Misc How dangerous is Amitriptyline?

[DesertHarp]

Years ago, a psychiatrist told me that the way to get off amitriptyline is to drop it by only 5 mg per month. I did that, after about 9 years of taking amitriptyline 50 mg every evening. When I got down to 35 mg per day, I started having a queezy stomach. Also I had more difficulty falling asleep. But I hung in there and got off the stuff. Unfortunately, I just don't feel or function as well off amitriptyline as I do on it. So I eventually went back on it.

The main downside of being on it, for me, is constipation. I believe that led to my recurring diverticulitis, which is no joke. I managed to get that problem under control by taking Miralax every day. I get the generic version. It works great!

No amount of antidepressants got rid of my depression. It really takes a change in your approach to life. Very hard to do.

 

[Man67]

Thanks mate for telling me your story. I will stay on 100mg as l can't go through another withdrawal. Could you please tell me what was the main side effect when you quit amitriptyline?

 

[DesertHarp]

Technically, according to medical literature, getting off amitriptyline is not suposed to entail "withdrawal." Instead, doctors call the discomforts of stoping it "discontinuation syndrome." Supposedly, "discontinuation syndrome" is not the same as "withdrawal." That may strike you as a "distinction without a difference," as the old saying goes. I would fully agree that stopping amitriptyline is no picnic. But I guess there is some kind of point to saying it is not quite as threatening as true withdrawal.

I've experienced withdrawal, when I've run out of hydrocodone, which I'm dependent on. The misery from that did seem more dramatic. With stopping amitriptyline, my main problem was insomnia that was quite severe. Doctors did used to underestimate the challenge of stopping amitriptyline. Many years ago, a psychiatrist told me I would only need 8 days to ween off of the medication. (He wanted to switch me to a different class of drugs.) Well, he was so wrong! The insomnia was off the hook, plus I just felt less well overall. I could only sleep in short bursts, where I felt like I was only half-asleep, like in a twilight state with too much dreaming. Nowadays, the doctors do know better. I can omit my opioid for a day or two without much suffering, but on day three it starts to be awful. With stopping amitriptyline suddenly, the bad consequence - insomnia - kicks in on the very first night.

100 mg is a pretty stiff dose. I never could tolerate that much. I did try. It made my saliva dry up and gave me a sore throat. I would suggest you try reducing by 5 mg per month. You might be able to get by on 75 mg a day. That might be safer for your heart. When I was briefly on 100 mg, I could feel my heart pounding in my chest, when I walked briskly outside. That kinda scared me.

Doctors also didn't used to realize that, if you bump up the dose a lot, without doing that gradually, it can give you some very unpleasant sensations - like restless leg syndrome.

Doctors just don't like prescribing amitriptyline anymore because of effects on heart, bowel, bladder and on pressure inside the eyeball. I seldom encounter anyone else who's on it. The thing is that it's probably the most effective antidepressant ever invented. Nothing else helped me.

 

[DesertHarp]

I literally can’t take more than 5 mg of amitriptyline every other day or else I’ll get nasty stomach pain. It causes the worst constipation at lowest mg doses of any drug I’ve ever tried

Yes, the constipation with amitriptyline is quite serious. After years of being on it, I developed pretty serious diverticulitis. Anyone can develop diverticuIar disease, but I suspect the medication was a contributing factor.

The standard advice is to take a stool softener, like Colace. That remedy is very inadequate.

 

[Man67]

Technically, according to medical literature, getting off amitriptyline is not suposed to entail "withdrawal." Instead, doctors call the discomforts of stoping it "discontinuation syndrome." Supposedly, "discontinuation syndrome" is not the same as "withdrawal." That may strike you as a "distinction without a difference," as the old saying goes. I would fully agree that stopping amitriptyline is no picnic. But I guess there is some kind of point to saying it is not quite as threatening as true withdrawal.

I've experienced withdrawal, when I've run out of hydrocodone, which I'm dependent on. The misery from that did seem more dramatic. With stopping amitriptyline, my main problem was insomnia that was quite severe. Doctors did used to underestimate the challenge of stopping amitriptyline. Many years ago, a psychiatrist told me I would only need 8 days to ween off of the medication. (He wanted to switch me to a different class of drugs.) Well, he was so wrong! The insomnia was off the hook, plus I just felt less well overall. I could only sleep in short bursts, where I felt like I was only half-asleep, like in a twilight state with too much dreaming. Nowadays, the doctors do know better. I can omit my opioid for a day or two without much suffering, but on day three it starts to be awful. With stopping amitriptyline suddenly, the bad consequence - insomnia - kicks in on the very first night.

