Amitriptyline for depression
About amitriptyline for depression
Amitriptyline is an antidepressant medicine. It's used to treat low mood and depression.
This medicine is only available on prescription. It comes as tablets and as a liquid.
Amitriptyline is also used for some types of pain and to prevent migraines. Find out more about amitriptyline for pain and migraine.
Key facts
- Amitriptyline is an antidepressant medicine. It works by increasing levels of a chemical called serotonin in your brain. This can improve your mood.
- You may start to feel better after 1 to 2 weeks but it can take 4 to 6 weeks for amitriptyline to work fully.
- Side effects such as a dry mouth and constipation are common. They're usually mild and go away after a couple of weeks.
- It's best to take amitriptyline in the evening or before you go to bed. This is because it can make you feel sleepy.
- Amitriptyline can cause side effects if you stop taking it suddenly. Talk to your doctor if you want to stop taking it.
Who can and cannot take amitriptyline
Most adults can take amitriptyline. It can also be taken by young people aged 16 to 17 years for depression or low mood.
Amitriptyline is not suitable for some people. To make sure it's safe for you, check with your doctor if you:
- have ever had an allergic reaction to amitriptyline or any other medicine
- have a heart problem – amitriptyline can make some heart problems worse
- have a rare blood disorder called porphyria
- have liver problems
- have epilepsy or are having electroconvulsive treatment (ECT) – amitriptyline may increase your risk of having a fit or seizure
- are pregnant, trying to get pregnant or breastfeeding
- have glaucoma – amitriptyline can increase the pressure in your eye
- have thoughts about harming yourself or ending your life
- have problems emptying your bladder
- have type 1 or type 2 diabetes
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.
How and when to take amitriptyline for depression
You'll usually take amitriptyline once a day. It's best to take it 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.
Dosage and strength
Amitriptyline tablets come in different strengths of 10mg, 25mg or 50mg.
Amitriptyline liquid also 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 a day if you need a stronger dose, but only under the supervision of a specialist.
Young people 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 150mg per day.
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.
How to take it
Amitriptyline does not usually upset your stomach, so you can take it with or without food.
Swallow the tablets whole with a drink of water. If you chew them, they taste bitter.
The liquid comes with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.
What if I forget to take it?
If you take amitriptyline once a day and forget a dose, leave your missed dose and take your next one 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 remember 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.
Taking more than your prescribed dose of amitriptyline can:
- make you feel agitated
- make you sick (vomiting)
- cause shaking
- cause a fast heart rate
- cause fits or seizures (shaking and jerking uncontrollably)
Contact 111 for advice now if:
- you've taken more than your prescribed dose of amitriptyline
Go to 111.nhs.uk or call 111
If you need to go to 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.
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 the medicine.
Common side effects
Keep taking the medicine but talk to your doctor or pharmacist if these common side effects bother you or do not go away:
- constipation
- dizziness
- dry mouth
- feeling sleepy, tired or weak
- difficulty peeing
- headaches
Serious side effects
It happens rarely, but some people have a serious side effect after taking amitriptyline.
Call a doctor straight away if:
- your heartbeat becomes fast or irregular
- the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin, or you have dark pee – these can be signs of a liver problem
- you have constant headaches, long lasting confusion or weakness, and frequent muscle cramps – together, these can be a sign of low sodium levels in your blood. In severe cases low sodium levels can lead to a fit or seizure
- you have thoughts about harming yourself or ending your life
- you have eye pain, a change in your eyesight, or swelling or redness in or around your eye
- you have constipation that lasts a long time, or problems peeing which are causing stomach ache
Call 999 and ask for an ambulance if:
- you have weakness on one side of your body
- you have trouble speaking or thinking
- you lose your balance or have blurred eyesight
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to amitriptyline.
These are not all the side effects of amitriptyline. For a full list see the leaflet inside your medicines packet.
How to cope with side effects of amitriptyline
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 other non-alcoholic drinks every day. If you can, it may also help to increase your level of exercise.
- 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 you have been sitting or lying down. Do not drive until you stop feeling dizzy.
- dry mouth – try sugar-free gum or sugar-free sweets.
- feeling sleepy or tired – take amitriptyline in the evening and try to cut down the amount of alcohol you drink. Do not drive, cycle or use tools or machinery if you're feeling sleepy. Talk to your doctor if this does not help.
- difficulty peeing – try to relax when you pee. Do not try to force the flow of urine. If you still cannot go, try again later. Talk to your doctor urgently if you cannot pee at all.
- headaches – make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. Paracetamol and ibuprofen may help if you need pain relief. Talk to your doctor if the headaches last longer than a week or are severe.
Pregnancy and breastfeeding
Amitriptyline and pregnancy
If you are already taking amitriptyline, you may be advised to continue taking it during pregnancy, especially if you take it to treat depression.
If you become pregnant while taking amitriptyline, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.
Your doctor can explain how taking amitriptyline can help you and how it might affect you. They will also help you choose the best treatment for you and your baby.
Amitriptyline and breastfeeding
If your doctor or health visitor says your baby is healthy, you can take amitriptyline while breastfeeding.
Amitriptyline passes into breast milk in very small amounts, so it's unlikely to cause any harm to your baby.
It's important to keep taking amitriptyline to keep you well. Breastfeeding will also benefit both you and your baby.
If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your midwife, health visitor or doctor as soon as possible.
For more information about how amitriptyline can affect you and your baby during pregnancy, find out more on the Best Use of Medicines in Pregnancy (BUMPS) website.
Cautions with other medicines
Many medicines and amitriptyline can affect each other and increase the chances of side effects.
Always check with your doctor or a pharmacist before starting any new medicine while you are taking amitriptyline.
Taking amitriptyline with opioid medicines can increase your risk of becoming very drowsy and having breathing problems. Opioid medicines include:
Tell your doctor if you have ever taken any other medicines for depression. Some antidepressants can affect the way amitriptyline works and cause very high blood pressure. This can happen even after you have stopped taking them.
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.
There's very little information about taking amitriptyline with other herbal remedies and supplements. They are not tested in the same way as medicines.