Amitriptyline: What It Does and How to Use It Safely

Amitriptyline is an older but still useful tricyclic antidepressant. People use it for depression, nerve pain, migraine prevention, and sometimes for sleep problems. It won’t act like an SSRI overnight — effects for mood can take 2–6 weeks — but lower doses often help nerve pain and sleep much faster.

Quick practical dosing and how it works

For depression, adults typically start around 25–50 mg daily and work up to 75–150 mg if needed. For nerve pain or migraine prevention, doctors often use much lower doses — 10–50 mg at night is common. Because amitriptyline makes many people sleepy, taking it at bedtime usually helps.

The drug raises levels of serotonin and norepinephrine in the brain and blocks some nerve signals. That explains both its benefits and many of its side effects.

Common side effects, risks, and smart precautions

Expect dry mouth, drowsiness, blurred vision, constipation, and lightheadedness when standing up. Those are the most common. More serious risks include fast or irregular heartbeat and seizures in overdose. Amitriptyline can be risky for older adults because it raises fall risk and can worsen confusion.

Don’t mix amitriptyline with MAO inhibitors. Combining it with SSRIs, SNRIs, or certain migraine drugs can raise the risk of serotonin syndrome. Alcohol makes sedation and dizziness worse, so avoid drinking while you’re adjusting to the dose.

Tell your doctor if you have heart disease, glaucoma, an enlarged prostate, or a history of seizures. They may want an ECG first or choose a different medication.

Stopping suddenly can cause withdrawal symptoms like nausea, irritability, or sleep problems. If you and your doctor decide to stop, taper the dose slowly over days or weeks.

If you take other medicines, ask about interactions. Amitriptyline is metabolized by liver enzymes (CYP2D6), so some drugs can raise or lower its levels. A pharmacist can run a quick check and flag high-risk combinations.

Watch for warning signs that need urgent care: fainting, fast irregular heartbeat, severe chest pain, extreme drowsiness, or new confusion. In overdose, amitriptyline can be life-threatening—seek emergency help immediately.

Bottom line: amitriptyline is versatile and often effective at low doses for pain and sleep, but it carries real side effects and interaction risks. Use it under medical advice, start low, take it at night if it makes you sleepy, and get a slow taper if you stop. If anything feels off, call your prescriber or pharmacist — small adjustments can make a big difference.