget to take it?
If you take amitriptyline once a day and forget a dose, don't worry. Take your next dose 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 think about it 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.
Urgent advice: Call your doctor straight away if:
You've taken too much amitriptyline by accident and experience symptoms such as:
- feeling agitated
- being sick (vomiting)
- fast heart rate
- fits (seizures)
If you need to go to a 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 it.
Common side effects
Keep taking the medicine but talk to your doctor or pharmacist if these common side effects bother you or don't 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 you get:
- a fast or irregular heartbeat
- yellow skin, or the whites of your eyes go yellow – these can be signs of a liver problem
- constant headaches, long lasting confusion or weakness, frequent muscle cramps – these can all be signs of low sodium levels in your blood. In severe cases low sodium levels can lead to seizures
- thoughts about harming yourself or ending your life
- eye pain, a change in your eyesight, swelling or redness in or around the eye
- severe constipation or you're unable to pee and it's causing severe stomach pain
Call 999 straight away if you experience:
- weakness on one side of your body
- trouble speaking or thinking
- loss of balance or blurred eyesight
These can be signs of a stroke. If you suspect that you or someone else is having a stroke, phone 999 immediately and ask for an ambulance.
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
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 another non-alcoholic liquid every day. If you can, it may also help to do some exercise. Watch a short video on how to treat constipation.
- 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 sitting or lying down.
- dry mouth – chew sugar-free gum or sugar-free sweets.
- feeling sleepy or tired – take amitriptyline in the evening and cut down the amount of alcohol you drink. Do not drive or use tools or machinery if you're feeling sleepy. If this doesn't help, talk to your doctor.
- difficulty peeing – relax when you try to pee. Do not try to force the flow of urine. If it doesn't happen, try again later. Talk to your doctor urgently if you can't pee at all.
- headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Talk to your doctor if the headaches last longer than a week or are severe.
7. Pregnancy and breastfeeding
It's important for you and your baby that you stay well during your pregnancy. If you become pregnant while taking amitriptyline speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.
Amitriptyline has been linked to a very small increased risk of problems for your unborn baby. However if your depression is not treated during pregnancy this can also increase the chance of problems.
You may need to take amitriptyline during pregnancy if you need it to remain well. Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.
For more information about how amitriptyline can affect you and your baby during pregnancy, visit the Best Use of Medicines in Pregnancy (BUMPS) website.
Amitriptyline and breastfeeding
If your doctor or health visitor says your baby is healthy, amitriptyline can be used during breastfeeding.
Amitriptyline passes into breast milk in very small amounts. It's unlikely to cause any harm to your baby.
It is important to continue taking amitriptyline to keep you well. Breastfeeding will also benefit both you and your baby.
If you notice that your baby isn't feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your health visitor or doctor as soon as possible.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. Cautions with other medicines
Many medicines and amitriptyline can interfere with each other and increase the chances of side effects.
Tell your doctor if you have ever taken any other medicines for depression. Some rarely-used antidepressants can interfere with amitriptyline to cause very high blood pressure even after you have stopped taking them.
Make sure that your doctor and pharmacist know you're taking amitriptyline before starting or stopping any other medicine.
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.
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions
How does amitriptyline work in depression?
Amitriptyline is from a group of antidepressants called tricyclic antidepressants. It's thought to work by increasing levels of a chemical called serotonin in the brain. This can improve your mood.
When will I feel better?
You may see an improvement in your symptoms after a couple of weeks, although it usually takes between 4 and 6 weeks before you feel the full benefits.
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 won't change your personality or make you feel euphorically happy. It will simply help you feel like yourself again.
Don't 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 continue to take 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 pros and cons of continuing to take amitriptyline for longer than a few months. It will depend on how bad your symptoms are, whether it's a one-off problem or one that keeps coming back, how well amitriptyline works for you and whether you've had any bad side effects.
Is it safe to take for a long time?
Amitriptyline is safe to take for a long time. There don't seem to be any lasting harmful effects from taking it for many months or years.
Is it addictive?
Amitriptyline isn't addictive but you can get extra side effects if you stop taking it suddenly.
How do I come off amitriptyline?
If you've been feeling better for 6 months or more, your doctor may suggest coming off amitriptyline.
Your doctor will probably 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 extra side effects you might get as a reaction to coming off the medicine. These include:
- 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 – 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 pharmacist.
Can I drive or ride a bike?
Some people feel sleepy while they're taking amitriptyline. It might be best to stop driving and cycling for the first few days of treatment until you know how this medicine makes you feel.
Is amitriptyline better than other antidepressants?
Amitriptyline doesn't 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 aren't feeling any better after taking amitriptyline for 6 weeks or 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.
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:
- men having problems with getting an erection and problems ejaculating
- women having some vaginal bleeding
- both men and women having breast swelling
Sexual side effects are not common and should pass after the first couple of weeks. If they don't, and this is a problem for you, go back to your doctor to see if there's another antidepressant you can try.
If you're a woman and 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 firm evidence to suggest that taking amitriptyline will reduce fertility in either men or women.
However, speak to a pharmacist or your doctor before taking it if you're trying to get pregnant.
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 can increase the risk of side effects if you're taking amitriptyline.
It can be potentially dangerous to take amitriptyline with:
- stimulants like MDMA (ecstasy) or cocaine
- hallucinogens like LSD
- novel psychoactive substances (which used to be known as legal highs) like mephedrone
Amitriptyline hasn't been properly tested with recreational drugs. Talk to your doctor if you think you might use recreational drugs while taking amitriptyline.