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Elavil Tapering

This entry was posted in Antidepressant on by .
Medically Reviewed Fact Checked

Last Updated on July 20, 2021 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Elavil’s toxicity is a grave concern, literally, given its high risk of suicidality. In fact, Elavil is reportedly the #1 drug for suicides. For this reason alone, considering Elavil tapering should be of the highest priority.

At Alternative to Meds Center, we offer a designed-for-you Elavil tapering program that is administered exactingly, professionally, and compassionately.

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About Elavil

If you are looking for information on Elavil tapering, please note that in the US, the brand name Elavil is more commonly sold under many other names, such as Endep, Nextrip, Gentrip, Amiwel, and other various names, as well as its generic name, amitriptyline.4 This drug of many names is generally prescribed as a last resort to treat depression, where other types of antidepressants have not resulted in the desired outcome for the patient.

For clarity, everything regarding Elavil tapering in this article will apply to drugs sold under the generic name amitriptyline or any of the brand names currently in use globally.

One of the most concerning points to mention, whether you are starting or stopping Elavil, is that this drug is believed to be the #1 drug for deaths due to suicide. A recent research paper authored by Nelson et al reported statistics from the US Poison Control Centers, linking Elavil (amitriptyline) to 4 of every 10 antidepressant-related suicides.1

Many drugs are known to cause suicidal thinking, including Elavil and other tricyclics, and SSRIs, and others. However, Elavil is especially of concern due to the high mortality rate, as per the black box warning on the drug’s package insert.10 This and other safety information may lead one to consider that getting off Elavil in a safe and controlled setting may be the best health choice for you or your loved one.

FDA WARNING: Never attempt abrupt cessation of Elavil (amitriptyline), unless medically advised. To do so may have significant health consequences.2,3


Elavil Tapering Guidelines

Elavil Tapering Guidelines Include:

  • elavil tapering guidelinesSlow tapering is recommended.
  • Elavil is serotonergic, and though rare, be alert to emerging symptoms of serotonin toxicity.
  • Ask your prescribing physician for the smallest dose pills available. (10mg blue round tablets).
  • Your doctor can help you configure the correct dosage and can help with cutting when pills need to be cut in half, or quarters, etc.
  • Be conservative in your first reduction, for instance, a 10 to 25% reduction may be a good starting point. This can be adjusted as needed for personal sensitivities.
  • The half-life of a drug is a marker for when to expect withdrawals to emerge. Elavil’s half-life is about 20 hours. Discuss your symptoms with your prescriber and when to take the next pill.
  • Expect to remain at the reduced dosage for a week or longer, before making the next cut.
  • Tolerance and personal variabilities are different from person to person. The best approach is to be alert to changes, and flexible to accommodate them throughout the taper.
  • Tapering off Elavil can be easier if you allow adequate time to settle after each adjustment. This could mean 5 or more days or several weeks at each level.
  • It is not unusual for the final cuts to be more problematic, which means go slower near the end of the taper process.

Sometimes a prolonged or difficult protracted withdrawal can occur, where troubling withdrawals do not reduce as expected. In this case, we are here to help you or your caregiver. If interested, please ask us about inpatient care that is available at Alternative to Meds for Elavil tapering.

What is Elavil Prescribed to Treat?

Elavil is FDA-approved to treat MDD (major depressive disorder). However, there have been a wide array of off-label uses, in a wide cross-section of populations. Elavil is not recommended for the under-25 population due to the increased risk of suicide in that age range. In a review of prescribing antidepressants in primary care, published in the BMJ 15 it was found that tricyclics (TCAs) were the most often prescribed off-label (81%) of all the antidepressant types. And, amitriptyline was the most often prescribed of the TCAs at 91% for off-label uses such as insomnia or pain. Amitriptyline was among the least prescribed for its approved use, which is MDD. It was suggested in the review that the vast number of prescription drugs make it challenging for doctors to keep track of intended uses for various drugs, both new and older products.

Another possible explanation is that doctors are possibly relying on the zeal of pharmaceutical advertising that may suggest off-label uses for antidepressants in general.16,17

In particular, the label 2 on the amitriptyline package states, “Endogenous depression is more likely to be alleviated than are other depressive states.” Endogenous depression is a depression where no trauma or stress exists. Despite the advertisers proclaiming “chemical imbalance” as the only endogenous cause of depression, research shows that depression might well be from low thyroid 21 or toxic exposure 22 or even vitamin deficiencies and poor food choices.19 Endogenous does not mean feeling depressed or stressed from a suffocating marriage, or a high-pressure job, for instance. But are these terms really understood by the prescribers? How can a physician know that a vitamin deficiency exists or doesn’t exist if they don’t test for it? Are tests done to ensure that various causes of depression such as toxic exposure or poor diet can or cannot be ruled out? In most cases, no they are not done. In fact, for decades now the pharmaceutical industry has pushed the idea broadly and repeatedly that a chemical imbalance is the sole cause of depression, and that these drugs are the only remedy. It was a highly profitable sales pitch, and sadly, continues to be an overarching theme. But that pitch has started to become disabused of any credibility by research and publicly available statistics on treatment outcomes.17,18,19

