Misc How dangerous is Amitriptyline?

[4DQSAR]

If by some miracle 25mg Agomelatine start to work can that be a substitute for Amitriptyline?

I don't know. It's a novel class of antidepressant

Antidepressant efficacy of agomelatine: meta-analysis of published and unpublished studies

Objective To systematically review published and unpublished efficacy studies of agomelatine in people with depression. Design Systematic review and meta-analysis. Data sources Literature search (Pubmed, Embase, Medline), Cochrane Central Register of Controlled Trials, European Medicines...

www.bmj.com

Note how the article compares it's eccacacy with 'a standard antidepressant'. I have seen this phrase used HUNDREDS of times. But when I took a closer look, quite often I would note that the standard antidepressant was, you guessed it, amitriptyline. Not problematic in itself but I kept noting that studies would compare the highest prescribable dose of a newer antidepressant with the lowest prescribable dose (for depression) of amitryptyline. Prozac was the first example I read. They were comparing 60mg of the latter with 25mg of amitryptyline.

BUT depression is far more complex than a simple monoamine imbalance. Papers and patents on novel antidepressants litter journals. Compounds that appeared to work in animal models but which were of no value in man.

The truth is that prescribing antidepressants is still a bit of a hit and miss affair. Stuff that's proven useless to me has helped others hugely.

I believe agomelatine can produce a metabolite that is potentially toxic but if it makes your life vastly better, do you seek the longest life (statistically) OR the best tradeoff between lifespan and quality of life? If it works, don't focus on those tiny risks, concentrate on your life being better. SSRIs make me worse but work wonderfully for my wife, so I don't knock them.

 

[Man67]

Based on agomelatine's pharmacology, I don't think it would be a suitable substitute for amitriptyline. Agomelatine acts mainly as a melatonin agonist with much lower affinity for other receptors.

Eliminate 10mg Zolpidem or 3mg Bromazepam from the sleeping meds?

 

[4DQSAR]

Eliminate 10mg Zolpidem or 3mg Bromazepam from the sleeping meds?

Well one is a hypnotic, the other an anxiolytic. I don't think anoyone can give you a firm asnwer as different people react differently to both drugs.

If anxiety is producing insomnia, bromazepam taken BID or TID may be more practical, but if it's purely insomia, Z-drugs don't produce morning after sedation in most people.

But be aware that both drugs form a pretty nasty dependence and doctors would only consider prescribing short-term and only if they see it improving long-term outcomes.

Pyrazolaam, pynazolam and pyezolam were all made from bromazepam so I'm aware that the metabolism is a bit different. It has no active metabolites which for my purposes, was a feature, not a bug.

 

[LucidSDreamr]

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?

It’s not that hard to taper off of. I tapered off of 75 mg and found it pretty easy to get off of.

I did found it to work as an awesome antidepressant (almost recreational) but I was on it for pain and it did nothing for pain.

The GI constipation was too much with that drug; I’d get horrible stomachs cramps that would last for even months after stopping it

 

[Conky]

Well one is a hypnotic, the other an anxiolytic. I don't think anoyone can give you a firm asnwer as different people react differently to both drugs.

If anxiety is producing insomnia, bromazepam taken BID or TID may be more practical, but if it's purely insomia, Z-drugs don't produce morning after sedation in most people.

But be aware that both drugs form a pretty nasty dependence and doctors would only consider prescribing short-term and only if they see it improving long-term outcomes.

Pyrazolaam, pynazolam and pyezolam were all made from bromazepam so I'm aware that the metabolism is a bit different. It has no active metabolites which for my purposes, was a feature, not a bug.

You say that as if all doctors closely follow/monitor patients after prescribing a sedative. Months could go by before they speak to the patient again.

 

[4DQSAR]

It's entirely up to the patient to maintain contact with the doctor. At least where I live, doctors will generally suggest you return if symptoms do not improve. It's your health.

 

[Man67]

Well one is a hypnotic, the other an anxiolytic. I don't think anoyone can give you a firm asnwer as different people react differently to both drugs.

If anxiety is producing insomnia, bromazepam taken BID or TID may be more practical, but if it's purely insomia, Z-drugs don't produce morning after sedation in most people.

But be aware that both drugs form a pretty nasty dependence and doctors would only consider prescribing short-term and only if they see it improving long-term outcomes.

Pyrazolaam, pynazolam and pyezolam were all made from bromazepam so I'm aware that the metabolism is a bit different. It has no active metabolites which for my purposes, was a feature, not a bug.

I've been taking them for more than 10 years.

It’s not that hard to taper off of. I tapered off of 75 mg and found it pretty easy to get off of.

I did found it to work as an awesome antidepressant (almost recreational) but I was on it for pain and it did nothing for pain.

The GI constipation was too much with that drug; I’d get horrible stomachs cramps that would last for even months after stopping it

Meanwhile they raised the dosage to 150mg. Nobody wants me tapper it down due to potential serious health issues. In other words they don't want to be responsible if something happens to me.

 

[4DQSAR]

If you have been consuming a benzodiazepine and a drug that acts in an almost identical manner to benzodiazepines for over a decade, they cannot possibly still provide anxiolytic or hypnotic activity. The body adjusts to such medications in a matter of weeks. All that taking them can be doing now is simply preventing withdrawal symptoms.

