Special NOTE of CONCERN: The Canadian Government issued a recall public advisory on Jan 26, 2022, on Apotex’s APO-amitriptyline hydrochloride (10mg ) tablets due to a contamination issue from impurities found in the product.
In the US you can report adverse reactions to prescription drugs on the special FDA reporting site at Medwatch.
Taking multiple medications can make the withdrawal process quite a bit more complex.5 Always consult a medical practitioner familiar with withdrawal from prescription drugs for the safest guidance, especially where multiple medications have been prescribed.
As is the case for many drugs, Elavil withdrawal symptoms resemble the drug’s side effects which can intensify during amitriptyline cessation. It may be difficult for even highly trained physicians to differentiate what are withdrawals, what are drug side effects, and what are signs of toxicity, as in hyponatremia or other conditions. Tragically, physicians in the main are NOT trained or educated about how to help someone wean off antidepressants – yet these are the very physicians who prescribe such drugs every day. In any case, symptoms that are potentially life-threatening DO require immediate medical attention.3,8,31 Original symptoms can also come back with a vengeance.3
The severity of withdrawals can sometimes lead to the erroneous conclusion that a person has relapsed into a psychiatric disorder or condition. A misdiagnosis is not at all uncommon and may be disastrous at this critical juncture, leading to further medical complications.10 This is especially seen when amitriptyline withdrawal was too rapid or sudden, and where other factors were not addressed either before, during, or after medication use. How slowly or quickly a person’s body metabolizes a drug is also important to factor in, if planning to wean off amitriptyline. The same cautions apply to the various brand name versions of amitriptyline. When it comes to preparation for weaning, there are some basic fundamentals and guidelines that can help, which can be reviewed both here, and elsewhere on our site for antidepressant withdrawal.
Elavil withdrawal/amitriptyline withdrawal symptoms described below are similar to withdrawals from other tricyclic antidepressants.6,9,34
Amitriptyline withdrawal symptoms can include:
Brain zaps
Drug cravings
Akathisia
Delirium
Anxiety
Nausea, vomiting
Excessive sweating, chills, goosebumps
Dizziness
Anger
Crying or other sudden emotional outbursts
Depersonalization*
Hypersensitivity to lights, sound, and external motion
Muscle pains and aches
Weight gain or loss
Headache, tension in the back of the head
Tiredness, fatigue
Abdominal cramps
Agitation
General malaise
Rash, swelling, especially of the face and tongue, inflammation of the nasal mucous membrane
Vomiting
Diarrhea
Insomnia
Sleep disturbances, interrupted sleep, unusual and vivid dreams
Irritability
Restlessness
Joint pain
*Depersonalization is not exclusive to coming off amitriptyline. Amitriptyline withdrawal research published by Rusconi et al. shows the wide range of drugs that can lead to depersonalization during withdrawal.4
It is easy to find a doctor to prescribe you medications, but where are the doctors that specialize in Elavil or amitriptyline withdrawal and amitriptyline side effects?
Despite a large body of evidence and patient advocacy groups, doctors still tend to dismiss patients concerned about being damaged by amitriptyline or those haunted with unusual side effects. Are you looking for better answers?
Do Your Symptoms Require Elavil?
Alternative to Meds has been an antidepressant withdrawal help expert for over 15 years. We have published evidence regarding our success. Many of us became guides because we had suffered similarly and had to walk a similar path as you. This peer-type relationship is evident in our treatment model and in how we nurture people back to health. You can contact us at Alternative to Meds for more information on our amitriptyline withdrawal programs.
15 Years Experience by Professionals Who Understand Your Journey.
Despite amitriptyline being one of the earliest antidepressant medications brought to market over 60 years ago. very little research was ever done on the potential of amitriptyline addiction. Hence, amitriptyline was long considered to be without addictive properties. However, recent research has shed more light on amitriptyline addiction, and the signs and consequences of amitriptyline addiction. Amitriptyline addiction is not common, but instances of amitriptyline dependence and amitriptyline addiction have now been documented, according to an impressive review of actual case studies and amitriptyline research authored by Umaharan et al, published in the Journal of Case Reports in Psychiatry in January 2021.2
Amitriptyline addiction or dependence is generally classed into two categories: physiological or physical dependence, and more prominently, psychological dependence. In the research mentioned above, a case history report follows a patient who became both physically and psychologically addicted to amitriptyline.