Alternative to Meds Center knows there are safer alternatives than toxic drugs. Symptoms can be lessened and even entirely eliminated without neurotoxic, suicide-inspiring prescription drugs. The center has helped many thousands of clients who were struggling with how to get off Elavil or other drugs safely and comfortably. The recommended way according to the FDA as well as many other health authorities is to withdraw from Elavil using a slow and gradual approach. A gradual taper and holistic drug-free therapies can considerably ease the Elavil tapering process and shorten the length of time one might otherwise experience during withdrawal.3

Special Health Advisory for Serotonergic Drugs11-14

There are rare instances that call for an immediate and abrupt Elavil (amitriptyline) cessation, requiring a hospital setting to successfully avoid injury or death. Symptoms generally recede in a day after discontinuing the medication. Serotonin syndrome is probably under-reported according to researchers Volpi-Abadie et al as reported in The Ochsner Journal, due to lack of patient education and possible misdiagnosis. Elavil is not as risky as some other serotonergic drugs unless combined with other serotonergic medications, which will increase the likelihood of this reaction. Serotonin toxicity can occur when taking single or multiple serotonergic medications, or, where some antidepressants are switched too quickly, not allowing for potential interaction. This is especially true where a drug has a relatively long half-life. For example, fluoxetine has a one-week half-life, so carries more risk of SS than amitriptyline, which has a half-life of approximately one day. However, one should always remain alert to signs of serotonin syndrome — a potentially fatal condition where too much serotonin builds up in the synapses in the brain. This is especially of concern in all drugs that inhibit serotonin reuptake.

Signs of serotonin syndrome, serotonin overdose, or serotonin toxicity may include:

Altered mental state:

  • overexcited state
  • agitation
  • restlessness
  • anxiety

Neuromuscular abnormalities:

  • stiffness, rigid muscles
  • tremors
  • akathisia
  • twitching, jerking motions

Autonomic system dysfunction:

  • tachycardia (racing heart rate)
  • arrhythmias
  • flushing
  • vomiting
  • diarrhea
  • dilated pupils
  • fever, burning sensation, hot flashes
  • dry mucous membranes

Gradual Elavil Tapering Recommended in All Other Cases

Apart from serotonin syndrome or other life-threatening drug reactions and cross-reactions, abruptly stopping Elavil is not recommended. Abrupt cessation can result in major health problems, as well as prolonged Elavil withdrawal symptoms which can linger for a very long time. Long and difficult withdrawals or protracted withdrawals can be prevented by gradual, gentle, and supported Elavil tapering. The Alternative to Meds Center’s Elavil tapering protocols are carefully designed to avoid severe or protracted withdrawals.

Safe Approach to Withdrawal from Elavil, Nextrip, Endep, et al

Anyone who is considering trying to quit Elavil would be well advised to seek competent help so that a plan can be designed to carefully follow, and most importantly with Elavil tapering being overseen by a trusted and experienced medical practitioner. Properly monitored Elavil tapering could be a life or death matter in some individuals, due to Elavil’s toxicity characteristics and possible negative effects not only on neurochemistry, but on the body’s respiratory system, heart, as in arrhythmias, and many other severe side effects.11-14,20

Elavil is no longer approved for prescribing to children or teens, as the FDA black box stipulates, due to the extremely high suicide risks.2 However, adults also experience suicidal reactions as previously mentioned and as stated in the black box warning. We cannot overstate the importance of seeking an Elavil tapering program that provides 24/7 monitoring and careful oversight so that these concerns can be adequately monitored.

A Drug for All Seasons

Perhaps you might have been prescribed Elavil for any 4 of the following:

  • MDD (major depressive disorder)
  • Panic disorder
  • Pain
  • Anxiety disorders
  • Premenstrual issues
  • Eating disorders
  • Obsessive-Compulsive Disorders
  • Headaches
  • Cough
  • Parkinson’s Disease
  • Chronic hiccups
  • Body dysmorphic disorders
  • Bedwetting
  • Insomnia
  • Quitting smoking

Research tells us that the list goes on and on. However, a prescription of Elavil may not have helped with these conditions. Additionally, taking a toxic drug such as Elavil may have even caused other unwanted symptoms to begin to emerge that you never experienced before taking Elavil. This may have resulted in an overall worsening of health rather than any real or actual improvements to your health and is noted on the FDA label as a possible outcome of taking Elavil.2

It is not at all uncommon to have been prescribed Elavil unnecessarily. Why does this happen so often? Without a doubt, underlying root causes for undesirable symptoms may have been overlooked before beginning a toxic drug regimen, perhaps in haste or desperation. But that could only mask symptoms, and only temporarily at that.