100 mg is a pretty stiff dose. I never could tolerate that much. I did try. It made my saliva dry up and gave me a sore throat. I would suggest you try reducing by 5 mg per month. You might be able to get by on 75 mg a day. That might be safer for your heart. When I was briefly on 100 mg, I could feel my heart pounding in my chest, when I walked briskly outside. That kinda scared me.

Doctors also didn't used to realize that, if you bump up the dose a lot, without doing that gradually, it can give you some very unpleasant sensations - like restless leg syndrome.

Doctors just don't like prescribing amitriptyline anymore because of effects on heart, bowel, bladder and on pressure inside the eyeball. I seldom encounter anyone else who's on it. The thing is that it's probably the most effective antidepressant ever invented. Nothing else helped me.

Thanks mate for the detailed info. In my case amitriptyline is only a sleep aid, nothing more. Never experienced any antidepresive or pain managing effect. I was taking 150mg for years and didn't need anything else for sleep until I developed tolerance. I tapered down to 100mg without any withdrawal symptoms. It makes me sleepy a bit but not enough to fall asleep. I also tried 75mg but couldn't feel any sedating effect. It seems that I'm stuck for life? At least with some zolpidem and bromazepam l am able to get 4-5 hours of sleep at the moment. In any case lt's better than insomnia.

 

[DesertHarp]

I have these potent cannabis gummies. The container says they are 30 mg each. One half gummy, on top of the other stuff I take, is absolutely amazing. One of the best sleep inducers I've ever tried.

Maybe the gummies work because I'm new to cannabis and don't have tolerance yet. Antipsychotics, like Seroquel (quetiapine), can knock you out, but I suspect cannabis is actually safer.

 

[emkee_reinvented]

I've been on 100mg Amitriptyline for a decade. It doesn’t work as antidepressant at all. It's off the label sleeping aid and I take it together with 20mg Zolpidem and 6mg Bromazepam. Just then I can have 4-5 hours of sleep (if I am lucky). Wanted to tapper it down but my Neurologist (who originally prescribed this poison) is strongly against it. Why?

Do you Dream, on that coctail? Benzo's alone never prevented me from dreaming, but does stave off nightmares. Your dose is quite high. Do you need hour's of waking up, as a side effect.

Personally I hate off label use, they prescribed me Seroquel once.
Benzo's for sleep is essentially the same, although some do fall under hypnotic's. True hypnotic's they are not. Ever tried Mulungu, imo the best natural sleep aid. (no side effects noticed, no next day grogginess)

Did they do a sleep examination. Or do you know allready what the (main) cause of your poor sleep might be?

 

[emkee_reinvented]

I have these potent cannabis gummies. The container says they are 30 mg each. One half gummy, on top of the other stuff I take, is absolutely amazing. One of the best sleep inducers I've ever tried.

Maybe the gummies work because I'm new to cannabis and don't have tolerance yet. Antipsychotics, like Seroquel (quetiapine), can knock you out, but I suspect cannabis is actually safer.

HHCp an chemical anologue of CBD, basickly HHC with some extra carbon's making it 30 x stronger. Was like THC minus the psychedelic and (for some) energetic effect's.

Great for relaxing and sleep. To bad it's hard to get over here. Not the gummie's, but like a real bud.

 

[Man67]

Do you Dream, on that coctail? Benzo's alone never prevented me from dreaming, but does stave off nightmares. Your dose is quite high. Do you need hour's of waking up, as a side effect.

Personally I hate off label use, they prescribed me Seroquel once.
Benzo's for sleep is essentially the same, although some do fall under hypnotic's. True hypnotic's they are not. Ever tried Mulungu, imo the best natural sleep aid. (no side effects noticed, no next day grogginess)

Did they do a sleep examination. Or do you know allready what the (main) cause of your poor sleep might be?

No, I don't dream and I am never dizzy. I take amitriptyline around 8pm and bromazepam and zolpidem around 11pm. Main cause for my insomnia is PTSD (am a war veteran).

 

[DrBear]

Sorry to read that you are suffering so much. If there is a question about your psychiatrists' treatment and you are not feeling better, can you have a consultation with a different psychiatrist? In the US, second opinions are part of what should be recommended at this juncture. It doesn't mean you don't trust or like or will continue to work with your current psychiatrist if you choose to do so. Furthermore, no competent psychiatrist should ever object to their patient obtaining another opinion so long as that other consultant is properly trained and competent. Bottom line --> get a second opinion.

