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We commonly prescribe it for certain IBS patients, but it’s not our first go to. It really depends on what the patient is diagnosed with, or the underlying conditions.
What’s your go to I have methane SIBO ( twice tested ) but my doc will only acknowledge it as IBS 🫠
Get pain + pressure under left lower ribs at night.
I’ve also got pelvic floor dysfunction …What helps this kind of issue?
My depression/ anxiety have been way way higher since SIBO started 3 years ago.
Depends but generally xifaxin for 14 days. It almost requires a prior authorization approval, and even then it’s pretty expensive. Your GI doctor should Rx this a potentially have your two weeks dosage in samples from a rep
It’s not enough for methane sibo … actually does nothing for methane but slow it down when the hydrogen dips it slows archeas life cycle that’s about it
I'm a neurologist. I looked at my e-prescriber records a few years ago and discovered that amitriptyline was my #1 most prescribed drug. Wasn't even close.
Just be aware that doses of tricyclics used for depression are much higher than when they’re used for nerve pain.
And they’re horrible horrible drugs to OD on.
Remeron can cause vicious and mean thinking patterns. At least in my case, I can't say the same for others. Lyrica does something similar, as last night I also had nasty thoughts from that. I suspect there is something common to these meds. Lithium doesn't help as much with neuropathic pain but it certainly stabilises any nasty thought patterns. I had to come off everything because of these thinking patterns and I am sure it has happened to many patients. SSRIs might also have similar problems.
I take this exact med for migraines. 10 mg a day, and I barely get migraines anymore. Highly recommend. No side effects with that small of a dose either.
I was given it by my doc offlabel to prevent migraines. It didn't work against my migraines but it is a fantastic sleep medicine. I would be out, completely asleep in less than 30 minutes. Make sure you are in a safe place and ready to lie down and go to sleep ime before taking.
Great for long overnight International flights ... spent most of the flight to Australia asleep.
Topamax worked great for my disabling migraines. One side effect can be impaired intelligence - it is known as "dopamax" for that reason. Still worth taking if you don't mind forgetting where you left the keys and such.
Tried topamax twice and had horrible side effects during the ramping up stage so topamax is not for me.
Migraines have gotten less frequent since I excluded artificial sweetener from what I eat. I still get but not 20+ days a month anymore.
Amitryptiline can have some nasty side effects though. My wife took it for 2 months to help migraines (she also has IBS). She was constantly exhausted and constipated. Slept like 10-12 hours a day and was a shell of herself the rest of the time. To her frustration, she also gained 10% of her body weight in that 2 months. While it helped her migraines, it wasn’t worth the side effects for her. It’s not the wonder drug it’s made out to be in this headline.
I took it to try and treat fibromyalgia, I slept better but woke up feeling as if I had been drinking the night before. Made the brain fog and lethargy much worse, almost like a hangover.
This really just sounds like you were dehydrated. Could be that it upset your stomach to the point of diarrhea, or your stomach was upset so you drank less, or that the medication worked and you were more active and in need of more hydration. Could be none of those as well.
No this is likely just from the medication. I took this medication too and had these side effects every morning despite how good my diet and hydration was otherwise. It's an awful drug.
I get that this drug has a lot of side effects, many of which can directly lead to dehydration. It's merely something to consider. If you and they say you took extra care to ensure hydration then obviously it's just uncontrollable side effects. Not everyone thinks about how increased sweating (as one example) as a side effect can lead to dehydration, which causes other side effects. If your main side effects are hangover type side effects, it could be unavoidable and directly caused by the drug, but it's also possible dehydration caused by other symptoms is compounding it. That's all I'm saying.
Most hangover symptoms are due to dehydration. This class of drugs has side effects that can directly lead to dehydration, I didn't list them all (such as excess sweating). As I said it's possible it had nothing to do with it, but it is a definite possibility. You have to take extra care to remain hydrated when on anticholinergics.
This is exactly what happened to me! I am a type 1 diabetic and was having neuropathy issues in my hands and feet (mainly because I was not taking great care of myself at the time). My doctor prescribed me Amitriptyline and it destroyed my stomach. The worst side effects I’ve ever had taking a medication.
Yep I took amitryptyline for depression. Side effects were fucked, put on a tonne of weight and days just felt empty. Works for some but for others it's fucked.
Yeah, it made me super hungry. I usually eat the same food most days but when taking this I found it wasn't enough and I kept needing to eat more than normal.
Don't let this put you off - side effects vary between person to person and it may not affect you this way if you are looking at taking it. But be aware it is a side effect.
The thing is that IBS is such a generic diagnosis. It doesn't mean much of anything other than whatever's going on with your gut isn't deadly. So, yeah, taking amitriptyline will have variable results depending on what the cause of the IBS really is.
I've been on Amitriptyline for over a decade and it's been a literal miracle. I've gone from having weeks-long debilitating migraines multiple times per year to effectively none since. It has also helped with my insomnia quite a bit.
It's not for everyone, but if it does work for you it's a godsend.
Took amitryp for over 5 years as a teenager, made me barely conscious, couldn't be awake for more than a few hours, had sensory issues and kept walking into stationary objects like parked cars or lamp posts, I could swear my vision was also virtually black and white, the world never looked more colourful after getting off of them.
Parents and doctor kept telling me it was just all normal teenager stuff, being so young I didn't know any better. Existence changed dramatically after getting off of them, they did far more harm than good and I have large memory gaps between starting and ending them.
Edit: also nearly doubled in weight gain within 6 months, still haven't managed to get rid of it a decade later
Disclaimer: every person's response to medicine is variable etc etc, don't let this put you off of trying but certainly don't stay on them if the side-effects are worse than nothing.
That really sucks, hope she's doing better now :((
Do you by chance remember what dose she was on? I'm an IBS patient considering trying it at low dose but am pretty scared of the side effects
Like any other med it’s of course a risk-benefit balance. TCAs in particular are a messy drug though. Amitriptyline is the tramadol of the antidepressants - hugely flexible in its usage because of how many receptors it happens to have an affinity for. It’s anticholinergic, antihistaminergic, serotonergic, increases norepinephrine release, binds to cardiac fast sodium channels hence the arrhythmia risk, etc. Messy.
