What do you want to know more about?

---

What is it?

Elavil is a brand name for the drug amitriptyline, which belongs to a class of antidepressants called tricyclic antidepressants (TCAs). TCAs are among the oldest types of antidepressants, and they work by increasing the levels of certain chemicals in the brain, such as serotonin and norepinephrine, that regulate mood and pain perception.

History:

Amitriptyline was first synthesized in 1960 by a team of researchers at Merck, and it was initially marketed as a treatment for schizophrenia. However, it soon became apparent that amitriptyline had more potent effects on depression than on psychosis, and it was approved by the FDA for the treatment of major depressive disorder in 1961. Elavil was one of the most widely prescribed antidepressants in the 1960s and 1970s, until newer and safer drugs, such as selective serotonin reuptake inhibitors (SSRIs), became available.

Mechanism of Action:

Amitriptyline works by blocking the reuptake of serotonin and norepinephrine, two neurotransmitters that are involved in mood regulation, pain modulation, and sleep quality. By preventing these chemicals from being reabsorbed by the nerve cells, amitriptyline increases their availability and activity in the brain, which can help alleviate the symptoms of depression, such as low mood, loss of interest, insomnia, and chronic pain.

Evidence for use:

Amitriptyline is one of the most extensively studied antidepressants, and it has been shown to be effective for treating various types of depression, such as major depressive disorder, dysthymia, and bipolar depression. Amitriptyline is also used off-label for other conditions, such as migraine, neuropathic pain, fibromyalgia, irritable bowel syndrome, and insomnia. According to a meta-analysis of 39 randomized controlled trials, amitriptyline was found to be superior to placebo and comparable to other antidepressants in terms of efficacy and tolerability for the treatment of depression.

Benefits vs other medications:

Amitriptyline has some advantages over other antidepressants, such as:

- It is relatively inexpensive and widely available, making it accessible for many patients who cannot afford newer drugs.

- It has a long half-life, which means it stays in the system for a long time and does not require frequent dosing.

- It has a broad spectrum of action, which means it can treat not only depression, but also other co-occurring conditions, such as anxiety, pain, and insomnia.

- It can enhance the effects of other antidepressants, such as SSRIs, when used in combination, which can improve the response rate and reduce the risk of relapse.

Dosing:

The usual starting dose of amitriptyline for depression is 25 to 50 mg per day, taken at bedtime or in divided doses throughout the day. The dose can be gradually increased by 25 to 50 mg every week, depending on the patient's response and tolerance. The maximum dose of amitriptyline for depression is 300 mg per day, but most patients do not need more than 150 mg per day. The dose should be reduced slowly when discontinuing the medication, to avoid withdrawal symptoms.

Side Effects/ Adverse reactions / Contradictions:

Amitriptyline can cause a number of side effects, some of which are common and mild, and some of which are rare and serious. The most common side effects of amitriptyline include:

- Drowsiness, dizziness, and fatigue

- Dry mouth, blurred vision, and constipation

- Weight gain and increased appetite

- Difficulty urinating and sexual dysfunction

- Sweating, tremors, and headaches

The rare but serious side effects of amitriptyline include:

- Cardiac arrhythmias, such as irregular heartbeat, palpitations, and low blood pressure

- Seizures, convulsions, and coma

- Serotonin syndrome, a potentially life-threatening condition caused by excessive serotonin in the brain, which can manifest as agitation, confusion, fever, muscle rigidity, and diarrhea

- Suicidal thoughts and behaviors, especially in children, adolescents, and young adults

Amitriptyline is contraindicated in patients who have:

- Hypersensitivity or allergy to amitriptyline or any of its ingredients

- Recent history of heart attack, stroke, or heart failure

- Glaucoma, urinary retention, or prostate enlargement

- Bipolar disorder, schizophrenia, or other psychotic disorders

- Liver or kidney disease, or thyroid problems

- Pregnancy or breastfeeding

Amitriptyline can also interact with other medications, such as:

- Other antidepressants, especially MAOIs, which can cause a dangerous rise in blood pressure and serotonin syndrome

- Antihistamines, sedatives, and opioids, which can increase the risk of drowsiness, respiratory depression, and overdose

- Anticonvulsants, such as carbamazepine and phenytoin, which can lower the blood levels and effectiveness of amitriptyline

- Warfarin, aspirin, and other blood thinners, which can increase the risk of bleeding and bruising

Positives or Pros:

Some of the positive aspects of taking amitriptyline for depression are:

- It can improve the mood, energy, and motivation of depressed patients, and restore their interest and pleasure in life.

- It can reduce the frequency and severity of migraines, headaches, and other types of chronic pain, which can improve the quality of life and functioning of patients.

- It can help patients fall asleep faster and stay asleep longer, which can improve their circadian rhythm and overall health.

- It can augment the effects of other antidepressants, which can increase the chances of remission and recovery.

Negatives or Cons:

Some of the negative aspects of taking amitriptyline for depression are:

- It can cause a range of side effects, some of which can be bothersome, uncomfortable, or even dangerous, and require medical attention or discontinuation of the medication.

- It can be toxic in high doses, and overdosing on amitriptyline can be fatal, especially when combined with alcohol or other drugs.

- It can take several weeks to show its full effects, and patients may experience a worsening of their symptoms or suicidal thoughts before they feel better.

- It can cause withdrawal symptoms, such as nausea, headache, and anxiety, if stopped abruptly or without medical supervision.

Conclusion:

Elavil (Amitriptyline) is an old but effective antidepressant that can treat various types of depression and other conditions, such as pain and insomnia. However, it also has many side effects, interactions, and contraindications, and it requires careful monitoring and adjustment by a doctor. Patients who are prescribed Elavil should follow the instructions and advice of their doctor, and report any changes in their mood, behavior, or physical health. Elavil can be a helpful medication for some patients, but it is not a cure-all, and it should be used with caution and respect.

Sources:

- Amitriptyline: MedlinePlus Drug Information

- Amitriptyline for depression | Medicines for Children

- Amitriptyline - an overview | ScienceDirect Topics

- Amitriptyline for chronic pain: a review of the literature

- Amitriptyline versus other types of pharmacotherapy for depression

By Birk Gundersen, RN, BSN.