Amitriptyline (Elavil)

What amitriptyline is

Amitriptyline is a medication sold under the brand name Elavil. It works on serotonin and norepinephrine, two of the chemical messengers nerve cells use to communicate, and it is one of the older medications of its kind, sometimes called a tricyclic. Because it also affects other signals in the body, it tends to be more sedating and to cause more dry-mouth-type effects than newer options, which is part of why a clinician weighs it carefully.

What it treats

Your clinician might suggest amitriptyline for one of these, among other possible off-label uses:

• Depression
• Certain kinds of nerve pain, such as the burning pain that can linger after shingles
• Preventing migraines
• Sometimes, in low doses, to help with sleep

Whether it is a good fit depends on several factors, including your history and what you are working on. As with everything in psychiatry, that is decided case by case.

How it works

Honestly, no one knows with complete certainty how amitriptyline produces its benefit. What research supports is that it helps keep more serotonin and norepinephrine available in the spaces between nerve cells, and that this is central to how it helps, both for mood and for certain kinds of pain. It also affects other signals in the body, which is where many of its side effects come from. The biology is only part of the picture: how much a medication helps, and how it feels, is individual. Two people on the same medication can have very different experiences.

How to take it

There is no single right way to take amitriptyline; it depends on you and your clinician. Some people take it once a day, often in the evening because it can be sedating, while others take smaller amounts across the day. The plan you and your clinician make together is the one to follow, not a number you read online. A few general points apply broadly:

• Take it the way you and your clinician agreed. Because it can make you drowsy, be careful with driving or anything that needs full alertness until you know how it affects you, and remember that alcohol adds to the drowsiness.
• Because amitriptyline can be dangerous in amounts larger than prescribed, more so than many newer medications, keep it stored safely and take only the amount you agreed on. If you or someone else ever takes too much, treat it as an emergency and call 911 or go to the nearest emergency department.
• If you miss a dose, ask your clinician or pharmacist what to do rather than doubling up.
• Try not to stop on your own. Stopping suddenly can cause uncomfortable effects such as nausea, headache, and low energy, and your clinician can taper it gently if and when that makes sense.

What to expect

This varies from person to person. Some effects can show up before the benefit does: drowsiness and dry mouth, if they happen, often appear early, while any lift in mood usually takes longer, commonly a few weeks and sometimes more. Some of the early effects ease as your body adjusts. If nothing has shifted after a fair trial, that is useful information, not a dead end, and there are other options. As always, this is case by case.

Side effects

Not everyone gets side effects, and many that do happen ease over the first weeks. The lists below are possibilities, not certainties.

Possible more common side effects:

• Feeling drowsy or tired
• Dry mouth
• Constipation
• Blurred vision
• Trouble urinating
• Dizziness or unsteadiness, especially when standing up
• Weight gain

If any of these stick around or bother you, they are worth raising. Send a non-urgent message through the patient portal or bring it up at your next visit; often a small change helps.

Less common, but concerning side effects that could require emergency care:

• A fast, pounding, or irregular heartbeat, chest pain, or fainting. Amitriptyline can affect the heart's rhythm
• Signs of an allergic reaction: a severe rash or hives, or swelling of the face or tongue
• Yellowing of the skin or eyes
• Eye pain or redness, or a sudden change in vision such as blurred sight or seeing halos around lights, which can be a sign of rising pressure in the eye
• Muscle spasms of the jaw, neck, or back, or uncontrollable shaking of part of the body
• A seizure
• Confusion, or hallucinations such as seeing or hearing things that are not there
• Unusual bleeding or bruising
• Feeling abnormally high, wired, or irritable, with racing thoughts and far less need for sleep than usual
• Any new or worsening thoughts of harming yourself

For any of these, use the help options at the top of this page: call 911 or go to the nearest emergency department for a medical emergency or severe reaction, or call or text 988 for a mental health crisis.

When to reach out, and where

For routine questions, side effects that can wait, or how things are going, send your clinician a message through the patient portal. These are part of your ongoing care and are answered in the normal course of a few business days, so they are best for things that are not urgent.

If something feels urgent, you do not need to wait for a reply. The help options at the top of this page are the fastest way to get care: 911 or the nearest emergency department for a medical emergency or severe reaction, or 988 any time for a mental health crisis or thoughts of self-harm.

Questions to ask your clinician

• What are you hoping amitriptyline will help with in my case?
• How and when will we know if it is working?
• What should I do if I notice side effects?
• How long should I give it before we reassess?
• What is the plan if this one turns out not to be the right fit?
• How will we handle stopping it, if and when we get there?