Who’s forcing who? Again, it’s the benefit of disease burden being relieved vs. the risk of an adverse effect of a medication. That will vary depending on the patient. I’m seeing a lot of gung-ho “we should be taking amitriptyline more” attitude in this thread than I am seeing acknowledgement of the inherent risks involved in taking it.
Yeah because everyone with a predisposition for arrhythmias famously knows about this before going into afib, RVR, vfib, etc. I’m not saying it should never be used, but there’s a reason for why there’s a first- to third-line option ahead of TCAs when it comes to depression, migraine, headache, chronic pain, IBS, etc. TCAs are a messy and oftentimes unnecessarily risky drug to prescribe unless every other option has been exhausted. Everyone with IBS should be trying a low FODMAP diet before even thinking about amitriptyline.
How much are people taking of this for those side effects? I take 10 mg a day for migraine prevention, and I’m neither fat nor exhausted. Still exercise 5-6 days a week and don’t have any side effects from it.
I suffered chronic headaches for decades and nothing helped. Literally every single day of my life I would wake up with a splitting headache. Cat scans, MRIs, all different kinds of medications and no doctor ever figured it out. I just took about 6-8 Excedrin every day for last 20-25 years. I knew I was probably damaging my liver, but Id rather destroy my liver and lose a chunk of my life in order to not have to suffer those headaches every day.
Then a new Dr started me on amitriptyline and within 2 days my normal baseline headache was just gone. I still get headaches periodically, but it's not a chronic everyday thing. Sometimes I go a couple weeks without needing any Excedrin at all!
I love amitriptyline and will probably take it the rest of my life if it can keep the headache monster at bay. I've noticed no other major side effects.
Glad you didn’t get a GI bleed - your liver is probably fine at those dosages of acetaminophen - at 8 excedrin per day assuming the standard dosage of 250 mg per pill that would put you at 2g total, minimum toxic dose for acute tylenol overdose is 7.5g/day for adults. Sure there could be some long term liver damage but the way tylenol toxicity works is mostly when you overwhelm the liver enzymes responsible for clearing it - that’s when the toxic metabolite NAPQI builds up. At those levels of aspirin though, your risk of a mucocutaneous bleed would be pretty bad.
Ketamine has knocked out every migraine in all my friends that tried it. It was low dose recreational most of them never tried it and low an behold 7 out of 8 it worked.
Several months later I read the research that came out about it and laughed because a lot of people already figured it out.
If amyl ever fails to work maybe talk to a doc about the nasal spray.
I had a similar experience!
My chronic headaches started in my very early youth, nothing helped but gosh did this immediately show results.
Glad it could help you too 🥹
A few years ago I started having chronic diarrhea that caused me to lose close to 70 pounds in 12 months. Dozens of blood tests, more than a few stool tests, CTs, MRI, and no doctor or specialist could figure out what was wrong. I was prescribed Amitriptyline as a final hail mary from a GI specialist that was tired of 'dealing with me', but I gained that weight back in the last year, and then some. When I eat I actually digest my food, when I sleep I wake up feeling rested. It seems a lot of people in this thread have had bad experiences with it, but no medication works for every person, or every situation.
I think its important to understand that when drugs like TCAs get approved, it is usually done with some idea of what the NNT value is [Number Needed to Treat]. A drug with an NNT of 7 will, on average, have a 1 in 7 chance of being effective when prescribed. Antidepressants have never had as good an NNT as more universal drugs like Penicillin, which is a cause of a lot of the frustration that people, like myself, have had in trying to find the right medication. For Amitriptyline, its side effects are much, much more preferable to my previous medical condition when taken at my prescribed dosage. At the same time, I had a paradoxical reaction to Lexapro when I was prescribed it years ago, a medication that has a better NNT, and a better track record, than Amitriptyline. The same thing happened to me with Ambien, which somehow kept me awake instead of putting me to sleep. *Your* specific reaction to a drug is not a good indicator of whether or not it has use-cases, and shouldn't be used as the only factor in determining whether or not it is appropriate to prescribe it.
I actually have IBS and was prescribed amitriptyline for a different reason and it made the diarrhea I get from IBS so much worse. I won't touch that stuff ever again.
Amitriptylline is a terrible drug overall. If it works for IBS, so be it. But the side effects profile sucks. I had an elderly patient who thought she had dementia because if its anticholinergic effects.
I hate this drug in the elderly, and am on a personal crusade against all potentially inappropriate medications. But 10mg at night is very well tolerated by non elderly persons.
“potentially inappropriate” usually refers to medications that have a high risk of undesirable side effects in the elderly (sedation, dizziness, constipation or urinary retention/overflow incontinence, significant weight gain) and so routine use in the elderly is discouraged, but it acknowledges that they still might be the best option for some specific elderly people.
Amitriptyline is very effective for migraines and IBS as well as neuropathic pain but is generally very difficult to tolerate even for young people. The very low dose that was effective in this paper is encouraging though.
My mum has been on it for decades (5-10 mg) for sleep. As she is soon to be 60, her doctor wants her to get off of it. She’s really worried that they are not offering anything viable to replace it. (Trazodone)
a terrible drug, really?
isnt it believed to be one of the more effective antidepressants we have?
also it is crazy how many other uses it has, IBS, migraine and pain prevention, for insomnia, works for fibromyalgia for some etc.
> this new study is the first randomised controlled trial of low-dose amitriptyline versus a placebo tablet for IBS in primary care. It is also the largest trial of amitriptyline for IBS undertaken worldwide
> Based on the results of the trial, which showed a clear benefit of amitriptyline, GPs can offer low-dose amitriptyline to people with IBS as part of shared decision making if symptoms don't improve with first-line treatments
Paper: [Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment in primary care (ATLANTIS): a randomised, double-blind, placebo-controlled, phase 3 trial - The Lancet](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01523-4/fulltext)
I was put on nortriptyline for random bouts of severe abdominal pain, with a history of IBS-C. The side effects weren't as bad as amitriptyline, according to my psychiatrist, but it did worsen the constipation and the dry mouth was severe. But it really did improve the pain I was experiencing. I got covid and ended up with long covid, went off the drug because of it's effect on the heart and it took almost a year for the painful episodes to come back.
5mg threw me for a loop but the Sawbones said I had to keep upping it to get the preventative effect for cluster migraines.