Amitriptyline addiction was reportedly linked to its sedative, psychedelic, and euphoric effects, according to the highly detailed case report study. Of great concern, amitriptyline is subject to dose tolerance, where a person desires a higher dose to achieve the same results. In the case of this antidepressant, this can induce a lethal outcome, as the overdose lethality of amitriptyline is extremely high. In fact, amitriptyline ranks as having the highest lethality rate of all antidepressants in the world.1
How Long do Amitriptyline Withdrawal Symptoms Last?
Amitriptyline withdrawal is commonly reported to last a number of weeks or months until these symptoms eventually begin to fade.23
Individual factors can greatly affect the time it takes to recover from withdrawal, such as age, general health, genetic factors, quality of the diet, social support or lack thereof, stress from the immediate environment, co-prescribed medications, extant pathology, or other factors.
Discontinuing/Quitting Amitriptyline)
Whether one is experiencing amitriptyline addiction or dependence, some people will experience very mild amitriptyline withdrawals, while others may feel so overwhelmed as to make the task feel impossible to endure. It can happen that without proper support and guidance, the person may decide to give up completely and go back on the antidepressant. Despite the well-established risks of prescribing TCAs and SSRIs and other medications concurrently, the practice is shockingly common.17,22 Polydrug detoxification can become too complex to manage in a detox facility that is designed for mono drug detoxification.5 With proper step-by-step help, it may be possible for even the most difficult of amitriptyline withdrawals to be gently and correctly guided along to a successful outcome. Once amitriptyline addiction or dependence has developed, we strongly urge anyone to find the help that will get you through the gradual cessation experience safely rather than suffering on your own.
Can I Stop Taking Amitriptyline Cold Turkey?
It is unsafe to try stopping amitriptyline cold turkey. Abrupt withdrawal from amitriptyline (or Elavil, Endep, or other brand names) can be hard to distinguish from the signs of acute toxicity.3
Acute toxicity develops rapidly whatever the cause and requires immediate hospitalization to prevent injury or death. Airway compromise, respiratory failure, coma, seizure, and convulsions can all present and need intensive care to prevent irreparable damage.
Coming off tricyclic antidepressant drugs such as Elavil (amitriptyline) should never be done abruptly or too quickly. Always consult a medical caregiver/physician who is familiar with safe Elavil or amitriptyline withdrawal treatment before you begin any attempt to come off an antidepressant.
Two important facts about this drug are that Elavil withdrawal/amitriptyline withdrawal should never be done abruptly and that amitriptyline ranks number one of all antidepressant drugs for death due to suicide.
An astounding 2 of every 5 antidepressant-related suicides link to amitriptyline, according to a 2017 report by Dr. J Craig Nelson (UCal), and Dr. Daniel A. Spyker (Oregon Health & Science University in Portland).1 This report suggests strongly that it would be best to learn how to get off amitriptyline and similar drugs safely so as to avoid such consequences.
Amitriptyline (under the brand name Elavil) was one of the very first TCAs (tricyclic antidepressants) ever produced. The “tricyclics” were first marketed in the 1960s. The word tricyclic comes from the triple ring of atoms that comprise the drug’s structure. The toxicity of this drug has become renowned. Attempting suicide with a high dose of amitriptyline is usually “successful,” as Elavil’s lethal effects are tragically well documented over the last nearly six decades. Fatal overdoses with amitriptyline/Elavil have been reported, due to the drug’s toxic effects on neurochemistry, the heart, respiratory and other systems.1
We have collated important and useful information concerning this neurotoxic substance, but there may be other questions you have about amitriptyline addiction, dependence, or other questions that you should consult your doctor or caregiver about. Be especially vigilant with your research, especially if you have not yet begun a prescription. As even the FDA label suggests, though not as clearly as we would like, there may be alternative, safer ways to achieve your health and wellness goals rather than tricyclic medications that the drugmakers and regulators themselves admit are unknown as to how they work.9
Below, we will cover Elavil or amitriptyline side effects, helpful information regarding Elavil withdrawal/ amitriptyline withdrawal treatment, and other information that may be useful in deciding how or when to seek Elavil or amitriptyline tapering and withdrawal help. The information below provides help to anyone to acquire some familiarity with how the drug can potentially affect various functions of the body, including the heart, the digestive and urinary tracts, and the brain.
