TREATMENT DATABASE

CAUTION: Tricyclic antidepressants increase the amount of norepinephrine in the brain. They cannot be given in conjunction with MAOIs because of the risk of producing dangerously high blood pressure. The National Institutes of Health (NIH) does not recommend tricyclics for children or teens.

Amitriptyline is a tricyclic antidepressant. Tricyclics are named after their chemical structure, which contains three rings of atoms. Tricyclics were developed in the 1950s and are primarily prescribed for depression.

USES IN ME/CFS: Amitriptyline is beneficial for treating pain, sleep disturbance, headaches, and gastrointestinal problems. It may be recommended if doxepin produces excessive sedation. In addition, amitriptyline is often helpful in treating interstitial cystitis, a disorder that affects many women with ME/CFS. Interstitial cystitis symptoms that may respond to amitriptyline are frequent urination, and bladder and pelvic pain. Dr. Alan Wein, a urologist who specializes in treating interstitial cystitis, has noted that amitriptyline is effective for nearly 50% of his patients, probably because of its antihistamine properties. The most frequent benefits reported by people with ME/CFS are improved sleep and reduced pain.

The side effects of amitriptyline are similar to those of doxepin, although exacerbation of muscle weakness in ME/CFS seems to be more common with amitriptyline than with other antidepressants. Some patients have had to discontinue the drug because of weight gain, dry mouth, and palpitations. Dr. Lapp notes that while amitriptyline may help patients improve sleep, it can reduce deep sleep, which impairs its effectiveness over the long term. There is some evidence that amitriptyline may cause CoQ10 deficiency, resulting in oxidative stress and altering the function of mitochondria. In a 2011 study, Bautista-Ferrufino et al recommend supplementation with CoQ10 during treatment with amitriptyline.

Treatment rating for Elavil (amitriptyline)