Amitriptyline for depression

Amitriptyline is not suitable for some people. For example, check with your doctor if you have a heart problem, liver problems or epilepsy.

Amitriptyline comes as tablets or liquid that you usually take twice a day. Follow the instructions that come with your medicine.

Side effects of amitriptyline include feeling sleepy or dizzy and constipation. More serious side effects can happen in rare cases.

It can cause problems to take amitriptyline with some other medicines, such as opioids or other antidepressants. Check with a pharmacist or doctor.

Most adults can take amitriptyline for depression or low mood.

Amitriptyline is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

• have ever had an allergic reaction to amitriptyline or any other medicine
• have a heart problem – amitriptyline can make some heart problems worse
• have liver problems
• have epilepsy or are having electroconvulsive treatment (ECT) – amitriptyline may increase your risk of having a fit or seizure
• have ever taken any other medicines for depression – some antidepressants can affect the way amitriptyline works, even after you've stopped taking them
• are pregnant, trying to get pregnant or breastfeeding
• have an eye condition called glaucoma – amitriptyline can increase the pressure in your eye
• have thoughts about harming yourself or ending your life
• have problems emptying your bladder
• have type 1 or type 2 diabetes

Amitriptyline can make it more difficult to keep your blood sugar stable. If you have diabetes and you usually test your blood sugar levels, you may have to do this more often for the first few weeks of treatment with amitriptyline. You may also need to adjust your diabetes treatment. Speak to your doctor if your blood sugar levels are causing you concern.

Amitriptyline tablets come in different strengths of 10mg, 25mg or 50mg.

Amitriptyline liquid also comes in 3 different strengths containing 10mg, 25mg or 50mg in a 5ml spoonful.

The usual dose of amitriptyline for depression in adults is 50mg a day (25mg twice a day).

Some people may need to start on a lower dose of 10mg to 25mg a day, to reduce the chance of side effects. This includes people with heart problems, and older people.

The dose will then be gradually increased, if necessary, until you and your doctor agree that you have found a dose that suits you.

The maximum recommended dose of amitriptyline is 150mg a day, but this should only be under the supervision of a specialist.

How to take it

You'll usually take amitriptyline twice a day.

Amitriptyline does not usually upset your stomach. You can take it with or without food.

Swallow the tablets whole with a drink of water. If you chew them, they taste bitter.

The liquid comes with a plastic syringe or spoon to help you measure out the right dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

Some of the common side effects of amitriptyline will gradually improve as your body gets used to the medicine.

These common side effects happen in more than 1 in 100 people. There are things you can do to help cope with them:

Get more fibre into your diet such as fresh fruit, vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example, by going for a daily walk or run. If this does not help, talk to your pharmacist or doctor.

This may be due to low blood pressure. Amitriptyline can reduce your blood pressure when you stand up.

Drink plenty of water or other non-alcoholic drinks. Do not stand up too quickly after you've been sitting or lying down. Do not drive, cycle or use tools or machinery if you feel dizzy.

Chew sugar-free gum or suck sugar-free sweets.

Do not drink too much alcohol. Do not drive, cycle or use tools or machinery if you feel sleepy or tired.

Try to relax when you pee. Do not try to force the flow of pee. If you cannot pee, try again a short time later.

Call 111 or talk to your doctor urgently if you cannot pee at all.

Make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Paracetamol and ibuprofen may help if you need pain relief.

Talk to your doctor if the headaches do not go away or are severe.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

If you're already taking amitriptyline to treat depression, you may be advised to continue taking it during pregnancy.

There's no concern that amitriptyline will affect your baby's development. If you take amitriptyline around the time you give birth, your baby will be monitored after they're born for temporary withdrawal effects such as problems with sleeping and feeding.

If you become pregnant while taking amitriptyline, speak to your doctor. You do not need to stop taking your medicine unless your doctor tells you to do so.

If your baby is healthy, you can take amitriptyline while breastfeeding. Always check with a pharmacist or doctor first.

Amitriptyline passes into breast milk in very small amounts, and has only been linked with side effects in very few breastfed babies.

It's important to keep taking amitriptyline to keep you well. Breastfeeding will also benefit both you and your baby.

It's very rare for breastfed babies to have side effects from medicines you're taking. But it's important to keep monitoring your baby if you're taking any medicine while breastfeeding.

Contact your healthcare professional or call 111 as soon as possible if you notice that your baby:

• is not feeding as well as usual or putting on weight as you would expect
• seems unusually sleepy
• seems restless or irritable
• is constipated
• is not peeing as much (not producing as many wet nappies)

If your baby has any symptoms that are not listed, or if you're worried about them, you can also call 111 or contact any healthcare professional.

Carry on taking the medicine, and keep breastfeeding as usual until you've got advice about your baby's symptoms.

It's important not to share a bed with your baby while you're taking amitriptyline.

Many medicines and amitriptyline can affect each other and increase the chances of side effects.

Always check with your doctor or a pharmacist before starting any new medicine while you're taking amitriptyline.

Taking amitriptyline with opioid medicines can increase your risk of becoming very drowsy and having breathing problems. Opioid medicines include codeine, morphine and oxycodone.

Tell your doctor if you've ever taken any other medicines for depression. Some antidepressants can affect the way amitriptyline works and can cause very high blood pressure. This can happen even after you stop taking them.