About Amitriptyline: Side Effects & Risks of Use
Amitriptyline is a prescription tricyclic antidepressant medication. Tricyclic antidepressant drugs are one of the earlier classes of antidepressant medications. This class of drugs was developed to treat major depressive disorder, a severe manifestation of depression.
Read on to learn more about amitriptyline and the potential side effects associated with its use.
Amitriptyline for Depression
The Food and Drug Administration (FDA) approved amitriptyline for the treatment of depression in the 1980s. Since then, the newer antidepressant medications have been developed that have far fewer and less serious side effects associated with their use, such as selective serotonin reuptake inhibitors (e.g., Prozac), and tricyclic antidepressants like amitriptyline are no longer used as frequently.
Other tricyclic antidepressant drugs similar to amitriptyline include:
- Desipramine (Norpramin).
- Nortriptyline (Pamelor).
- Imipramine (Tofranil).
This class of drugs works by blocking the reabsorption of several different neurotransmitters, including norepinephrine, serotonin, and dopamine.
Amitriptyline may also be prescribed for other off-label uses that are not approved by the FDA, including the treatment of different types of pain, migraine headache, and ADHD.
Amitriptyline is currently only available in the United States in generic forms, although it was once marketed under the brand name Elavil. It is not a controlled substance listed by the United States Drug Enforcement Administration (DEA), but does require a prescription from a physician.
Side Effects of Amitriptyline Use
Although amitriptyline and other tricyclic antidepressant medications are generally as effective for the treatment of the symptoms of depression as newer antidepressant medications, they also have more side effects.
Common side effects associated with amitriptyline include:
- Headache, blurred vision, weakness, and/or a sensation of dizziness.
- Gastrointestinal issues, such as nausea, vomiting, diarrhea, constipation, and/or stomach cramps.
- Sedation, lethargy, weakness, and/or sleepiness.
- Dry mouth.
- Difficulty urinating.
- Pain, burning, or tingling in the hands and feet.
- Changes in appetite or weight (weight gain or weight loss).
- Loss of sex drive.
- Confusion, slurred speech or difficulty speaking.
- Irregular heartbeat or chest pain.
- Muscle spasms or tremors.
- Fainting spells.
- Unusual bleeding or bruising.
- Hallucinations, and/or seizures (rare and require immediate medical attention).
Risk of Suicide With Antidepressant Use
Antidepressant medications are also noted to have a rare potential to produce suicidal feelings and behavior in children, teenagers, and adults age 24 and younger. These individuals are more susceptible to suicidality when using these medications than older individuals, but suicidality may occur in anyone who uses antidepressant medications.
Some signs of suicidality associated with amitriptyline use include:
- Worsening depression instead of improving it. (It typically takes 2–4 weeks after beginning the medication before depressive symptoms are reduced.)
- Agitation, panic attacks, irritability, and aggression.
- Problems sleeping.
- Thoughts of harming or killing oneself.
- Hyperactivity, hostility, and increasing impulsivity.
Potential for Amitriptyline Abuse
Some individuals mistakenly believe that use of antidepressant medications like amitriptyline leads to some type of euphoria or “high.” This misconception springs from the idea that a drug that is designed to treat clinical depression must somehow “make people happy” or induce states of euphoria. This is not how antidepressant medications work.
There are some anecdotal reports of specific individuals consuming very large amounts of amitriptyline to produce euphoria or experience hallucinations. Most of these reports are case studies, and many of them are decades old.
Amitriptyline is not a significant drug of abuse, as it does not produce euphoria, and attempts to use large doses of the drug can increase the risk of serious side effects that would normally be rare, including overdose and organ damage. An overdose of amitriptyline could be potentially fatal.
Although the abuse potential of amitriptyline and other antidepressants is low, regular use for more than 6–8 weeks can produce a mild syndrome of physical dependence.
The symptoms of withdrawal from antidepressant medications vary greatly, but they most often involve flulike symptoms that dissipate quickly and are not significantly distressing. Physicians who wish to discontinue their patients from antidepressant medications can avoid these symptoms by using a tapering strategy.
Individuals who attempt to use amitriptyline recreationally in large doses are at risk of developing serious issues with antidepressant toxicity and overdose.
Symptoms of an amitriptyline overdose may include:
- Increased body temperature.
- Blurred vision.
- Dilated pupils.
- Irregular or rapid heartbeat.
- Changes in blood pressure (hypotension or hypertension).
- Potential cardiac arrest (heart attack).
- Hallucinations and/or seizures, which can be fatal.
Most often, an overdose on amitriptyline or other tricyclic antidepressant medication is either accidental or a suicide attempt. These medications have a very narrow therapeutic window and can be toxic at doses that are not significantly higher than the recommended dose.
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