Amitriptyline is a classic tricyclic antidepressant. Due to the fact that it was one of the first to be synthesized, it is often called the “old antidepressant.” However, despite the emergence of a number of more modern drugs, treatment of depression with Amitriptyline is still carried out today. The main advantage of this drug is its pronounced dual action. The medicine is effective not only against depression, but is also widely used in the treatment of chronic pain. However, due to a fairly large number of contraindications, it cannot be considered universal.
What is Amitriptyline?
The medicine should be taken orally after meals with plenty of water.
Amitriptyline is one of the most prominent representatives of the first generation of antidepressants. It has a direct effect on the nerve cells of the brain, allowing you to suppress anxiety and reduce the severity of depressive conditions.
Important! Unlike a number of analogues, Amitriptyline does not cause hallucinations, and therefore it is often prescribed for migraines and chronic headaches.
The medicine is available in tablet form and as a solution for injection. The tablets are small in size, round in shape and covered with a white coating. The solution appears as a clear liquid that is either colorless or faintly colored.
How does Amitriptyline work?
This drug has a pronounced sedative effect, which is why it is often used to treat depressive conditions. It helps reduce severe emotional arousal and anxiety. In addition, the drug has the following properties:
- antihistamine;
- thymoleptic;
- antiserotonin;
- analgesic;
- anxiolytic;
- antiulcer;
- M-anticholinergic.
Amitriptyline is also used to lower body temperature and blood pressure during general anesthesia.
The effect of taking the drug occurs no earlier than two weeks after the start of its use.
Indications and contraindications
Amitriptyline is strictly contraindicated during pregnancy
The advisability of taking this drug arises in the following cases:
- The patient was diagnosed with severe depression. Symptoms of sleep disturbance, emotional overexcitation and anxiety are observed. We can talk about depression caused by mental trauma, alcoholism or organic brain damage.
- Disorders of mental activity that occur against the background of the development of schizophrenia. Amitriptyline is often used in the treatment of depressive conditions in schizophrenic patients.
- Mixed emotional disturbances. If the complication of the patient’s mental state was caused by several factors, then this remedy also helps to stabilize the patient’s well-being.
- Attention disorders, the patient’s inability to carry out any active activity.
- Bulimia, which is of a nervous nature.
- Nocturnal enuresis.
- Chronic pain observed in cancer patients, rheumatic diseases and migraines. Amitriptyline is also prescribed to patients with postherpetic neuralgia, atypical pain in the heart area and neuropathies of various origins.
- Peptic ulcer of the duodenum and stomach.
This drug has a fairly wide list of contraindications, and therefore its use should be carried out exclusively under the supervision of a doctor.
It is prohibited to take Amitriptyline if you have the following diseases and conditions:
- Myocardial infarction, which is in an acute form or subacute period of development.
- Serious problems in the functioning of the heart muscle. We are talking about intraventricular conduction disorders, atrioventricular blockades, etc. The drug should be used with caution in patients with coronary heart disease and arrhythmias.
- Acute alcohol intoxication.
- Thyroid diseases.
- Angle-closure glaucoma.
- Pregnancy. Prescribing this drug during the 1st and 3rd trimesters is strictly prohibited. In case of emergency, Amitriptyline is taken under medical supervision.
- Breast-feeding. If Amitriptyline therapy is absolutely necessary, breastfeeding should be discontinued.
- The presence of acute intoxication with hypnotics, analgesics and psychoactive drugs.
Amitriptyline is not prescribed to children under 6 years of age.
Side effects
When taking the drug, tachycardia and heart rhythm disturbances may occur.
When taking this drug, it is necessary to take into account a number of possible side effects, which manifest themselves as follows:
- Confusion, weakness and dizziness, fainting.
- Heart rhythm disturbances, tachycardia.
- Urinary retention, constipation, development of paralytic intestinal obstruction.
- Minor weight gain.
Due to the large number of side effects, many doctors use inappropriately low dosages of Amitriptyline in treatment, which results in a significant reduction in the effectiveness of treatment.
