Amitriptyline

Amitriptyline can help to adjust the levels of the chemicals in your brain

The brain is usually good at making sure we have enough of the chemicals we need to function properly.

• Experiments suggest that depression is more likely to happen when the brain doesn’t have enough of a chemical called serotonin (also called ‘5HT’) and noradrenaline.
• Receptors in the brain release these chemicals and then take them back up again in a cycle.
• Tricyclic antidepressants like amitriptyline block these chemicals being taken back up into the brain cells.
• This means that the amount of serotonin and noradrenaline become more normal and the depression becomes better.

Amitriptyline may have some effect on depression in young people, but is not recommended in national treatment guidance for the UK

• National treatment guidance from NICE does not recommend the use of amitriptyline for depression in young people in the UK.
• Research shows that amitriptyline may have some helpful effect on depression in young people who are have reached puberty.
• Younger children and young people are unlikely to get a good effect.

You should take amitriptyline as agreed with your doctor

• You will get the best from your medicine if you use it regularly every day.
• Make sure that you know your dose. If it is not written on the label, check it with your pharmacist or doctor.
• You may have to take it more than once a day.
• Choose times each day that you can always remember. This could be mealtimes, or when you brush your teeth.
• As it can make you sleepy, it might be best to take it at night time, 30 minutes before bedtime.
• Many young people take tricyclic antidepressants just once at night. If you are having problems because you have to take it at school or work, or you find it hard to remember more than once a day, talk to your doctor about your dose.
• You can take it before or after food.
• Swallow the tablet with a drink of water - if you chew it, it tastes bitter.

If you forget to take a dose then just take it as soon as possible

What to do if you miss a dose:

• If you remember later during the day, take it as soon as possible.
• If you forget to take it by your next dose, only take the next dose.
• Do not take a double dose.

What might happen?

If you forget to take your tablets for a few days, you may start getting withdrawal symptoms:

• You might get flu-like symptoms (chills, muscle aches, sweating, headaches, feeling sick)
• You might have strange dreams and your sleep might be disturbed
• You might feel irritable and restless
• You could get mania or hypomania (high mood or feeling very happy) a few days after stopping the tablets
• You should talk to your doctor about these symptoms.

You must go to A&E if you take too much – amitriptyline is very dangerous in overdose

What to do if you take too much:

• If you have taken more amitriptyline than it said on the label, you must get help quickly – even if you do not feel any different.
• Go to A&E. Take your medicine with you, to show to the doctors. Tell them how much you have taken.
• Get a friend or family member to go with you, if you can, just in case you feel ill on the way.

You might get any of the following signs:

• fast or uneven heartbeat
• low blood pressure (feeling dizzy or faint)
• your pupils (black centre part of your eye) going large
• feeling sleepy
• feeling agitated
• being sick
• having a low body temperature or a high fever
• having fits, or stiffness in your muscles
• going into a coma

It can take 2 weeks for amitriptyline to start helping

• You should start to see the good effects from amitriptyline after 2 weeks
• Your doctor might increase your dose through the first month to get the right level for you
• If you do not feel better by the end of 4 weeks, you should go back to your doctor to try something else.

Many people take amitriptyline for six months or more

You and your doctor should talk about how long you need to take amitriptyline.

• You may not get the full effect for a month.
• If you take amitriptyline for low mood (depression), you will probably take it for at least six months - otherwise your symptoms of low mood can come back.
• If you have had more than one time when you felt depressed, you may take an antidepressant for 2 years to stop this happening again.

Tell your doctor or pharmacist before you take amitriptyline if you have any of these conditions

You need to talk to your doctor or pharmacist if any of the following apply to you:

• you have any blood disorders (you may bruise easily, frequently suffer from infections or be anaemic)
• you have another mental health condition (e.g. schizophrenia or manic depression)
• you have liver or heart disease
• you cannot go for a wee easily, or have an enlarged prostate gland
• you have an overactive thyroid gland and are taking medicines to treat a thyroid disorder
• you have a history of epilepsy
• you are being given electroconvulsive therapy (ECT)
• you have increased pressure in the eye (known as narrow-angle glaucoma)
• you are taking monoamine oxidase inhibitors (MAOI, another type of antidepressant) or you have taken MAOIs within the previous 14 days for depression
• you are breast-feeding
• you have a problem with your blood called porphyria

If you have any thoughts of suicide, or of other ways of hurting yourself, go straight to a hospital with your tablets.

This may be a side-effect, and you need urgent help.

Amitriptyline can make some people think about hurting themselves or committing suicide. This can happen to anyone, especially people who are under the age of 25.

You must go straight to hospital with your tablets if you have any of these thoughts. You must tell the doctor that you are taking amitriptyline. There are other things you can take instead.

Amitriptyline has many possible side effects, and if they happen they can be serious

Some side-effects that do appear should get better after a few days. If they do not, you should go back to your doctor

Some side-effects of amitriptyline may – strangely - seem like other mental health symptoms. Some side-effects here are also the opposites of each other. The balance of chemicals in the brain is very fragile, and hard to control! If they do not get better after a few days on the tablets, go back to the doctor.

Do not stop taking the tablets until you talk to your doctor, or you may get withdrawal symptoms as well.

