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Amitriptyline Withdrawal

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.

elavil withdrawal symptomsThe 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

Elavil or amitriptyline withdrawal symptoms are generally not life-threatening if the reduction is gradual. The adverse reactions when coming off the drug can nonetheless be very uncomfortable, especially after long-term use or very high dosage. More information will be discussed below on how to get off amitriptyline ( Elavil, Endep©, Vanatrip©, etc. ) and similar drugs safely and comfortably.

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?

successful elavil withdrawal
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.
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Amitriptyline Addiction, Amitriptyline Dependence

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. antidepressants addictionHowever, 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.

elavil risk of suicidal ideationTwo 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.

Elavil Withdrawal

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.



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 antidepressant drugsMarketed 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.


1. Nelson JC MD, Spyker DA PhD MD “Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014” American Journal of Psychiatry, [INTERNET] 2017 Jan 31 [cited 2022 May 19]

2. Umaharan T, Sivayokan S, Sivansuthan S. Amitriptyline Dependence and Its Associations: A Case Report and Literature ReviewCase Rep Psychiatry. 2021;2021:6647952. Published 2021 Jan 29. doi:10.1155/2021/6647952 [cited 2022 May 19]

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]

4. Rusconi AC, Carlone C, Muscillo M, Coccanari de’ Fornari MA, Podda L, Piccione M. Sindrome da sospensione di SSRI: incidenza e differenze su tre gruppi di pazienti in trattamento con paroxetina [SSRI discontinuation syndrome: incidence and differences on three groups of patients treated with paroxetine]. Riv Psichiatr. 2009 May-Jun;44(3):169-75. Italian. PMID: 20066803. [cited 2022 May 19]

5. Dunsaed F, et al., “Standardised detoxification in cases of polydrug use.” N.D. Tidsskriftet [online] [cited 2022 May 19]

6. Robertson W, “Symptoms of tricyclic antidepressants.” CMA Journal [Sept 1 1981] [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 approachIndian J Endocrinol Metab. 2014;18(6):760-771. doi:10.4103/2230-8210.141320 [cited 2022 May 19]

9. FDA label Amitriptyline HCI [online] [cited 2022 May 19]

10. Dilsaver SC, Greden JF. Antidepressant withdrawal phenomena. Biol Psychiatry. 1984 Feb;19(2):237-56. PMID: 6324897. [cited 2022 May 19]

11. Lejoyeux M, Adès J. Antidepressant discontinuation: a review of the literature. J Clin Psychiatry. 1997;58 Suppl 7:11-5; discussion 16. PMID: 9219488. [cited 2022 May 19]

12. Lenzer J. Frank Joseph AydBMJ. 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: [cited 2022 May 19]

14. Chen LW, Chen MY, Lian ZP, et al. Amitriptyline and Sexual Function: A Systematic Review Updated for Sexual Health PracticeAm J Mens Health. 2018;12(2):370-379. doi:10.1177/1557988317734519 [cited 2022 May 19]

15. Couper-Smartt JD, Rodham R. A technique for surveying side-effects of tricyclic drugs with reference to reported sexual effects. J Int Med Res. 1973;1(5):473-6. doi: 10.1177/030006057300100541. PMID: 4806734. [cited 2022 May 19]

16. Cowen PJ, Braddock LE, Gosden B. The effect of amitriptyline treatment on the growth hormone response to apomorphine. Psychopharmacology (Berl). 1984;83(4):378-9. doi: 10.1007/BF00428550. PMID: 6436869. [cited 2022 May 19]

17. Gillman PK. Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacol. 2007;151(6):737-748. doi:10.1038/sj.bjp.0707253 [cited 2022 May 19]

18. Haider S, Grabovac I, Rieder A, Dorner TE. Depressive Symptoms, Lack of Physical Activity, and Their Combination Towards Health Care Utilisation Frequency. Int J Environ Res Public Health. 2019 Nov 26;16(23):4697. doi: 10.3390/ijerph16234697. PMID: 31779075; PMCID: PMC6926940. [cited 2022 May 19]