In the UK at least, it is now official policy that any patient who has been prescribed a benzodiazepine or Z-drug for over 3 months should simply continue to be prescribed them. They are of no benefit, but the risks of discontinuing treatment far outweighs the risks associated with continued use.

If I were you I would get a Medic Alert bracelet informing emergency services. It sounds like you only consume a modest dose but if something bad happens, emergency services need to know as withdrawl symptoms may mask other medical conditions.

I'm prescribed clobazam for epilepsy and without it I do suffer seizures - so I have such a bracelet.

 

[Smyth2]

Amitriptyline is okay stuff. Normally I take 150mg in the evening an hour or so before retiring. There's no point in tapering just keep taking it.

 

[Man67]

Amitriptyline is okay stuff. Normally I take 150mg in the evening an hour or so before retiring. There's no point in tapering just keep taking it.

One of the side effects are suic. thoughts and intentions. I have it almost every day. None of other meds I take have that warning.

 

[4DQSAR]

I don't believe that suicidial ideation is a common side-effect of the tricyclic antidepressants. It's only when a serious adverse effect occurs in more than 1 in 100 people prescribed a medication that then requires a 'black box warning'. It's not automatically the case that the medication is responsible.

As I keep saying, if a given antidepressant doesn't work for you, go back to the doctor. It's common for patients having to try two or more medcations before finding the one that best suits them.

 

[Man67]

I don't believe that suicidial ideation is a common side-effect of the tricyclic antidepressants. It's only when a serious adverse effect occurs in more than 1 in 100 people prescribed a medication that then requires a 'black box warning'. It's not automatically the case that the medication is responsible.

As I keep saying, if a given antidepressant doesn't work for you, go back to the doctor. It's common for patients having to try two or more medcations before finding the one that best suits them.

I don't believe that suicidial ideation is a common side-effect of the tricyclic antidepressants. It's only when a serious adverse effect occurs in more than 1 in 100 people prescribed a medication that then requires a 'black box warning'. It's not automatically the case that the medication is responsible.

As I keep saying, if a given antidepressant doesn't work for you, go back to the doctor. It's common for patients having to try two or more medcations before finding the one that best suits them.

So far I tried between 15 - 20 different antidepressants from each category. Amitriptyline is the only one that I'm not supposed to quit due to serious side effects. Saw my Dr. today and he confirmed it. Treatment Resistant Depression doesn't respond to traditional meds.

 

[4DQSAR]

I'm at fault if I meeded your mentioning of treatment resistant depression. In such cases medications are rarely of value. Regular client-centred councelling has been shown to be the most effective approach although I'm the first to note that it's an essentially ongoing process and takes up a lot of time (at least) and a lot of money (depending on where you live).

I recieved such therapy for what I can best describe as shell shock, because I was actually in an explosion. Flashbacks, nightmares and intrusive thoughts were untenable but after a year of treatment, my life was considrably improved. Everyone is unique and no matter what others tell you, your response to councelling will be unique.

 

[Man67]

Based on agomelatine's pharmacology, I don't think it would be a suitable substitute for amitriptyline. Agomelatine acts mainly as a melatonin agonist with much lower affinity for other receptors.

Amitriptyline (50mg) was given to me by Neurologist for chronic headache. It didn't work but it helped me sleep better. After some time I developed tolerance so they increased the dose to 100mg and after that to 150mg.

It was never prescribed to me for depression. Is it possible that Amitriptyline make my depression worse? I've got all kinds of side effects and no benefits at all.

 

[Conky]

Amitriptyline (50mg) was given to me by Neurologist for chronic headache. It didn't work but it helped me sleep better. After some time I developed tolerance so they increased the dose to 100mg and after that to 150mg.

It was never prescribed to me for depression. Is it possible that Amitriptyline make my depression worse? I've got all kinds of side effects and no benefits at all.

Yeah, that can happen sometimes

What are the main side effects?

Have you mentioned this to the prescriber?

If there are no benefits then you may want to start looking for a replacement that is more tolerable and that you can give informed consent

 

[Man67]

Yeah, that can happen sometimes

What are the main side effects?

Have you mentioned this to the prescriber?

If there are no benefits then you may want to start looking for a replacement that is more tolerable and that you can give informed consent

The list of side effects is too long to be published. The prescriber said that it's too dangerous to tapper it down and that I'll feel much worse. And they are talking about pain killers being addictive? HYPOCRITES.

 

[Conky]

The list of side effects is too long to be published. The prescriber said that it's too dangerous to tapper it down and that I'll feel much worse. And they are talking about pain killers being addictive? HYPOCRITES.

Well, there are other options out there that don't have strong anticholinergic activity (among others) like amitryptiline

 

[Man67]

Just started Agomelatine a couple of weeks ago. It works for sleep but I don't expect much more as I was diagnosed with TRD. I started tapering Amitriptyline from 150mg to 125mg. It will take some time...

 

[Conky]

Yeah Agomelatine has a very short half life which limits it's usefulness

Anyway good luck with the taper and keep us updated on your progress regarding potential withdrawals or improvements

Hopefully your doctor will respect your decision and work with you to minimize unpleasant effects that could emerge on the smaller dose of amitriptyline

 

[Man67]

How much Amitriptyline is too much? I was on 150mg for years and developed tolerance. Doesn't even help with sleep anymore. Is it ok if raise the dosage to 200-250mg before sleep?