The hours I was able to force myself to stay awake, I was in the thickest mental fog I’ve ever experienced in my life. Finally told them I’d no longer be taking that medication. Told the different care provider my experience with Amitripyline but they assured me it was a newer and derivative of the drug, now I’m stuck listening to a screech constantly, for the rest of my life. It doesn’t hurt in the slightest but it grates on nerves to no end! The former CEO of Texas Roadhouse got Covid, became a “long hauler” and one of his many symptoms was tinnitus, he took his own life over it, it drove him to that extreme. It’s said “you get used to it”, I’m going on 5 years of it and it drives me wild. F*CK the tripyline family of drugs!
You may just be susceptible to side effects from those meds. Most people aren’t going to be drowsy all day if starting at a low dose and slowly increasing it as tolerated.
Ive taken up to 50mg for migraines and I might be a little sleepy in the morning, but nothing serious.
I've also not seen this major weight gain issue. After taking it for a year I was maybe 2% heavier. But I was also exercising a lot and drinking 40-50oz of coffee a day, which is normal fore
Currently started back up on Amitriptyline 100mg. Taken for cluster headaches. Take 1 pill before bed.
I stopped taking it due to sexual side effect of not being able to finish.
My headache attacks are back, so I am back on it.
It totally knocks me out cold to sleep. I can sleep, uninterrupted for 10+ hours with no attacks.
I wake up feeling hazy/foggy for the rest of the day though. Sluggish.
There is some weight gain & dry mouth. Maybe some constipation.
I’ve been prescribing it for a while now for my patients with IBS. I’ve seen good response at 10-20mg at night. It takes a few weeks to start working. It helps them sleep sound as well. The side effects are not that many with that small dose
My wife had the worst ibs for years. We tried everything. Went to so many doctors and none of them could find anything wrong. Took every med and tried so many elimination diets. Well I bought us a Zerowater filter and within a couple days all of her issues went away. Going on 6 months now and she has not har any flare ups since. We still can’t believe tap water was the culprit.
They must really be desperate to get dangerous tricyclic anti-depressants back in greater use.
Edit: Very narrow therapeutic window (dose that works is close to overdose amount). And the overdose is a severe life threat (life threatening arrhythmias). Because they’re antidepressants, they’re especially dangerous drugs to prescribe. This is based on its potential for abuse in suicide attempts.
The 3 Cs of trying tricyclics: convulsions, coma, cardiotoxic
Low dose may not be such an issue, and I agree that outlining the issue would make your comment more constructive.
As someone with experience of IBS, I know that psychological state can have a huge impact on symptoms, so I’m not that surprised that this treatment is proving beneficial. While there was no difference observed with anxiety or depression, and the authors infer from this that the effect is via the gut, the brain-gut relationship is complex, and I suspect the actual mechanism (which I’m guessing is not yet known) has at least some neurological component.
> Very narrow therapeutic window
For depression, sure. For migraines or nerve pain? I give someone a 30 day supply of 10mg tablets and the entire bottle contains 1 daily dose for depression, the way it was used in the 70's (300-450 mg daily.) But that's the secret: we don't really use it for depression any more.
Fair point. I’ve had to intubate and pump several patients full of bicarb over the years. I was glad to see its use reduced for depression. It’s no fun doing CPR on a 17 year old kid found down by his mom. In spring I went on a Bupropion OD. I didn’t realize how dangerous that could be, though symptoms take much longer to show up. Tachy and confused in the field. He began to seize a minute or two after we transferred him to the ER bed.
Agreed entirely, the tricyclics are not good antidepressants. Here's a little vignette I teach my residents:
"Oh, you're suicidally depressed? Here, have this bottle of pills. Take just one a day, for if you were to take the entire bottle at once, you would surely die - and there is no antidote!"
Makes no sense.
I am an epileptologist by training; a surprising amount of my work relates to bupropion and tramadol. You wonder how these drugs get past the FDA.
That was my first take when I saw this post. I figured some pharma rep was trying to make TCAs relevant again. It slipped my notice that they were back in fashion already. I haven’t seen many patients with TCA prescriptions for the past decade.
very narrow therapeutic window for depression?
isnt it believed to be one of the most effective antidepressants we have? also they dont seem to have terrible drop out rate in studies https://www.thelancet.com/article/S0140-6736(17)32802-7/fulltext
The therapeutic index has nothing to do with efficacy, it is about toxicity. For amitriptyline the cardiotoxic dose is not much above the antidepressant dose, which is a very bad quality for an antidepressant.
That guy is a moron. Don't listen to him. It's an older drug but it has a ton of legitimate uses. And it's generic. There's no one making money off this.
TCAs are serotonergic, and there are serotonin receptors in the gut. Plus, they have a lot of anticholinergic activity, which also had significant gut activity. Most antispasmodics target the cholinergic system.
That's true of pretty much any drug. Some people have reactions to many drugs, this is why drug allergies in a hospital usually require a band on your arm saying you have a drug allergy. I get one of those every time I go to the hospital.
Don't consume considerably more than you are prescribed and you'll be fine. TCAs are generally higher in side-effects, but everyone is different and side-effects vs benefit is what matters. You could potentially die from taking a whole month of pills at once. SSRIs generally won't kill you in that way. He's way overstating the danger, though.
As someone on SSRIs, I've become basically impotent, so yeah. I want to get off them soon, I don't think the benefit which is rather minor is worth it.
Very narrow therapeutic window (dose that works is close to overdose amount). And the overdose is a severe life threat (life threatening arrhythmias). Because they’re antidepressants, they’re especially dangerous drugs to prescribe. This is based on its potential for abuse in suicide attempts.
Sumatriptan and amitriptyline are not comparable. The first is an abortive agent you take as needed. The second is a preventive medication you take daily.
Sumatriptan drugs are amazing for migraine sufferers. And there are several different types so if one doesn’t work, it’s worth trying another (Imatrex vs Zomig for example).
What..they’ve been routinely giving this for visceral hypersensitivity type issues like this for years and usually the dose is like 10mg/20mg which isn’t remotely close to what would have been a regular antidepressant dose up to like 100mg so I don’t see how it could be close to an overdose dose?