In case of overdose, this drug can lead to the development of severe poisoning. Therefore, it is often acquired by people with suicidal tendencies. The doctor’s task in this case is to timely recognize such a patient and prevent death.
The effect of Amitriptyline in the treatment of depressive conditions
This drug can treat the following disorders:
- depression;
- nocturnal bulimia;
- worry and anxiety;
- mental disorders, etc.
To assess the effectiveness of this drug in the fight against depression, one should consider the mechanism of its effect on the body. With the development of depression, a sharp decrease in norepinephrine and serotonin is observed in the patient’s body. This happens because they begin to flow to the brain cells.
The high effectiveness of Amitriptyline in the treatment of depression lies in improving the patient’s mood due to the release of norepinephrine and serotonin from the brain structures. As a result, symptoms of depression are alleviated. If the absorption of neurotransmitters in cells occurs repeatedly, then this no longer affects a person’s mood.
Side effect
Amitriptyline, when taken in large quantities, causes numerous side effects. Taking it can provoke the development of problems with almost all organs and systems.
Due to blocking of m-cholinergic receptors, it can:
- increase intraocular pressure;
- dry mouth occurs;
- impaired vision;
- delayed urination;
- constipation and intestinal obstruction occur;
- sweating increases;
- accommodation paresis develops;
- body temperature rises.
These side effects usually disappear after getting used to the drug or as a result of reducing the dose.
Other side effects caused by the complex manifestation of all the actions of the drug are also possible:
- disturbances in concentration;
- excessive sleepiness;
- nightmares;
- dizziness;
- dysarthria;
- tachycardia;
- changes in the blood picture;
- nausea;
- anorexia;
- motor excitement;
- symptoms of heart failure;
- hallucinations;
- heartburn;
- arrhythmia;
- noise in ears;
- stomatitis;
- pain and discomfort in the epigastrium;
- change in tongue color;
- decreased libido;
- taste disturbance;
- glucosuria;
- swelling of the testicles;
- angioedema;
- breast growth;
- weight gain;
- hair loss;
- galactorrhea;
- blood pressure lability;
- enlarged lymph nodes.
With long-term use of high doses of the drug, cardiotoxicity is likely to develop.
Separately, it should be noted the symptoms characteristic of withdrawal syndrome: increased excitability, diarrhea, nausea, headaches, vomiting, irritability, sleep disturbances with unusual dreams.
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Method of use for depression
The daily dose should be gradually reduced if a positive effect is obtained
Amitriptyline should be taken only if prescribed by a doctor. In most cases, the dosage is calculated individually, taking into account the severity of the disease.
The medicine should be taken orally after meals with plenty of water. Chewing the tablets is prohibited, as this may irritate the stomach walls.
Let's look at how to take Amitriptyline for depression:
- The initial daily dose is considered to be 50-75 mg. Thus, the drug is taken one tablet (25 mg), twice or thrice a day. A course of treatment of depression with Amitriptyline is carried out until the patient’s condition stabilizes.
- The optimal dose of the drug is 175-200 mg. Moreover, most of this dose is taken at night.
- If we are talking about the development of severe depression that is not responsive to therapy, then the daily dose can be increased to 300 mg. In some cases, it is possible to take a larger dose of the substance, which is calculated individually for each patient.
In the latter case, the drug is administered by injection. In this case, the initial doses are higher than usual, and their increase occurs at a faster rate. In this case, constant monitoring of the patient’s somatic condition is necessary.
The daily dose should be gradually reduced when a pronounced effect is obtained. If a resumption of depression is observed, it is necessary to return to the original dosage.
If in the fourth week of treatment no changes in the patient’s condition are observed, then further therapy is considered inappropriate. In this case, the doctor prescribes another drug.
Interaction with other drugs
When using Amitriptyline, you should take into account the peculiarities of its interaction with other drugs:
- Barbiturates, antidepressants and other drugs that depress the central nervous system. When taken simultaneously with Amitriptyline, an increased inhibitory effect on the central nervous system, a hypotensive effect, and depression of respiratory function are observed.