 

[Man67]

Sorry to read that you are suffering so much. If there is a question about your psychiatrists' treatment and you are not feeling better, can you have a consultation with a different psychiatrist? In the US, second opinions are part of what should be recommended at this juncture. It doesn't mean you don't trust or like or will continue to work with your current psychiatrist if you choose to do so. Furthermore, no competent psychiatrist should ever object to their patient obtaining another opinion so long as that other consultant is properly trained and competent. Bottom line --> get a second opinion.

I was diagnosed with TRD after trying and combining around 20+ antidepressants from each category. There is no cure for Treatment Resistant Depression except some new trials with Spravato nasal spray (ketamine) and MDMA which are extremely expensive and I can't afford it. I know that exercise is highly recommended but I have no mental or physical power to get out of bed or leave home. I consulted with my Dr.,Psychiatrist and Neurologist regarding Amitriptyline and all of them agreed that I shouldn't tapper it down. I guess nobody wants to be responsible for possible withdrawal effects.

 

[Man67]

Years ago, a psychiatrist told me that the way to get off amitriptyline is to drop it by only 5 mg per month. I did that, after about 9 years of taking amitriptyline 50 mg every evening. When I got down to 35 mg per day, I started having a queezy stomach. Also I had more difficulty falling asleep. But I hung in there and got off the stuff. Unfortunately, I just don't feel or function as well off amitriptyline as I do on it. So I eventually went back on it.

The main downside of being on it, for me, is constipation. I believe that led to my recurring diverticulitis, which is no joke. I managed to get that problem under control by taking Miralax every day. I get the generic version. It works great!

No amount of antidepressants got rid of my depression. It really takes a change in your approach to life. Very hard to do.

My Psychiatrist finally told me why I still have to take 150 mg Amitriptyline every night, despite the fact that it doesn't work for my TRD at all. It slightly helps my insomnia and that's all. "If you quit you will fell apart". So I'm stuck with it for the rest of my life?

 

[MedicinalUser247]

If you take the whole bottle you may die ! That's how dangerous.

 

[Cult315]

Thanks for the tip. Apparently it will be available in Australia from 1/7/24. Prescription only by Psychiatrist. Unfortunately it's not subsidised by the Government and average price is around $25.000 per treatment.

I was about to respond about psilocybin(mushrooms) before I saw his post and your response. While technically you could do the same with Ketamine I can’t personally recommend it because I haven’t done nor know anything about it. But for shrooms I’m sure you could easily source some locally if you know just about anybody who likes recreational drugs and avoid paying $25k.

I don’t usually talk about it much but I’ve been depressed(and recklessly suicidal as my doc used to call me) my entire life and while I quite honestly refused to try different anti depressant meds it was because all the ones they’d put me on as a teen seemed to make my condition much worse, so I found my own antidepressant in drug use. Namely opiates but anything mind-altering helped really.

A few years ago I’d been extra rough and luckily reached out to one friend who I’d wanted to see before I went out the door, dude drove from Colorado to me in a day with a pound of shrooms, and while he didn’t quite know the extent of what I was thinking he convinced me to take a trip with him. He also tried to get me into microdosing, which I think is the entire point of taking shrooms for depression, but my doses weren’t micro lol. I’d done shrooms plenty in the past but never saw them as a tool, just a temporary escape. The first trip I did when he came up was 9 grams and the next day I honestly felt way fucking better. 9 grams is a little crazy but I’m a little crazy. I won’t go into details about everything that went on in my mind but it genuinely helped me in one trip, not fully but enough to really change my mind long enough to hang around. For the next 6 months I continued to do them, eating the entire pound in that time frame and I truly no longer suffer from depression, or at least no where near the scale it was at the rest of my life. I really don’t think you need to do anywhere near what I did either, and while I won’t say for sure it’ll work for you it’s worth a shot. The only problem is certain meds block shrooms effects(sertraline for sure, not sure about the amitryptyline). Not sure how they are in Australia but they’re super cheap around here, and you could look into ordering spores and growing your own if the spores are able to be shipped to your country

 

[Cult315]

My Psychiatrist finally told me why I still have to take 150 mg Amitriptyline every night, despite the fact that it doesn't work for my TRD at all. It slightly helps my insomnia and that's all. "If you quit you will fell apart". So I'm stuck with it for the rest of my life?

I know you mentioned before that your psychologist is a great guy, but I’d highly advise seeing a different psych. I’m sure he is genuinely concerned about you falling apart mentally due to insomnia and mental changes associated with tapering/quitting the amitriptyline, but keeping you on a drug that’s known to be bad for heart health at such a high dose just because it slightly helps your insomnia just seems to be bad practice. Especially with a patient that’s willing to come off of it and try something else

At the very least I’d consult another psychiatrist or even your primary doctor and get their opinion on your concerns about your meds and if they’d advise changes.