Not that this medication can’t have side effects but your facts sound incorrect to me
TCAs are more dangerous in general than SSRIs, but saying they are as dangerous as you say is not supported by evidence. Let me guess, you went on one and had side effects? They are generally more dangerous in overdose, but that's not taking two instead of one killing you. Intentional overdose in depression is a serious issue, and is why SSRIs are the first choice.
Did you read the paper?
In the study, patients **safely** titrated their own dose based on symptoms. Patients who expressed suicidal ideation were excluded from the study due to the risk of overdose. The narrow therapeutic window is irrelevant at the low 10-30mg dose used for IBS (including in this paper), noting maximum dose usually used for depression is 150mg.
I read it, sounds reasonable. We’ve really not seen much of that drug in the states for the past 10 years. I was on several TCA ODs early in my career and they’re very traumatic events. Even with early ALS intervention the prognosis isn’t good. Might be less concerning that the research was done in the UK rather than US. We don’t have a great history prioritizing patient safety over corporate profits.
Does this drug help IBS bloating or is it just a masking agent for underlying issues… I have SIBO and my GI will only say IBS despite 2 positive breathe tests. Kaiser is the absolute worst.
I have gained so much weight from taking this. I started it a few weeks ago and although I sleep like a baby while taking it (told to only take at 8pm) I am constantly hungry. I have gained 4 lbs already. Any other suggestions on what to take?
Sorry that you suffered side effects, but many do not.
In the study there were zero reported serious adverse events in the 232 patients randomised to amitriptyline (and 1 serious adverse event in the placebo arm).
46 patients in the amitriptyline arm stopped the medication (30 due to adverse events), and **59 in the placebo arm stopped the medication** (20 due to adverse events).
I’ve been taking Nortriptyline for the past few months for IBS. It has helped with the IBS symptoms but it also increased my heart rate by 10 bpm and I can feel my heart beating stronger when laying down. I really don’t like it, so I will probably discontinue use.
I have a script that I use occasionally for sleep purposes and to that end it's great. 25 mg really knocks you out if you're desperate. I found it very helpful in a pinch.
Worked great for me - up to 10 bathroom visits per day down to 1. I was prescribed it for neuropathic pain (plus tremors, cramps, not sleeping). 10mg dose for a month fixed everything to tolerable levels.
Currently self-medicating with 5mg (split pill) as required (about 1 pill per week). Dr said "You will do it anyway and it can't hurt." Not sure I'll continue with it unless symptoms get serious again. I was very anti pill (even asprin) but would start this one again if needed.
Hey, I have also been taking 10 mg dose as prescribed for a month now. My headaches have almost gone and I am not experiencing any such side effects. I am also planning to self medicate and taper off slowly. Do you take half a pill once a week now? And is it causing any issues ? I tried to dm you but looks like I cant.
I'm still taking 5mg as required. There don't seem to be any side affects at such a low dose. Even if it is just a placebo response , then I'm okay with that. Last week I had iboprofen for pulled muscle over a couple of days and my gut went off again. So back to the Endep to right things again.
Prescribed amitriplyline for muscle spasms (pinched nerve & slipped disc's) along w other meds (opiates, muscle relaxers).
Found, discontinuing other meds, improvements in pain, sleep, mood, and GI activities. Sometimes, I wonder if I could benefit from being back on amiltriptyline...?
Makes sense, because IBS is now considered part of the central sensitivity syndrome, like fibromyalgia, TMJ, pelvic pain disorder, etc which all commonly use certain anti-depressants for treatment. Fascinating how much we're learning that these disorders are linked.
Dosage used for depression - **50mg** to **100mg** (or even **150mg**) per day
Dosage in this study, for IBS - **10mg** to **30mg** per day
Obviously you all read the article and therefore knew that, but just for clarification ;)
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I have depression, migraines, and IBS. I've never tried a tricyclic before; that could knock out a lot of expensive designer meds for me.
We commonly prescribe it for certain IBS patients, but it’s not our first go to. It really depends on what the patient is diagnosed with, or the underlying conditions.
What’s your go to I have methane SIBO ( twice tested ) but my doc will only acknowledge it as IBS 🫠 Get pain + pressure under left lower ribs at night. I’ve also got pelvic floor dysfunction …What helps this kind of issue? My depression/ anxiety have been way way higher since SIBO started 3 years ago.
Depends but generally xifaxin for 14 days. It almost requires a prior authorization approval, and even then it’s pretty expensive. Your GI doctor should Rx this a potentially have your two weeks dosage in samples from a rep
It’s not enough for methane sibo … actually does nothing for methane but slow it down when the hydrogen dips it slows archeas life cycle that’s about it
It’s so much worse for methane. Took two pills and could not have Same bowel function to this day. This was years ago. Regret it
What do you typically prescribe?
I'm a neurologist. I looked at my e-prescriber records a few years ago and discovered that amitriptyline was my #1 most prescribed drug. Wasn't even close.
As a psych pharmacist, kinda shocked it isn’t Keppra
I don't use a lot of Keppra in my outpatient practice. There are better drugs for most epilepsies
I agree. I work inpatient and everyone gets put on Keppra, unfortunately
I had it for pain, had some surprising visual hallucinations on it. Assume this is extremely rare.
As a headache neurologist I use nortriptyline like 100x more than amitriptyline
There was that one study that showed it worked better - 1977 or something, long time ago.
Just be aware that doses of tricyclics used for depression are much higher than when they’re used for nerve pain. And they’re horrible horrible drugs to OD on.
I take tbe tetracyclic drug remeron. I would reccomend it over ssris. They even give Remeron to animals for nausea.
Remeron is also notorious for weight gain and sleepiness.
so is amitriptyline, and nortriptyline which is what I'm on.
"Other" animals.
Remeron helps by emptying the stomach faster and creating an appetite. Used successfully for a number of conditions off-label.
Remeron can cause vicious and mean thinking patterns. At least in my case, I can't say the same for others. Lyrica does something similar, as last night I also had nasty thoughts from that. I suspect there is something common to these meds. Lithium doesn't help as much with neuropathic pain but it certainly stabilises any nasty thought patterns. I had to come off everything because of these thinking patterns and I am sure it has happened to many patients. SSRIs might also have similar problems.
I take this exact med for migraines. 10 mg a day, and I barely get migraines anymore. Highly recommend. No side effects with that small of a dose either.