Unfortunately, with toxic drugs, there can be a whole range of additional health consequences. These may lead to the decision of getting off Elavil. This can be turned to one’s advantage, however, where a person then has the opportunity of exploring other treatment approaches to find relief from their original symptoms. Symptoms can be like guideposts that show the way to the correction of deficiencies, toxic accumulations, or other correctable reasons that health and life have not been free from discomforts.

Find Out More About How to Get Off Elavil Safely and Comfortably

Please contact us at Alternative to Meds Center for much more information about our programs that have helped so many trying to quit Elavil or other toxic prescription drugs. We can explain the various treatments and protocols used to make Elavil cessation a comfortable and transformative, health-restoring experience.

We invite you to find out more about how Elavil tapering can be part of a much more broad and comprehensive health program, one that can allow a person to start to be freed of their original symptoms that prescription drugs did not and could not fix.


1. Nelson JC, Spyker DA “Morbidity and mortality associated with medications used in the treatment of depression: an analysis of cases reported to US Poison Control Centers, 2004-2014” American Journal of Psychiatry [INTERNET] 2017 Jan [cited 2021 Jun 84]

2. FDA Label Amitriptyline, published by drug manufacturer Sandoz, section entitled “Medication Guide” [INTERNET] N.D. [cited 2021 Jun 8]

3. Shelton RC “Steps Following Attainment of Remission: Discontinuation of Antidepressant Therapy” US National Library of Medicine [INTERNET] 2001 [cited 2021 Jun 8]

4. Drugs.com Amitriptyline – brand names [online] [cited 2021 Jun 8]

10. Amitriptyline Black Box Warning, https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/085966s095,085969s084,085968s096,085971s075,085967s076,085970s072lbl.pdf

11. Hudd TR, Blake CS, Rimola-Dejesus Y, Nguyen TT, Zaiken K. A Case Report of Serotonin Syndrome in a Patient on Selective Serotonin Reuptake Inhibitor (SSRI) Monotherapy. J Pharm Pract. 2020 Apr;33(2):206-212. doi: 10.1177/0897190019841742. Epub 2019 Apr 28. PMID: 31030620.[cited 2021 Jun 8]

12. Keks N, Hope J, Keogh S. Switching and stopping antidepressantsAust Prescr. 2016;39(3):76-83. doi:10.18773/austprescr.2016.039 [cited 2021 Jun 8]

13. Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndromeOchsner J. 2013;13(4):533-540. [cited 2021 Jun 8]

14. Foong AL, Grindrod KA, Patel T, Kellar J. Demystifying serotonin syndrome (or serotonin toxicity)Can Fam Physician. 2018;64(10):720-727. [cited 2021 Jun 8]

15. Wong J, Motulsky A, Abrahamowicz M, McGill J, Eguale T, Buckeridge DL, Tamblyn R, “Off-label indications for antidepressants in primary care.”  BMJ 2017, 356doi: https://doi.org/10.1136/bmj.j603 (Published 21 February 2017) [cited 2021 Jun 8]

16. Ghinea N, Lipworth W, Kerridge I, Day R. Off-label promotion of prescription medicine: is it ever justifiable? Therapeutic Innovation & Regulatory Science. Accepted 19 December 2014. [online] [cited 2021 Jun 8]

17. Lacasse JR, Leo J. Serotonin and depression: a disconnect between the advertisements and the scientific literature. PLoS Med. 2005 Dec;2(12):e392. doi: 10.1371/journal.pmed.0020392. Epub 2005 Nov 8. PMID: 16268734; PMCID: PMC1277931. [cited 2021 Jun 8]

18. Meek C, “SSRI ads questioned” 

19. Rao TS, Asha MR, Ramesh BN, Rao KS. Understanding nutrition, depression and mental illnessesIndian J Psychiatry. 2008;50(2):77-82. doi:10.4103/0019-5545.42391 [cited 2021 Jun 8]

20. Thour A, Marwaha R. Amitriptyline. [Updated 2020 Nov 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537225/ [cited 2021 Jun 8]

21. Zhao T, Chen BM, Zhao XM, Shan ZY. Subclinical hypothyroidism and depression: a meta-analysis. Transl Psychiatry. 2018;8(1):239. Published 2018 Oct 30. doi:10.1038/s41398-018-0283-7 [cited 2021 Jun 8]


Originally Published Nov 2, 2019 by Lyle Murphy


This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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Elavil Tapering
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