Amitriptyline

Amitriptyline

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Tricyclic antidepressant (TCA) Can Be Addictive Some Abuse Potential High Weight Gain Risk
Sedating: Yes Driving: Avoid QT risk: Moderate Akathisia: Low Metabolic: Moderate Prolactin: Low ACB: 3 t½: 25 h Tmax: 4 h

The granddad of antidepressants. Amitriptyline is technically a tricyclic, but in 2025 the NHS mostly hands it out for pain and sleep. At low doses it knocks you out cold; at higher doses it’s a full antidepressant, but with so many side effects most people never last that long. Dry mouth, constipation, weight gain, morning grogginess — it’s like being wrapped in a wet blanket. Still, for nerve pain or stubborn insomnia, it’s quietly become the go-to “antidepressant that isn’t really for depression anymore.”

🩺 Main Uses

Depression; neuropathic pain; migraine prevention; insomnia (off-label).

🧪 The Science & Facts

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Half‑life (t½)

25 h

How long the drug hangs around. Longer half‑life = slower changes.

Time to Peak (Tmax)

4 h

Roughly when you feel the main effect after a dose.

What it hits (receptors)

Primary:

SERT (reuptake inhibitor)NET (reuptake inhibitor)H1 (antagonist (very strong))M1 (antagonist)alpha1 (antagonist)

Very sedating; commonly prescribed off-label for pain and sleep.

How your body processes it (metabolism)

Substrate: CYP2D6Substrate: CYP2C19

High drug–drug interaction potential.

⚠️ Warnings

  • High anticholinergic burden • QT prolongation/arrhythmia risk and overdose toxicity • Avoid with other strong anticholinergics

⏬ Taper & Withdrawal

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If you’re reducing

Taper over weeks. Avoid rapid stop due to cholinergic rebound.

Possible withdrawal

Sleep disruption, anxiety, sweating, nausea.

Info here is educational, not medical advice. Always taper with prescriber support if possible.

🧠 Trusted External Sources Last reviewed 22 Aug 2025, 21:03 by Connor O’Driscoll

🔗 Interaction Checker

Always verify drug interactions using the Drugs.com Checker.

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⚠️ Black Box Warning

All antidepressants: ↑ suicidal thoughts/behaviours in under-25s.

This is a plain‑English summary of headline safety warnings. Talk to a clinician before changing any medication.