Testimonial
Elavil Withdrawal
Success
At ATMC I was always supported. The staff was great at providing opportunities for me to work towards stability. What helped me here was always keeping a positive outlook and the constant encouragement and reminders to keep faith in myself.
~Jackie
What Is Amitriptyline Used For?
Elavil/amitriptyline is a tricyclic antidepressant that was FDA-approved to treat depression with an additional prescribing statement that amitriptyline is more likely to work when the cause of a depressive state is unknown. Though doubtlessly ignored by many prescribers, this statement singularly points to the risks of prescribing psychotropic drugs before actually investigating possible causes for unwanted symptoms.9
Amitriptyline is a relatively old drug, that came out of research for schizophrenia treatment in the 1950s. One of the drug’s strongest proponents, a psychiatrist researching for Merck named Frank Joseph Ayd, suggested using it as an antidepressant rather than as an antipsychotic drug.12 Marketed as Elavil, it was presented to a relatively eager-eyed consumer base along with a rash of new drugs and new discoveries about the human body, genes, hormones, and much new information that rode in on the post-WWII wave of cultural, economic, political, and social change.
Prescription drug companies were well on the way to entrench themselves in the mainstream treatment of physiological illnesses, for example, with the advent of new vaccines. Food preservatives were being developed that would alter the food industry forever. And, mental health treatment was quickly transforming into a system that relied much more than before on chemical-based remedies rather than psychotherapy-based and other holistic solutions to mental unease.
The 1950s were a time of discovery and experiment and drugs like Elavil emerged at the dawn of the 1960s. The drug was tried out on a surprising number of conditions, and tested on all ages, including very young children. However, prescribing Elavil or its generic equivalent to anyone under the age of 25 is now not recommended due to the serious risk of suicide, as the FDA black box warning most clearly stipulates. In the US, the drug is mostly prescribed as a drug of last resort, opting for a tricyclic only when other types of antidepressants have not worked. However, many off-label uses for Elavil13 have developed in the decades following its release, such as these:
SAD (social anxiety disorder, or panic disorder)
GAD (generalized anxiety disorder)
Diabetic neuropathy
Interstitial cystitis (bladder pain syndrome)
Insomnia
Premenstrual symptoms
ADHD (attention-deficit hyperactive disorder)
OCD (obsessive-compulsive disorder)
Anorexia Nervosa (eating disorder)
Bulimia (eating disorder)
Bipolar disorder
BPD (borderline personality disorder)
Parkinson’s Disease
Headaches, migraine headaches
Fibromyalgia
Quitting smoking
Tourette Syndrome
IBS (irritable bowel syndrome)
Bedwetting
Narcolepsy
Chronic hiccups
BDD (body dysmorphic disorder)
In neurologically impaired children or Parkinson’s patients, to control excessive salivation
And a host of other conditions.
Amitriptyline Alternative Names and Slang
Amitriptyline, or any of its various brand names, has not earned any common street names, as it rarely ever made its way into the world of recreational use/abuse despite its euphoric and hallucinogenic effects at high doses. Due to the toxicity of the drug on the brain and the cardiovascular system at such high levels, recreational use would not uncommonly be fatal.
US drug makers no longer use the brand name “Elavil.” However, new brand names for amitriptyline number in the hundreds in the US and around the globe. Many drugs combine amitriptyline with other types of medications.25 As of 2017, 64 different drug manufacturers produce this drug under many names, such as:
Generic amitriptyline
Vanatrip
Amilite
Amitrip
Amiwel
Eliwel
Dot Trip
Gentrip
Mitrip
Nextrip
Endep
And others. Be sure to ask your prescriber what is in your medication.
Amitriptyline Side Effects
Some of the most common and relatively mild side effects of amitriptyline have been reported as constipation, urinary retention, a feeling of drowsiness, dizziness, lightheadedness, dry mouth, weight gain, and blurred vision.13
Note: To reduce lightheadedness, it may help to remember to get up from a lying or sitting position more slowly than normal, and increased salt and water intake may also help relieve the condition.30
There are other amitriptyline (Elavil/Endep/Dot Trip, etc.) side effects that may develop and should be monitored carefully should they worsen or become hard to tolerate, which could signal that medical attention is needed on an immediate basis.
