Amitriptyline Uses
Amitriptyline is a tricyclic antidepressant that has been approved by the FDA to treat depression in adults. The name brand of the drug is Elavil, but it is being used now “off-label” as Amitriptyline to treat a number of psychiatric and neuroligic conditions.
This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.
Although the FDA approved Elavil (amitriptyline) to treat depression, it has many other common uses in medicine.
Amitriptyline uses:
Chronic pain syndrome
Anxiety
Insomnia
Nerve pain, Polyneuropathy, Trigeminal or Herpetic Neuralgia
IBS Irritable Bowel Syndrome
Eating disorders
Pelvic pain
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How does Amitriptyline work?
Amitriptyline works on two neurochemicals, serotonin and noradrenalin.
Serotonin is called the “happy” hormone because it modulates well-being and a feeling of happiness. It affects mood, digestion, and daily appetite for food. Serotonin is also a precursor for melatonin and helps control the biologic cycle for sleeping and wakefulness.
Noradrenalin is a neurotransmitter secreted in the brain and spinal cord which increases alertness, arousal, and attention. It causes vasoconstriction of blood vessels and regulates blood pressure in times of stress.
How long does it take Amitriptyline to work?
Amitriptyline usually needs to be taken for 2-4 weeks to produce adequate results. It is taken chronically and given at bedtime to help with sleep.
Chronic Pain Syndrome
Go to medical school, get a license, and start seeing patients and there will be some who come in and complain of chronic pain somewhere in their body that often has been previously evaluated by another doctor with negative results.
The pain is commonly in their back, or their neck, or their head, or in their abdomen. Many of these persons may be taking opioid narcotics, which is rarely a good option for their future health. Often, they also don’t sleep well and have low energy. The doctor should get them off the narcotics and Amitriptyline, in this situation, and in low dose (10-20 mg) may provide some help.
Anxiety, properly called Generalized Anxiety Disorder (GAD)
Unfortunately, this is a very common human condition. GAD affects 6.8 million adults or 3.1% of the U.S. population, yet only 43.2% are receiving treatment.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) generalized anxiety disorder is defined as:
The patient complains of symptoms of excessive anxiety and worry about a variety of topics, events, or activities. The worry could be about employment or the patient’s own or a family member’s health.
The worry is difficult to control and not related to a threat or prevalent risk. Patients with GAD spend a lot of their daytime worrying about something.
The patient’s anxiety and worry come with at least 3 of the following symptoms.
The symptoms occur for more days than not during the past six months.
The symptoms cause significant distress or social impairment.
The patient has at least three ancillary symptoms which are:
Restlessness or mental tension
Fatigability, easy tiring.
Poor concentration as if the mind goes blank.
Irritability
Increased muscle tension and soreness in the neck, shoulders, jaw, or teeth, grinding or bruxism.
Trouble sleeping which may come with difficulty falling asleep, maintaining sleep, night restlessness or unsatisfying sleep.
Insomnia
Trouble sleeping is part of the diagnostic make up of both Generalized Anxiety Disorder and Major Depression.
Nerve pain, Polyneuropathy, Trigeminal or Herpetic Neuralgia
The peripheral sensory nerves are particularly involved with causing pain. It could be the median nerve in wrist with carpal tunnel syndrome, the fifth cranial nerve with trigeminal neuralgia, or the seventh cranial nerve in the face with post herpetic neuralgia.
Neuralgia is pain along the course of a nerve, especially in the head or face. It may come with a heat sensation or sharp, lancinating intensity. It may be associated with a numb or tingling sensation.
IBS Irritable Bowel Syndrome
Diarrhea that sometimes comes with IBS may be helped with Amitriptyline which decreases gastrointestinal motility. Amitriptyline inhibits the activity of neurons that control the intestines. This may help reduce pain.
A recent study, published in The Lancet in 2023, showed that patients taking amitriptyline were almost twice as likely to report an overall improvement in symptoms as those taking a placebo.
Eating disorders
In general antidepressant treatment of anorexia nervosa has given dismal results although one study of patients with both bulimia and anorexia nervosa found amitriptyline to be better than placebo.
Pelvic Pain
pelvic sensitivity
Painful pelvic muscles
Painful vulval skin
General statement
Although not an analgesic and not addictive, Amitriptyline may help improve painful conditions. And not a hypnotic or sedative, nor an addictive drug like the benzodiazepines, it may help sleep.
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