The manufacturers of amitriptyline do not say how common the side-effect is, so we have put the full list below.

The most common reported effects amongst children and young people are:

• feeling sleepy
• dry mouth
• blurred eyesight, changes to your eyesight, or increased pressure in the eye
• constipation
• fever
• difficulty in going to pee 

The following effects have all been reported in adults:

Effects on your hormones:

• changes in whether you want to have sex, and whether you get the usual effects from sex
• breast swelling in men and women, and milk flow
• swelling of the testicles (balls) in men
• changes in blood sugar levels
• increased appetite and weight gain
• more of the hormone ADH (antidiuretic hormone) in your body, which may make you pee more frequently, or finding it difficult to pee

Effects on your blood:

• changes in your blood cells (you may get a sore throat, mouth ulcers and recurring infections, bleeding or bruising easily)

Effects on your brain and central nervous system:

• dizziness or weakness
• tiredness or sleepiness
• headache
• difficulty concentrating
• confusion, anxiety, restlessness, or disorientation (not knowing where you are)
• difficulty sleeping, or nightmares
• slight hyperactivity, excitement, or unusual behaviour
• delusions, or seeing things that are not there (hallucinations)
• numbness or tingling or pins and needles (particularly in the hands and feet)
• lack of co-ordination
• shaky movements, or tremor
• fits
• unconsciousness
• slow or slurred speech

Effects on your skin and hair:

• skin rash, including one caused by sunlight
• hair loss

Effects on your heart:

• feeling faint when you stand up (postural hypotension)
• change in blood pressure
• fast/racing heart, or uneven or slow heartbeat
• heart attack
• stroke

Effects on your liver:

• hepatitis, including changes in liver function (as seen in blood tests)
• jaundice (yellowing of the skin and/or whites of the eyes)

Effects on your ears:

• Buzzing or ringing in your ears

Effects on your eyesight:

• blurred or double vision, changes in eyesight

General effects:

• increased sweating and fever
• widely dilated pupils
• greater risk of broken bones

Other medicines may cause problems when taken with amitriptyline. Tell your doctor or pharmacist if you are taking any of the following:

• medicines to treat some mental health conditions such as clozapine, pimozide, thioridazine, chlorpromazine, haloperidol, prochlorperazine, or sulpiride
• cimetidine (to treat stomach ulcers)
• ethchlorvynol (to help you sleep)
• entacapone or selegiline (to treat Parkinson’s disease)
• oral contraceptives (“the pill”)
• sibutramine (to reduce your appetite)
• sympathomimetic medicines such as adrenaline (epinephrine), ephedrine, isoprenaline, noradrenaline (norepinephrine), phenylephrine and phenylpropanolamine (contained in many cough and cold remedies)
• ritonavir (to treat HIV)
• fluconazole (to treat fungal infections).

Always talk to the doctor if you are taking other medicines.

Tell the pharmacist you are taking amitriptyline if you buy medicines (including things you put on your skin) for common illnesses.

Get your heart rhythm checked regularly when you are taking amitriptyline

• Amitriptyline can cause changes in the heart rhythm, especially in young people.
• The only way the doctor can check it is with an electrocardiogram (ECG) machine.
• Your doctor should check your heart rhythm with an electrocardiogram (ECG) before you start amitriptyline, and regularly when you are taking it.

Amitriptyline does not mix well with drugs

• If you mix cannabis and amitriptyline, you could get a fast heartbeat.
• If you take heroin or methadone with amitriptyline, you could feel extremely sleepy.
• You could get an irregular and dangerous heartbeat if you take amitriptyline with cocaine, amphetamines, ecstasy, MDA or 6-APB.

Tell the doctor if you are going to have an operation – you may need to stop amitriptyline for a few days

• Amitriptyline does not mix well with some anaesthetics used in surgery.
• You need to tell the people who are going to do your operation, before the day it takes place.
• They may ask you not to take your amitriptyline for a few days before your operation.
• If you take both together, you may get low blood pressure or a change in your heartbeat.

Stopping the medication causes the balance of chemicals in the brain to alter

• Once you start taking amitriptyline, the brain adjusts to having a new level of serotonin and noradrenaline around.
• If you stop taking the amitriptyline all at once, the balance starts to change again.
•  You could get some symptoms from the change.

Stopping this medicine quickly, or reducing the dose too much at once, may cause withdrawal symptoms 

You will probably get uncomfortable withdrawal symptoms if you stop amitriptyline suddenly. It is better to agree stopping with a doctor who will reduce you gradually.

These symptoms could be:

• Feeling sick
• Headache
• Feeling weak and generally unwell
• Feeling very happy or over-excited
• Speech problems
• Shaking

You can stop taking it safely with your doctor’s help

If you want to stop, go to the doctor and they will help you to bring the dose down until you can stop. This will take a few weeks. You may still get some side-effects, especially during the first two weeks as you reduce the dose:

• Feeling restless
• Feeling irritable
• Having strange dreams or your sleep being disturbed
• Feeling very happy or over-excited

These effects will go away as you carry on reducing the dose. Talk to your doctor if they are uncomfortable and are affecting your life.