- Clonidine, antihistamines. The effect is similar to that described above.
- Phenothiazines, Atropine, antiparkinsonian drugs, antihistamines. An increase in anticholinergic effect is observed, side effects from the bladder, intestines, visual organs and the central nervous system are possible. Paralytic type intestinal obstruction may develop.
- Anticonvulsants. There is an increase in central nervous system depression and a decrease in the effectiveness of these drugs.
- Phentothiazines, anticholinergics, benzodiazepines. There is a high risk of developing epileptic seizures, and the patient may develop neuroleptic-type malignant syndrome.
- Guanethidine, Clonidine, Mutildopa, Reserpine, Betanidine. When taken simultaneously with Amitriptyline, the hypotensive effect of these drugs is reduced.
- Thyroid hormones. There is a mutual enhancement of both the therapeutic effect and the toxic effect on the patient’s body.
- Probucol, Pimozide. Severe cardiac arrhythmia may occur.
Contraindications for use
Amitriptyline has a large number of contraindications that significantly limit the possibility of its use; taking the medication is prohibited if:
- myocardial infarction in the acute and recovery period;
- acute liver diseases;
- heart failure;
- disorders of myocardial conduction functions;
- hypertension;
- exacerbations of gastric and duodenal ulcers;
- impaired renal function;
- prostate hypertrophy;
- paralytic ileus;
- pyrolytic stenosis;
- atony of the bladder;
- pregnancy;
- breastfeeding;
- children under 6 years of age (tablets) and 12 years of age (injection forms);
- hypersensitivity to the components of the drug;
- simultaneous use of MAO inhibitors, as well as with a break of less than 2 weeks after taking them.
Particular care should also be taken when using the medicine when:
- alcoholism;
- bronchial asthma;
- epilepsy;
- inhibition of the hematopoietic process;
- glaucoma;
- schizophrenia;
- manic-depressive psychosis;
- intraocular hypertension.
Analogs
Taken orally immediately after meals (irritates the gastric mucosa), with a small amount of water
If it is impossible to prescribe Amitriptyline to the patient, the doctor may prescribe one of the following analogues:
- Saroten;
- Anafranil;
- Doxepin;
- Novo-Triptin;
- Melipramine.
It should be understood that each of the above drugs has its own side effects and contraindications that should be taken into account when using these drugs.
Reviews
Vitaly, Rostov-on-Don Amitriptyline was prescribed to my wife, who was severely depressed. She lost her job and was unable to find a job for a long time, despite enormous experience in her field. When the depression became completely unbearable, they consulted a doctor who prescribed her several medications, including Amitriptyline. The first effect was noticeable after about two weeks of use. I thought about going to the doctor to change the therapy, but the medicine worked, and now my wife is much better.
Zhanna, Saratov After my mother’s death, I was depressed for a long time. I live alone, so there was no one to take me to the doctor - I went myself. Amitriptyline helped me cope with my fears and worries, and return to a full life.
special instructions
Amitriptyline reduces attention and causes drowsiness. Because of this, its use is not recommended when driving, as well as performing work that requires increased concentration.
Drug and alcohol
While using Amitriptyline, drinking alcohol is strictly prohibited, as this can lead to serious consequences.
This is explained by the similarity of the mechanisms of action of the drug and alcohol, which is expressed in the mutual strengthening of the effect on the body and the most pronounced toxic effect.
With the simultaneous use of alcohol and medication, the temperature and blood pressure may rise significantly, the heart rhythm may be disturbed, and paralytic obstruction may occur.
In addition, due to the inhibitory effect on the respiratory center, breathing may be impaired until it stops completely and death occurs.
Also, the simultaneous use of alcohol and Amitriptyline has a very negative effect on the liver and kidneys. Toxic liver necrosis and severe renal dysfunction may develop.
Other important nuances
It is prohibited to take the drug if there are serious dysfunctions of these organs.
The use of the drug during pregnancy and lactation is prohibited. Tablets are taken from the age of 6 years, and an injection solution - from 12 years.
