Amitriptyline hydrochloride is a dibenzocycloheptadiene derivative, classified as a tertiary amine tricyclic antidepressant that is used to restore balance to chemicals in the brain. Tricyclic antidepressants are approved to treat depression and anxiety disorders and have also been shown to be effective in reducing neuropathic pain, partially in patients suffering from fibromyalgia. In fact, amitriptyline is the first-line treatment for pain, fatigue, and lack of sleep in patients suffering from fibromyalgia. Amitriptyline is also used to treat bowel disorders, such as irritable bowel syndrome, by modulating pain both locally and centrally.
Depression: Amitriptyline is FDA approved to treat depression in adults and children at or over the age of 12. Specifically, this antidepressant is aimed at treating major depression (endogenous and psychotic) and depression that is accompanied by sleep disturbances1. Amitriptyline may also be used to treat anxiety related to depression.
Fibromyalgia: Amitriptyline is also used to treat pain and fatigue in patients suffering from fibromyalgia. Although post-treatment studies do not elucidate the link between the drug and ease of pain2, amitripytline has been used for years to treat fibromyalgia symptoms and is currently part of the front-line treatment.
Other Pain Treatment: Tricyclic antidepressants in general, and in some cases amitriptyline specifically, have been effective in treating pain from many other conditions, such as diabetes, complication of shingles, mastectomy, and vulvodynia. 3
Irritable Bowel Syndrome: Amitriptyline and other tricyclic antidepressants have been shown to be effective in reducing abdominal pain in patients suffering from irritable bowell syndrome. The mechanism of action Is thought to be reduction of nerve sensitivity.4
Side Effects and Drug Interactions
Common side effects in patients taking amitriptyline include5:
Constipation or trouble urinating
Patients who experience serious but rare side effects should contact their pharmacist or physician right away. These side effects include:
Easy bruising or bleeding
Shaking, spasming, or mask-like facial expressions
Severe stomach or abdominal pain
Decreased sexual ability or desire
Enlarged or painful breasts
Although there are no common drug interactions with amitriptyline, patients who are intolerant to tricyclic antidepressants, or have are or have been on monoamine oxidase inhibitors (MAOIs) should not take this drug without advising their physicians.
Latest News and Research
Amitriptyline was developed in the 1950s as a tertiary amine antidepressant because of the drug’s abilityto raise levels of serotonin and norepinephrine by slowing their reabsorption in the brain.6 Although amitriptyline and other drugs in its class remain effective antidepressants, clinicians are now moving to use them off-label in pain management. In addition to the conditions listed above, amitriptyline shows promise in treating migraines in women7, as well as managing chronic pain.8 Amitriptyline may also be prescribed in ADHD patients, and is thought to work by reducing norepinephrine levels in the brain.9