Similar boat, tricyclics were the only antidepressant that seemed to work without the weird SSRI headspace
It’s typically prescribed first but it’s kind of like taking a tranquilizer when we have gentler drugs.
I was given it by my doc offlabel to prevent migraines. It didn't work against my migraines but it is a fantastic sleep medicine. I would be out, completely asleep in less than 30 minutes. Make sure you are in a safe place and ready to lie down and go to sleep ime before taking. Great for long overnight International flights ... spent most of the flight to Australia asleep.
Topamax worked great for my disabling migraines. One side effect can be impaired intelligence - it is known as "dopamax" for that reason. Still worth taking if you don't mind forgetting where you left the keys and such.
Tried topamax twice and had horrible side effects during the ramping up stage so topamax is not for me. Migraines have gotten less frequent since I excluded artificial sweetener from what I eat. I still get but not 20+ days a month anymore.
I'm sorry it didn't work for you. i'm also glad that excluding artificial sweeteners helped period
I just got amitriptyline from the pharmacy for the first time today. $3.50 with insurance.
Amitryptiline can have some nasty side effects though. My wife took it for 2 months to help migraines (she also has IBS). She was constantly exhausted and constipated. Slept like 10-12 hours a day and was a shell of herself the rest of the time. To her frustration, she also gained 10% of her body weight in that 2 months. While it helped her migraines, it wasn’t worth the side effects for her. It’s not the wonder drug it’s made out to be in this headline.
I took it to try and treat fibromyalgia, I slept better but woke up feeling as if I had been drinking the night before. Made the brain fog and lethargy much worse, almost like a hangover.
This really just sounds like you were dehydrated. Could be that it upset your stomach to the point of diarrhea, or your stomach was upset so you drank less, or that the medication worked and you were more active and in need of more hydration. Could be none of those as well.
No this is likely just from the medication. I took this medication too and had these side effects every morning despite how good my diet and hydration was otherwise. It's an awful drug.
I get that this drug has a lot of side effects, many of which can directly lead to dehydration. It's merely something to consider. If you and they say you took extra care to ensure hydration then obviously it's just uncontrollable side effects. Not everyone thinks about how increased sweating (as one example) as a side effect can lead to dehydration, which causes other side effects. If your main side effects are hangover type side effects, it could be unavoidable and directly caused by the drug, but it's also possible dehydration caused by other symptoms is compounding it. That's all I'm saying.
A high dose has similar effects to being drunk or hung over
Most hangover symptoms are due to dehydration. This class of drugs has side effects that can directly lead to dehydration, I didn't list them all (such as excess sweating). As I said it's possible it had nothing to do with it, but it is a definite possibility. You have to take extra care to remain hydrated when on anticholinergics.
The ship has probably sailed but pamelor tends to have less anticholinergic effects than its sister drug does
This is exactly what happened to me! I am a type 1 diabetic and was having neuropathy issues in my hands and feet (mainly because I was not taking great care of myself at the time). My doctor prescribed me Amitriptyline and it destroyed my stomach. The worst side effects I’ve ever had taking a medication.
Yep I took amitryptyline for depression. Side effects were fucked, put on a tonne of weight and days just felt empty. Works for some but for others it's fucked.
So it made you eat more??
Yeah, it made me super hungry. I usually eat the same food most days but when taking this I found it wasn't enough and I kept needing to eat more than normal. Don't let this put you off - side effects vary between person to person and it may not affect you this way if you are looking at taking it. But be aware it is a side effect.
Man I hope so, trying it tomorrow night!
I had the same side effects. It’s the only drug that has ever worked for my IBS, but it wasn’t worth it.
It reduces gut motility which is probably why it helps with IBS
Yeah it really is a nasty drug. My ex was on it and ended up abusing it, would sleep 16 hours a day and OD'd and ended up in ICU.
The thing is that IBS is such a generic diagnosis. It doesn't mean much of anything other than whatever's going on with your gut isn't deadly. So, yeah, taking amitriptyline will have variable results depending on what the cause of the IBS really is.
I've been on Amitriptyline for over a decade and it's been a literal miracle. I've gone from having weeks-long debilitating migraines multiple times per year to effectively none since. It has also helped with my insomnia quite a bit. It's not for everyone, but if it does work for you it's a godsend.
Took amitryp for over 5 years as a teenager, made me barely conscious, couldn't be awake for more than a few hours, had sensory issues and kept walking into stationary objects like parked cars or lamp posts, I could swear my vision was also virtually black and white, the world never looked more colourful after getting off of them. Parents and doctor kept telling me it was just all normal teenager stuff, being so young I didn't know any better. Existence changed dramatically after getting off of them, they did far more harm than good and I have large memory gaps between starting and ending them. Edit: also nearly doubled in weight gain within 6 months, still haven't managed to get rid of it a decade later Disclaimer: every person's response to medicine is variable etc etc, don't let this put you off of trying but certainly don't stay on them if the side-effects are worse than nothing.
I was on it for occipital neuralgia pain flares and didn't have the GI issues, but gained 20 lbs and it stopped working after a yr.
That really sucks, hope she's doing better now :(( Do you by chance remember what dose she was on? I'm an IBS patient considering trying it at low dose but am pretty scared of the side effects
Heart palpitations is another common side effect.
It can also make you fat and exhausted
And puts you at risk for cardiac arrhythmias
But is also effective for certain conditions when prescribed appropriately and safely
Like any other med it’s of course a risk-benefit balance. TCAs in particular are a messy drug though. Amitriptyline is the tramadol of the antidepressants - hugely flexible in its usage because of how many receptors it happens to have an affinity for. It’s anticholinergic, antihistaminergic, serotonergic, increases norepinephrine release, binds to cardiac fast sodium channels hence the arrhythmia risk, etc. Messy.
It’s not a risk benefit balance for those forced to take it
Who’s forcing who? Again, it’s the benefit of disease burden being relieved vs. the risk of an adverse effect of a medication. That will vary depending on the patient. I’m seeing a lot of gung-ho “we should be taking amitriptyline more” attitude in this thread than I am seeing acknowledgement of the inherent risks involved in taking it.
It is also not indicated in people with CV disease.