 

[seraphin]

My Psychiatrist finally told me why I still have to take 150 mg Amitriptyline every night, despite the fact that it doesn't work for my TRD at all. It slightly helps my insomnia and that's all. "If you quit you will fell apart". So I'm stuck with it for the rest of my life?

Have you tried valerian (tea or capsule)? It's an herb that has opiate type affects, but it doesn't affect the CNS like opium. Victorian ladies used to carry a bottle of the tincture to sip on throughout the day...presumably to relieve stress from having to deal with patronizing oppression and whatnot. I'm not sure of any harmful side effects, so you'd need to research. But they sell it in capsules in Walmart. I just consider it like an extra strong chamomile. LOL

As for Amitriptyline, I've taken it for inflamed sciatica. Luckily it doesn't knock me out like some folks. And it helps m'hubby sleep...and he can't sleep well without some kind of aid. I would adjust anywhere from 10mg to 50mg, depending on my pain level.

 

[DesertHarp]

My Psychiatrist finally told me why I still have to take 150 mg Amitriptyline every night, despite the fact that it doesn't work for my TRD at all. It slightly helps my insomnia and that's all. "If you quit you will fell apart". So I'm stuck with it for the rest of my life?

I have serious doubts about this psychiatrist you're seeing. Amitriptyline is a drug that is now very unpopular among doctors, who have become reluctant to prescribe it. It is toxic to the liver, causes constipation, blurred vision, and heart rhythm disturbances. Can also cause weight gain, tooth decay, throat irritation, dizziess and unstable blood pressure. 150 mg is a hefty dose. To be taking all that amitriptyline without any improvement in your depression is a really poor idea IMHO.

I hate to get cynical, but your psychiatrist may fear that, if he stops ordering this drug for you, he'll be out of a job. Ordering drugs is really all that psychiatrists do these days, so he may feel he has to keep you on something. I highly recommend you and he pick something that is less extreme in side effects.

I really question this doctor's character. He is in no position to know that you will " fall apart" without this particular drug. While I have benefitted greatly from amitriptyline, I don't believe it's a miracle drug. I don't believe it will hold someone together who would otherwise fall apart. It might be a good idea for you to see another psychiatrist.

 

[Man67]

I was about to respond about psilocybin(mushrooms) before I saw his post and your response. While technically you could do the same with Ketamine I can’t personally recommend it because I haven’t done nor know anything about it. But for shrooms I’m sure you could easily source some locally if you know just about anybody who likes recreational drugs and avoid paying $25k.

I don’t usually talk about it much but I’ve been depressed(and recklessly suicidal as my doc used to call me) my entire life and while I quite honestly refused to try different anti depressant meds it was because all the ones they’d put me on as a teen seemed to make my condition much worse, so I found my own antidepressant in drug use. Namely opiates but anything mind-altering helped really.

A few years ago I’d been extra rough and luckily reached out to one friend who I’d wanted to see before I went out the door, dude drove from Colorado to me in a day with a pound of shrooms, and while he didn’t quite know the extent of what I was thinking he convinced me to take a trip with him. He also tried to get me into microdosing, which I think is the entire point of taking shrooms for depression, but my doses weren’t micro lol. I’d done shrooms plenty in the past but never saw them as a tool, just a temporary escape. The first trip I did when he came up was 9 grams and the next day I honestly felt way fucking better. 9 grams is a little crazy but I’m a little crazy. I won’t go into details about everything that went on in my mind but it genuinely helped me in one trip, not fully but enough to really change my mind long enough to hang around. For the next 6 months I continued to do them, eating the entire pound in that time frame and I truly no longer suffer from depression, or at least no where near the scale it was at the rest of my life. I really don’t think you need to do anywhere near what I did either, and while I won’t say for sure it’ll work for you it’s worth a shot. The only problem is certain meds block shrooms effects(sertraline for sure, not sure about the amitryptyline). Not sure how they are in Australia but they’re super cheap around here, and you could look into ordering spores and growing your own if the spores are able to be shipped to your country

Thanks mate l really appreciate your advice. Due to self-isolation for the last several years, I don't know anyone why can help with psilocybin. Psychiatrist can prescribe it but the treatment is very expensive. Between 25 - 35 thousand $. I can't afford it.

 

[Dreamflyer]

I know that tricyclics like Amitriptyline are the one type of antidepressant that you can OD on fairly easily. I take Lexapro (SSRI) and Remeron (tetracyclic).

​

 

[Man67]

I know that tricyclics like Amitriptyline are the one type of antidepressant that you can OD on fairly easily. I take Lexapro (SSRI) and Remeron (tetracyclic).

​

You are absolutely right.