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Amitriptyline: How Addictive Is It?

amitriptyline addictiveAmitriptyline is a prescription medication that is classified as a 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 that is a formal mental disorder.

Other tricyclic antidepressant drugs similar to amitriptyline include desipramine (Norpramin), nortriptyline (Pamelor), and imipramine (Tofranil). This class of drugs works by blocking the reabsorption of several different neurotransmitters, including norepinephrine, serotonin, and dopamine.

The Food and Drug Administration (FDA) approved amitriptyline for the treatment of depression in the 1980s; however, since the development of newer antidepressant medications, such as selective serotonin reuptake inhibitors (e.g., Prozac), that have far fewer and less serious side effects associated with their use, tricyclic antidepressants like amitriptyline are no longer used as frequently.

Amitriptyline may also be prescribed for other uses that are not approved by the FDA, including for the treatment of different types of pain, migraine headache, and even 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 it does require a prescription from a physician.

Amitriptyline Side Effects

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
  • Rash
  • Muscle spasms or tremors
  • Fainting spells
  • Unusual bleeding or bruising
  • Hallucinations, and/or seizures (rare and require immediate medical attention)

Antidepressant medications are also noted to have a rare potential to produce suicidal feelings and suicidal behavior in children, teenagers, and adults younger than 24 years old. 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 of the signs of suicidality associated with amitriptyline use include:

  • Worsening depression instead of improving it (However, it should also be noted that 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

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Potential for Abuse

amitriptyline abuse

Some individuals have the seriously mistaken belief 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 high amounts of amitriptyline to produce euphoria or experience hallucinations. Most of these reports are case studies, and many of them are decades old. The drug is not a significant drug of abuse as it does not produce euphoria, and attempts to use very high doses of the drug can increase the risk for serious side effects that would normally be rare, produce an overdose as a result of a toxic state, and cause organ damage, such as liver, kidney, and cardiovascular issues. An overdose of amitriptyline could be potentially fatal.

Overall, the abuse potential of amitriptyline and other antidepressant medications is low. If they were potentially significant drugs of abuse, the DEA would list them as controlled substances.

Nonetheless, regular use of antidepressant medications for more than 6-8 weeks can produce a mild syndrome of physical dependence, which is often referred to as antidepressant discontinuation syndrome (ADS). The symptoms of withdrawal from antidepressant medications are quite variable, but they are most often flulike symptoms that have a very short duration and are not significantly distressing. Physicians who wish to discontinue their patients from antidepressant medications can avoid ADS in patients by simply using a tapering strategy.

Thus, amitriptyline and other antidepressant medications are not considered to be “addictive” in the sense that they are highly sought after drugs of abuse, and there is no identified antidepressant substance use disorder that is recognized by any clinical body such as the American Psychiatric Association. However, individuals who abuse drugs may attempt to abuse nearly any drug, including over-the-counter medications like aspirin, prescription medications, and any other drug they believe may produce the desired psychoactive effects they seek. Therefore, occasional attempts to abuse drugs like amitriptyline do occur.

 Individuals who attempt to use amitriptyline recreationally and use it in large doses are at risk to develop serious issues with antidepressant toxicity and overdose.

Amitriptyline Toxicity

 An overdose of a tricyclic antidepressant medication can be extremely serious.

Symptoms typically 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. Treatment for an overdose typically includes the use of intravenous fluids, activated charcoal, norepinephrine injections if there are cardiac issues, and benzodiazepines if seizures occur.

Conclusions

Amitriptyline is an older antidepressant medication that still has some medical uses. It is not a significant drug of abuse even though its continued use for more than a few months may result in the development of a mild syndrome of physical dependence. It is not listed as a controlled substance listed by the DEA, nor is it a highly sought-after drug of abuse. There are some reports of individuals using amitriptyline for recreational purposes, but these are relatively rare. Individuals who take large doses of the drug are at significant risk for overdose effects, which can be serious and even fatal.


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