19. Ljungberg T, Bondza E, Lethin C. Evidence of the Importance of Dietary Habits Regarding Depressive Symptoms and DepressionInt J Environ Res Public Health. 2020;17(5):1616. Published 2020 Mar 2. doi:10.3390/ijerph17051616 [cited 2022 April 28]

20. Ruusunen A, Lehto SM, Mursu J, Tolmunen T, Tuomainen TP, Kauhanen J, Voutilainen S. Dietary patterns are associated with the prevalence of elevated depressive symptoms and the risk of getting a hospital discharge diagnosis of depression in middle-aged or older Finnish men. J Affect Disord. 2014 Apr;159:1-6. doi: 10.1016/j.jad.2014.01.020. Epub 2014 Feb 14. PMID: 24679382. [cited 2022 May 19]

21. Huddy RL, Torres SJ, Milte CM, McNaughton SA, Teychenne M, Campbell KJ. Higher Adherence to the Australian Dietary Guidelines Is Associated with Better Mental Health Status among Australian Adult First-Time Mothers. J Acad Nutr Diet. 2016 Sep;116(9):1406-1412. doi: 10.1016/j.jand.2016.01.010. Epub 2016 Mar 4. PMID: 26947337. [cited 2022 May 19]

22. Moraczewski J, Aedma KK. Tricyclic Antidepressants. [Updated 2020 Dec 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:[cited 2022 May 19]>

23. Henssler J, Heinz A, Brandt L, Bschor T. Antidepressant Withdrawal and Rebound Phenomena. Dtsch Arztebl Int. 2019 May 17;116(20):355-361. doi: 10.3238/arztebl.2019.0355. PMID: 31288917; PMCID: PMC6637660. [cited 2022 May 19]

24. Smith JC, Curry SC. Prolonged toxicity after amitriptyline overdose in a patient deficient in CYP2D6 activityJ Med Toxicol. 2011;7(3):220-223. doi:10.1007/s13181-011-0158-2 [cited 2022 May 19]

25. Fact Sheet “Amitriptyline” [online] [cited 2022 May 19]

26. Mischoulon, D. (2008). Natural Medications for Psychiatric Disorders: Considering the Alternatives. Argentina: Lippincott Williams & Wilkins. [cited 2022 May 19]

27. Uhr M, Grauer MT, Yassouridis A, Ebinger M. Blood-brain barrier penetration and pharmacokinetics of amitriptyline and its metabolites in p-glycoprotein (abcb1ab) knock-out mice and controls. J Psychiatr Res. 2007 Jan-Feb;41(1-2):179-88. doi: 10.1016/j.jpsychires.2005.10.005. Epub 2006 Jan 4. PMID: 16387324. [cited 2022 May 19]

28. Cipolla MJ. The adaptation of the cerebral circulation to pregnancy: mechanisms and consequences. J Cereb Blood Flow Metab. 2013 Apr;33(4):465-78. doi: 10.1038/jcbfm.2012.210. Epub 2013 Jan 16. PMID: 23321787; PMCID: PMC3618397. [cited 2022 May 19]

29. Bérard A, Zhao J, Sheehy O, Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort BMJ Open 2017;7:e013372. doi: 10.1136/bmjopen-2016-013372 [cited 2022 May 19]

30. Stewart JM, Clarke D. “He’s dizzy when he stands up”: an introduction to initial orthostatic hypotensionJ Pediatr. 2011;158(3):499-504. doi:10.1016/j.jpeds.2010.09.004 [cited 2022 May 19]

31. Rondon H, Badireddy M. Hyponatremia. [Updated 2022 Jan 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: [cited 2022 May 19]

32. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012 Oct 1;36(5):427-440. doi: 10.1007/s10608-012-9476-1. Epub 2012 Jul 31. PMID: 23459093; PMCID: PMC3584580. [cited 2022 May 19]

33. WHO Model List of Essential Medicines [pdf online] [cited May 19]

34. Papp A, Onton JA. Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation. Prim Care Companion CNS Disord. 2018 Dec 20;20(6):18m02311. doi: 10.4088/PCC.18m02311. PMID: 30605268. [cited 2023 July 29]

Originally Published Sep 13, 2018 by Diane Ridaeus

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

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

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