The following are some adverse amitriptyline side effects1,13,23,25 — some are extremely severe that should be monitored carefully as they could signal a medical emergency:
Increased suicidality, thoughts of suicide, obsessive thoughts of death, hurting oneself, and hopelessness, especially in the early weeks of treatment.
Amitriptyline should be discontinued before surgical anesthesia, due to the risk of arrhythmias.
Mania, hypomania (shorter less intense period of manic condition.)
Hallucinating
Risk of bone fracture due to loss of bone marrow
Cognitive impairment, confusion
Memory loss
Long-term use is connected to an increased incidence of dementia
Crushing pain in the chest
Liver impairment, liver disease
Cardiac arrest and other heart conditions
Stroke
Coma
Seizures — lowered seizure threshold
Swelling of the face, hands, feet, etc.
Yellowing of the skin, eyes
Unusual bruising or bleeding
Uncontrollable shaking, tremors
Numbness or tingling
Fainting
Severe rash
TD (tardive dyskinesia)
Anxiety
Emotional blunting
Nightmares, vivid dreams
Insomnia
Sedation
Abnormal involuntary movements
Confusion
Restlessness
Akathisia (internal profound and unrelenting restlessness usually accompanied by rocking, pacing, twisting, marching, etc.)
Sexual dysfunction
Tachycardia, rapid, pounding, or irregular heartbeat
Overdose leading to coma, delirium, cardiac arrest
Dry mouth
Increased body temperature
Blurred vision
Constipation/urinary retention
High or low blood sugar levels
Testicular swelling in males, and swelling of breast tissue in females
Sexual dysfunction, 6-fold higher in males than females 14,15
May suppress the release of growth hormone 16
Note: Amitriptyline has more than 250 major interactions with other medications including common cold and cough remedies, sedatives, histamines, oral contraceptives, and even alcohol. Avoid concurrent use of medications, alcohol, and even OTC drugs. It is essential to your health and safety to check with your caregiver before taking any other drug, medicine, or alcohol while you are taking amitriptyline.
Although the exact mechanisms of amitriptyline are still unknown after 60 years, researchers suggest the drug affects at least 5 pathways and receptors, including serotonergic, dopaminergic, histamine, muscarinic, norepinephrinergic, and likely others which may explain, at least in part, why amitriptyline withdrawal may be so uncomfortable, and why amitriptyline interacts so dangerously with SSRIs, MAOIs, SNRIs, NRIs, and many other medications.17,22,23
Amitriptyline FAQs
Below are several commonly asked questions about amitriptyline or its brand names. If you have other questions please seek additional information and consult a medical practitioner whenever possible.
Is Amitriptyline a Narcotic?
No. Amitriptyline is classed as a tricyclic antidepressant. In a general sense, any drug or even alcohol, and some foods can have a “narcotic” effect, meaning inducing dullness or mental lethargy, having a sleep-inducing or a calming effect. But in the legal sense of how drugs are classified, no, amitriptyline or Endep or Elavil, etc., is not classified as a “narcotic.”
How Long Does Amitriptyline Stay in Your System?
Amitriptyline is metabolized rapidly in the system once ingested. Within 24 hours, roughly one-third to one-half of the drug is excreted. Certain medications can accelerate metabolization, if needed, in a medical setting such as attempting to reverse an overdose. Toxic levels of amitriptyline can linger far beyond expected elimination times in some cases, particularly in the Caucasian population, as reported in an overdose case report published in the Journal of Medical Toxicology.24
Special Note on Pregnancy and Amitriptyline
As a special note for pregnancy, amitriptyline crosses the placenta so it is not recommended for nursing mothers. Studies have shown that like most other antidepressant medications, amitriptyline is also able to permeate the blood-brain barrier. This is especially concerning for pregnant women, as the body usually defends the blood-brain barrier most strongly during pregnancy as a protection for the unborn child against such intrusions. Amitriptyline was associated with increased risks of organ malformation where the drug was taken during pregnancy, according to a large comparative study done in 2017 and published in the British Medical Journal. It is unfortunate that insufficient testing over the last 6 decades has left unanswered questions about the safety of taking this drug while pregnant.1,6,7,9,25,27,28,29
What is the half-life of amitriptyline?