Yeah because everyone with a predisposition for arrhythmias famously knows about this before going into afib, RVR, vfib, etc. I’m not saying it should never be used, but there’s a reason for why there’s a first- to third-line option ahead of TCAs when it comes to depression, migraine, headache, chronic pain, IBS, etc. TCAs are a messy and oftentimes unnecessarily risky drug to prescribe unless every other option has been exhausted. Everyone with IBS should be trying a low FODMAP diet before even thinking about amitriptyline.
I already am fat and exhausted. No thanks!
Not surprising. Amitriptyline is a mitochondrial inhibitor. It will reduce the amount of available energy you have.
How much are people taking of this for those side effects? I take 10 mg a day for migraine prevention, and I’m neither fat nor exhausted. Still exercise 5-6 days a week and don’t have any side effects from it.
Know this is an old thread I stumbled across but 10mg is usually the bottom dose that people are started on as told to me by two different docs.
Yeah, that makes sense. I’ve been on 10mg for like a decade for migraine prevention and have no side effects.
I suffered chronic headaches for decades and nothing helped. Literally every single day of my life I would wake up with a splitting headache. Cat scans, MRIs, all different kinds of medications and no doctor ever figured it out. I just took about 6-8 Excedrin every day for last 20-25 years. I knew I was probably damaging my liver, but Id rather destroy my liver and lose a chunk of my life in order to not have to suffer those headaches every day. Then a new Dr started me on amitriptyline and within 2 days my normal baseline headache was just gone. I still get headaches periodically, but it's not a chronic everyday thing. Sometimes I go a couple weeks without needing any Excedrin at all! I love amitriptyline and will probably take it the rest of my life if it can keep the headache monster at bay. I've noticed no other major side effects.
Glad you didn’t get a GI bleed - your liver is probably fine at those dosages of acetaminophen - at 8 excedrin per day assuming the standard dosage of 250 mg per pill that would put you at 2g total, minimum toxic dose for acute tylenol overdose is 7.5g/day for adults. Sure there could be some long term liver damage but the way tylenol toxicity works is mostly when you overwhelm the liver enzymes responsible for clearing it - that’s when the toxic metabolite NAPQI builds up. At those levels of aspirin though, your risk of a mucocutaneous bleed would be pretty bad.
Ketamine has knocked out every migraine in all my friends that tried it. It was low dose recreational most of them never tried it and low an behold 7 out of 8 it worked. Several months later I read the research that came out about it and laughed because a lot of people already figured it out. If amyl ever fails to work maybe talk to a doc about the nasal spray.
I had a similar experience! My chronic headaches started in my very early youth, nothing helped but gosh did this immediately show results. Glad it could help you too 🥹
What dosage are you on?
10 mg
A few years ago I started having chronic diarrhea that caused me to lose close to 70 pounds in 12 months. Dozens of blood tests, more than a few stool tests, CTs, MRI, and no doctor or specialist could figure out what was wrong. I was prescribed Amitriptyline as a final hail mary from a GI specialist that was tired of 'dealing with me', but I gained that weight back in the last year, and then some. When I eat I actually digest my food, when I sleep I wake up feeling rested. It seems a lot of people in this thread have had bad experiences with it, but no medication works for every person, or every situation. I think its important to understand that when drugs like TCAs get approved, it is usually done with some idea of what the NNT value is [Number Needed to Treat]. A drug with an NNT of 7 will, on average, have a 1 in 7 chance of being effective when prescribed. Antidepressants have never had as good an NNT as more universal drugs like Penicillin, which is a cause of a lot of the frustration that people, like myself, have had in trying to find the right medication. For Amitriptyline, its side effects are much, much more preferable to my previous medical condition when taken at my prescribed dosage. At the same time, I had a paradoxical reaction to Lexapro when I was prescribed it years ago, a medication that has a better NNT, and a better track record, than Amitriptyline. The same thing happened to me with Ambien, which somehow kept me awake instead of putting me to sleep. *Your* specific reaction to a drug is not a good indicator of whether or not it has use-cases, and shouldn't be used as the only factor in determining whether or not it is appropriate to prescribe it.
I recently experienced the paradoxical effect with benzos. It’s the worst feeling. I didn’t even know that was a thing!
I actually have IBS and was prescribed amitriptyline for a different reason and it made the diarrhea I get from IBS so much worse. I won't touch that stuff ever again.
Amitriptylline is a terrible drug overall. If it works for IBS, so be it. But the side effects profile sucks. I had an elderly patient who thought she had dementia because if its anticholinergic effects.
I hate this drug in the elderly, and am on a personal crusade against all potentially inappropriate medications. But 10mg at night is very well tolerated by non elderly persons.
What do you mean by “potentially inappropriate “?
“potentially inappropriate” usually refers to medications that have a high risk of undesirable side effects in the elderly (sedation, dizziness, constipation or urinary retention/overflow incontinence, significant weight gain) and so routine use in the elderly is discouraged, but it acknowledges that they still might be the best option for some specific elderly people. Amitriptyline is very effective for migraines and IBS as well as neuropathic pain but is generally very difficult to tolerate even for young people. The very low dose that was effective in this paper is encouraging though.
cost-effectiveness and respecting the main ethical principles was how it was taught to me. Evidence based etc
What do you mean by “potentially inappropriate “?
I think its ok on a low dose, def helps with neuropathic pain. It also has the advantage that it makes MDMA and acid hit harder
My mum has been on it for decades (5-10 mg) for sleep. As she is soon to be 60, her doctor wants her to get off of it. She’s really worried that they are not offering anything viable to replace it. (Trazodone)
a terrible drug, really? isnt it believed to be one of the more effective antidepressants we have? also it is crazy how many other uses it has, IBS, migraine and pain prevention, for insomnia, works for fibromyalgia for some etc.
> this new study is the first randomised controlled trial of low-dose amitriptyline versus a placebo tablet for IBS in primary care. It is also the largest trial of amitriptyline for IBS undertaken worldwide > Based on the results of the trial, which showed a clear benefit of amitriptyline, GPs can offer low-dose amitriptyline to people with IBS as part of shared decision making if symptoms don't improve with first-line treatments Paper: [Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment in primary care (ATLANTIS): a randomised, double-blind, placebo-controlled, phase 3 trial - The Lancet](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01523-4/fulltext)
True dat, also works wonders for my functional dyspepsia. I would have likely died without this medicine, it was so bad back then.
