Amitriptyline
What is Amitriptyline?
Amitriptyline is a tricyclic antidepressant employed primarily for addressing depressive disorders, both endogenous and psychotic, and also to ease anxiety associated with depression (1)(2)(4)(6). It functions by elevating the levels of serotonin and norepinephrine in the brain, neurotransmitters vital in mood regulation (2)(4). Additionally, Amitriptyline sees off-label application in managing chronic pain conditions such as diabetic neuropathy, fibromyalgia, and postherpetic neuralgia (1)(2)(5). The drug is procurable in both tablet and liquid formulations (4).
Dosage
Adults typically initiate Amitriptyline therapy for depression with a daily dose ranging from 50mg to 100mg. Depending on need and under specialist oversight, this can be escalated to 150mg daily (4). For older adults and youths between 16 and 17 years, the commencement dosage is often lower, between 25mg to 50mg daily, to curtail the potential for side effects. The drug's maximum permissible dose is 150mg per day (4).
Side Effects
Administering Amitriptyline can induce several side effects, inclusive of dry mouth, vision blurring, constipation, urination challenges, sleepiness, dizziness, and weight increment (1)(2)(3)(4)(6). More grave side effects could surface, notably suicidal ideations, with a pronounced risk among children, teens, and young adults (3). Vigilance is advised for emergent or amplifying suicidal or depressive inclinations. Other potential alarms include abrupt mood shifts towards anxiety, agitation, hostility, impulsiveness, or restlessness. Any such manifestations, especially at therapy onset or after dosage modulation, should prompt immediate consultation with a healthcare professional.
Interactions
Amitriptyline might present interactions with diverse medications, notably other antidepressants, antihistamines, antipsychotic agents, and high blood pressure drugs (1)(2)(4)(6). Before amalgamating Amitriptyline with other drugs or supplements, a medical consultation is essential.
Time of Day and With or Without Food
For consistency, it's recommended to consume Amitriptyline at a uniform daily time, ideally during bedtime (2). The drug can be ingested irrespective of food intake (4).
It is better to take at night (before 8pm, to avoid the side effect on the next morning).
Human Studies
Human studies have extensively probed Amitriptyline's efficacy in treating depression and chronic pain (1)(2)(4)(5)(6). Nevertheless, a comprehensive understanding of its therapeutic gamut necessitates further research.
To encapsulate, Amitriptyline is a tricyclic antidepressant primarily designed to counteract depressive disorders and associated anxiety. Off-label, it also addresses chronic pain conditions. Adult dosing typically commences with a daily 50mg to 100mg, potentially reaching 150mg under specialized supervision. Common side effects span from dry mouth to weight gain, with more severe potential side effects like suicidal tendencies. Medicinal interactions are possible and warrant caution. Consistency in daily intake, preferably at bedtime, is advised. Amitriptyline has been rigorously studied in human subjects, particularly regarding its antidepressant and analgesic properties, but more expansive research is awaited for a holistic appreciation of its therapeutic potential.
Citations:
(1) https://go.drugbank.com/drugs/DB00321
(2) https://my.clevelandclinic.org/health/drugs/19457-amitriptyline-tablets
(3) https://medlineplus.gov/druginfo/meds/a682388.html
(4) https://www.nhs.uk/medicines/amitriptyline-for-depression/
(5) https://www.ncbi.nlm.nih.gov/books/NBK537225/
(6) https://www.drugs.com/amitriptyline.html
Used of Long Covid
Amitriptyline for post-COVID headache: effectiveness, tolerability, and response predictors https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553757/