The half-life of amitriptyline is estimated at 20 hours. Half-life can be dependent on unique individual factors, such as genetics, age, nutritional deficiencies, etc. But in approximate terms, working out the half-life of amitriptyline means if you took 100mg, after 20 hours half of what was taken is still in your system, or, 50mg.
After another 20 hours, you would have 25mg left, and so on. Since there are so many factors that can influence the process, these are estimates that can change a bit from person to person. In general, it is at the half-life point of elimination where amitriptyline withdrawals will start to be felt.
Are there amitriptyline alternatives?
At Alternative to Meds Center, many methods of holistic, alternative treatments for mental unease are offered, and it is the goal of the center to provide gentle and effective ways to attain natural mental health, using holistic non-drug-based therapies. These alternative treatments can be applied to amitriptyline (or Elavil, Endep, Dot Trip, etc.) effectively.
It has been long-established that lack of physical exercise alone is associated with increased depression and other negative health consequences.18 Diet is another powerful tool to maintain mental wellness and combat symptoms of depression. A review published in the International Journal of Environmental Research points out that a pro-inflammatory diet, as well as a diet consisting of processed foods, are both associated with an increased risk of depressive symptoms.19,20 Choosing a drug-based therapy is not the only option as ongoing research 25 informs us of superior holistic protocols and Elavil alternatives that are more beneficial choices by far.
Treatment for Amitriptyline Addiction or Dependence
Mild treatment for amitriptyline dependence can help alleviate the symptoms that can often accompany coming off an antidepressant. Changing diet can be a powerful agent for neurotransmitter rehabilitation after drug use. Clearing out accumulated toxins from the body is another valuable tool for recovery. There are many other safe and gentle methods used at the Alternative to Meds Center that make Elavil cessation as smooth and mild as possible.
Amitriptyline addiction and dependence, as with any drug, can be tough to turn around the dosage is cut too quickly and without the proper care and nutritional support that the body needs to make a successful transition. Patience, compassion, holistic physical therapies, targeted nutrition, equine therapy, Qi Gong, colon hydrotherapy, IV and NAD therapy, and other non-invasive methods are available at Alternative to Meds to help in stopping amitriptyline (Elavil) or other drugs. Slow, gradual tapering is the recommended way to stop taking antidepressants safely.23
CBT or cognitive behavioral counseling is the gold standard for depression and is often used at the Alternative to Meds Center in amitriptyline addiction treatment.32
If you have questions about the best methods of treatment for Elavil or amitriptyline addiction, dependence, and cessation, Alternative to Meds Center can provide much information on request that can help in understanding the process of true recovery, and the most effective amitriptyline withdrawal treatment methods that are available to ensure a mild, comfortable taper and to restore mental health naturally.
3. Davison P, Wardrope J. Acute amitriptyline withdrawal and hyponatraemia. A case report. Drug Saf. 1993 Jan;8(1):78-80. doi: 10.2165/00002018-199308010-00009. PMID: 8471189. [cited 2022 May 19]
7. Wolfe RM. Antidepressant withdrawal reactions. Am Fam Physician. 1997 Aug;56(2):455-62. Erratum in: Am Fam Physic. 1998 Feb 15;57(4):646. PMID: 9262526. [cited 2022 May 19]
8. Sahay M, Sahay R. Hyponatremia: A practical approach. Indian J Endocrinol Metab. 2014;18(6):760-771. doi:10.4103/2230-8210.141320 [cited 2022 May 19]
12. Lenzer J. Frank Joseph Ayd. BMJ. 2008;336(7654):1196. doi:10.1136/bmj.a131 [cited 2022 May 19]
13. 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 2022 May 19]
Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.
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The brand name Elavil© has been discontinued in certain countries, but the generic drug, amitriptyline, is also marketed under other brand names, such as Endep©, Vanatrip©, “generic Elavil”, APO-Amitriptyline©, and others. Amitriptyline is still listed on the WHO’s essential medicine list as of 2019, along with about 500 other medications used in palliative care, and specified to treat depression disorders across the planet.33
Two important facts about this drug are that Elavil withdrawal/amitriptyline withdrawal should never be done abruptly and that amitriptyline ranks number one of all antidepressant drugs for death due to suicide.