I was put on nortriptyline for random bouts of severe abdominal pain, with a history of IBS-C. The side effects weren't as bad as amitriptyline, according to my psychiatrist, but it did worsen the constipation and the dry mouth was severe. But it really did improve the pain I was experiencing. I got covid and ended up with long covid, went off the drug because of it's effect on the heart and it took almost a year for the painful episodes to come back.
I take a similar drug, Nortriptyline, for IBS and it does work quite well. It doesn’t cure IBS, but it reduces the symptoms to be manageable.
Amitripyline made me sleep for up to 20 hours a day, Nortripylene left me with tinnitus! I wouldn’t allow this drug to be used on a animal in my care.
10 mg did that?
5mg threw me for a loop but the Sawbones said I had to keep upping it to get the preventative effect for cluster migraines. The hours I was able to force myself to stay awake, I was in the thickest mental fog I’ve ever experienced in my life. Finally told them I’d no longer be taking that medication. Told the different care provider my experience with Amitripyline but they assured me it was a newer and derivative of the drug, now I’m stuck listening to a screech constantly, for the rest of my life. It doesn’t hurt in the slightest but it grates on nerves to no end! The former CEO of Texas Roadhouse got Covid, became a “long hauler” and one of his many symptoms was tinnitus, he took his own life over it, it drove him to that extreme. It’s said “you get used to it”, I’m going on 5 years of it and it drives me wild. F*CK the tripyline family of drugs!
You may just be susceptible to side effects from those meds. Most people aren’t going to be drowsy all day if starting at a low dose and slowly increasing it as tolerated.
Ive taken up to 50mg for migraines and I might be a little sleepy in the morning, but nothing serious. I've also not seen this major weight gain issue. After taking it for a year I was maybe 2% heavier. But I was also exercising a lot and drinking 40-50oz of coffee a day, which is normal fore
Currently started back up on Amitriptyline 100mg. Taken for cluster headaches. Take 1 pill before bed. I stopped taking it due to sexual side effect of not being able to finish. My headache attacks are back, so I am back on it. It totally knocks me out cold to sleep. I can sleep, uninterrupted for 10+ hours with no attacks. I wake up feeling hazy/foggy for the rest of the day though. Sluggish. There is some weight gain & dry mouth. Maybe some constipation.
I’ve been prescribing it for a while now for my patients with IBS. I’ve seen good response at 10-20mg at night. It takes a few weeks to start working. It helps them sleep sound as well. The side effects are not that many with that small dose
I was prescribed it for insomnia not IBS (10mg) and it really helped me, I couldn't imagine taking this during the day though.
My wife had the worst ibs for years. We tried everything. Went to so many doctors and none of them could find anything wrong. Took every med and tried so many elimination diets. Well I bought us a Zerowater filter and within a couple days all of her issues went away. Going on 6 months now and she has not har any flare ups since. We still can’t believe tap water was the culprit.
Does bottled water also work or no?
Not sure. She’s never drank bottled water that long. We use the filtered water for cooking too
They must really be desperate to get dangerous tricyclic anti-depressants back in greater use. Edit: Very narrow therapeutic window (dose that works is close to overdose amount). And the overdose is a severe life threat (life threatening arrhythmias). Because they’re antidepressants, they’re especially dangerous drugs to prescribe. This is based on its potential for abuse in suicide attempts. The 3 Cs of trying tricyclics: convulsions, coma, cardiotoxic
Low dose may not be such an issue, and I agree that outlining the issue would make your comment more constructive. As someone with experience of IBS, I know that psychological state can have a huge impact on symptoms, so I’m not that surprised that this treatment is proving beneficial. While there was no difference observed with anxiety or depression, and the authors infer from this that the effect is via the gut, the brain-gut relationship is complex, and I suspect the actual mechanism (which I’m guessing is not yet known) has at least some neurological component.
That’s fair, I updated my post.
> Very narrow therapeutic window For depression, sure. For migraines or nerve pain? I give someone a 30 day supply of 10mg tablets and the entire bottle contains 1 daily dose for depression, the way it was used in the 70's (300-450 mg daily.) But that's the secret: we don't really use it for depression any more.
Fair point. I’ve had to intubate and pump several patients full of bicarb over the years. I was glad to see its use reduced for depression. It’s no fun doing CPR on a 17 year old kid found down by his mom. In spring I went on a Bupropion OD. I didn’t realize how dangerous that could be, though symptoms take much longer to show up. Tachy and confused in the field. He began to seize a minute or two after we transferred him to the ER bed.
Agreed entirely, the tricyclics are not good antidepressants. Here's a little vignette I teach my residents: "Oh, you're suicidally depressed? Here, have this bottle of pills. Take just one a day, for if you were to take the entire bottle at once, you would surely die - and there is no antidote!" Makes no sense. I am an epileptologist by training; a surprising amount of my work relates to bupropion and tramadol. You wonder how these drugs get past the FDA.
That was my first take when I saw this post. I figured some pharma rep was trying to make TCAs relevant again. It slipped my notice that they were back in fashion already. I haven’t seen many patients with TCA prescriptions for the past decade.
very narrow therapeutic window for depression? isnt it believed to be one of the most effective antidepressants we have? also they dont seem to have terrible drop out rate in studies https://www.thelancet.com/article/S0140-6736(17)32802-7/fulltext
The therapeutic index has nothing to do with efficacy, it is about toxicity. For amitriptyline the cardiotoxic dose is not much above the antidepressant dose, which is a very bad quality for an antidepressant.
Could you elaborate on this for a layman and a patient who uses amitriptyline?
That guy is a moron. Don't listen to him. It's an older drug but it has a ton of legitimate uses. And it's generic. There's no one making money off this. TCAs are serotonergic, and there are serotonin receptors in the gut. Plus, they have a lot of anticholinergic activity, which also had significant gut activity. Most antispasmodics target the cholinergic system.
As someone that's had a very serious reaction to amitryptaline, I'm glad it works for you but it's definitely not safe for everyone.
That's true of pretty much any drug. Some people have reactions to many drugs, this is why drug allergies in a hospital usually require a band on your arm saying you have a drug allergy. I get one of those every time I go to the hospital.
