Amitriptyline: what it treats and what to watch for
Amitriptyline is an older antidepressant still used today for depression, nerve pain, migraines, and sometimes insomnia. It belongs to the tricyclic antidepressant (TCA) group. People often get good results at low doses for pain or sleep, while higher doses are used for mood disorders. If you’ve been prescribed amitriptyline, this page gives practical, no-nonsense info so you know what to expect and how to stay safe.
How amitriptyline works and who should take it
Amitriptyline raises levels of certain brain chemicals (serotonin and norepinephrine) that affect mood and pain signals. Doctors prescribe it for major depression, diabetic neuropathy, post-herpetic neuralgia, chronic tension headaches, and fibromyalgia. It’s not usually the first choice for everyone—your doctor looks at your symptoms, other meds, heart health, and age before recommending it.
Typical doses, timing, and practical tips
Start low and go slow. For pain or sleep, doctors often start at 10–25 mg at night and may increase to 25–75 mg. For depression, typical ranges are 75–150 mg daily, split or taken at night. Older adults usually need lower doses because of stronger side effects and heart risks. Take it at the same time each day; many people take it at bedtime because it often causes drowsiness. Don’t stop suddenly—ask your doctor about a gradual taper to avoid withdrawal symptoms.
Common side effects include dry mouth, drowsiness, constipation, blurred vision, and weight gain. Less common but serious effects are fast heartbeat, fainting, severe dizziness, confusion, or urinary trouble. If you notice chest pain, fainting, or sudden severe symptoms, get medical help right away. Tell your doctor about existing heart problems; an ECG may be advised before starting in some people.
Watch for interactions. Don’t mix amitriptyline with MAO inhibitors, and be cautious with SSRIs, tramadol, some antipsychotics, and many antiarrhythmics—these combinations can raise the risk of serotonin syndrome or dangerous heart rhythm changes. Avoid alcohol and other sedatives while you’re adjusting to the drug. Always give your full medication list to your prescriber, including over-the-counter and herbal products.
Pregnancy and breastfeeding need a careful talk with your clinician—sometimes the benefits outweigh risks, but decisions are individual. Young people under 25 may have a small increased risk of suicidal thoughts when starting antidepressants; close monitoring is important. Keep regular follow-ups so your doctor can check dose, side effects, and whether it’s helping.
Final practical tips: take it at night if it makes you sleepy, stay hydrated to ease dry mouth and constipation, report new heart symptoms, and don’t stop suddenly. If you’re ever unsure, call your prescriber or pharmacist—small questions can prevent big problems.