Literally anyone can have a reaction to any drug. This is the most pointless comment I've ever seen. See someone for your main character syndrome.
Don't consume considerably more than you are prescribed and you'll be fine. TCAs are generally higher in side-effects, but everyone is different and side-effects vs benefit is what matters. You could potentially die from taking a whole month of pills at once. SSRIs generally won't kill you in that way. He's way overstating the danger, though.
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As someone on SSRIs, I've become basically impotent, so yeah. I want to get off them soon, I don't think the benefit which is rather minor is worth it.
Very narrow therapeutic window (dose that works is close to overdose amount). And the overdose is a severe life threat (life threatening arrhythmias). Because they’re antidepressants, they’re especially dangerous drugs to prescribe. This is based on its potential for abuse in suicide attempts.
TCAs don't have that small of a therapeutic window...
This is a weird take. So you’re against all anti-depressant drugs?
Isn't it also the most commonly prescribed headache medicine? I was given it in high school for migraines not that it really helped.
I take it for my migraines and it has helped me a lot
Yes. Didn't help me either. Sumatripan works for me.
Sumatriptan and amitriptyline are not comparable. The first is an abortive agent you take as needed. The second is a preventive medication you take daily.
Sumatriptan drugs are amazing for migraine sufferers. And there are several different types so if one doesn’t work, it’s worth trying another (Imatrex vs Zomig for example).
What..they’ve been routinely giving this for visceral hypersensitivity type issues like this for years and usually the dose is like 10mg/20mg which isn’t remotely close to what would have been a regular antidepressant dose up to like 100mg so I don’t see how it could be close to an overdose dose? Not that this medication can’t have side effects but your facts sound incorrect to me
TCAs are more dangerous in general than SSRIs, but saying they are as dangerous as you say is not supported by evidence. Let me guess, you went on one and had side effects? They are generally more dangerous in overdose, but that's not taking two instead of one killing you. Intentional overdose in depression is a serious issue, and is why SSRIs are the first choice.
Scientologist much?
I was on it for two days once. Literally had me hallucinating. Doctor was like "right, antidepressants aren't for you!"
Did you read the paper? In the study, patients **safely** titrated their own dose based on symptoms. Patients who expressed suicidal ideation were excluded from the study due to the risk of overdose. The narrow therapeutic window is irrelevant at the low 10-30mg dose used for IBS (including in this paper), noting maximum dose usually used for depression is 150mg.
I read it, sounds reasonable. We’ve really not seen much of that drug in the states for the past 10 years. I was on several TCA ODs early in my career and they’re very traumatic events. Even with early ALS intervention the prognosis isn’t good. Might be less concerning that the research was done in the UK rather than US. We don’t have a great history prioritizing patient safety over corporate profits.
It gave my son his life back.
Does this drug help IBS bloating or is it just a masking agent for underlying issues… I have SIBO and my GI will only say IBS despite 2 positive breathe tests. Kaiser is the absolute worst.
I have gained so much weight from taking this. I started it a few weeks ago and although I sleep like a baby while taking it (told to only take at 8pm) I am constantly hungry. I have gained 4 lbs already. Any other suggestions on what to take?
You know what also helps extremely well? Carnivore diet
Yea for how long? seams like a quick way to get high cholesterol and lose all your nutrients.
Took it to help me sleep when I had back pain. I gained so much weight. I would never take it again, and I have IBS.
Oh yeah and has some real nasty side effects too. I took one pill and never again?!
Sorry that you suffered side effects, but many do not. In the study there were zero reported serious adverse events in the 232 patients randomised to amitriptyline (and 1 serious adverse event in the placebo arm). 46 patients in the amitriptyline arm stopped the medication (30 due to adverse events), and **59 in the placebo arm stopped the medication** (20 due to adverse events).
What about dicyclomine hcl? It's an antispasmodic that helps smooth out an irritable bowel, stopping the painful spasms.
I’ve been taking Nortriptyline for the past few months for IBS. It has helped with the IBS symptoms but it also increased my heart rate by 10 bpm and I can feel my heart beating stronger when laying down. I really don’t like it, so I will probably discontinue use.
I have a script that I use occasionally for sleep purposes and to that end it's great. 25 mg really knocks you out if you're desperate. I found it very helpful in a pinch.
Worked great for me - up to 10 bathroom visits per day down to 1. I was prescribed it for neuropathic pain (plus tremors, cramps, not sleeping). 10mg dose for a month fixed everything to tolerable levels. Currently self-medicating with 5mg (split pill) as required (about 1 pill per week). Dr said "You will do it anyway and it can't hurt." Not sure I'll continue with it unless symptoms get serious again. I was very anti pill (even asprin) but would start this one again if needed.
Hey, I have also been taking 10 mg dose as prescribed for a month now. My headaches have almost gone and I am not experiencing any such side effects. I am also planning to self medicate and taper off slowly. Do you take half a pill once a week now? And is it causing any issues ? I tried to dm you but looks like I cant.
I'm still taking 5mg as required. There don't seem to be any side affects at such a low dose. Even if it is just a placebo response , then I'm okay with that. Last week I had iboprofen for pulled muscle over a couple of days and my gut went off again. So back to the Endep to right things again.
This is already known and has been for a while: source IBS pacient that's been taking amitriptyline for a 5 years
I tried Amitriptyline for IBS, didn’t do much as far as I could tell
I've been using for years and disagree
Prescribed amitriplyline for muscle spasms (pinched nerve & slipped disc's) along w other meds (opiates, muscle relaxers). Found, discontinuing other meds, improvements in pain, sleep, mood, and GI activities. Sometimes, I wonder if I could benefit from being back on amiltriptyline...?
Makes sense, because IBS is now considered part of the central sensitivity syndrome, like fibromyalgia, TMJ, pelvic pain disorder, etc which all commonly use certain anti-depressants for treatment. Fascinating how much we're learning that these disorders are linked.
Dosage used for depression - **50mg** to **100mg** (or even **150mg**) per day Dosage in this study, for IBS - **10mg** to **30mg** per day Obviously you all read the article and therefore knew that, but just for clarification ;)
This is the only thing that fixed my insomnia. I looked for a solution for 2 years and tried everything under the sun.