Amitriptyline (Elavil) is a tricyclic antidepressant (TCA) that has been used to treat major depression since its approval in 1961. It is regarded as one of the most popular tricyclic antidepressants of all time and has been regarded by the World Health Organization as an “essential medicine” or a drug needed in a basic health system. Although it is only approved by the FDA to treat depression, it is sometimes used off-label as a treatment for migraines, neuropathic pain, fibromyalgia, and nocturnal bedwetting (in childhood).
The drug works by inhibiting reuptake of serotonin and norepinephrine in the brain. It tends to increase serotonin significantly, while affecting norepinephrine to a moderate extent. These days, Amitriptyline is not commonly used as a first-line treatment for depression, but throughout the 1960s and 1970s, it was considered one of the best options. Some documentation even suggests that its efficacy may be superior to other antidepressants, including SSRIs.
Although this is an older drug can work well to treat depression, not everyone is going to have a positive reaction to taking it. For some individuals the side effects may be overwhelming and intolerable. For others, it may not be effective in reducing their depressive symptoms. Finally there are those who have had success taking the drug, but found that its antidepressant effects wore off over time. There are also people who just want to stop taking an antidepressant and function drug-free again. If you are considering going through withdrawal, below are some important things to keep in mind.
Factors that influence Amitriptyline withdrawal
Whenever you quit taking a medication, there are factors that will influence the severity of your withdrawal. These factors include things like: time span over which you took the drug, your dosage, how quickly you tapered, as well as other individual factors such as physiology, habits, and environment.
1. Time Span
How long were you taking Amitriptyline? If you were taking it for a short duration, chances are that your body and brain didn’t develop a tolerance or become reliant on the drug for functioning. Thus, those who took it for a short period of time (i.e. weeks or a couple months) should have an easier time coping with the withdrawal period. People who were on the drug for an extended period of time (i.e. years) will likely have a much tougher time with the withdrawal.
2. Dosage (50 mg, 75 mg, 100 mg, 150 mg)
Most people end up taking anywhere from 50 mg to 150 mg of the drug at bedtime. However, in more extreme cases, the dosage of 150 mg may be exceeded. The maximum recommended dose of this drug to be taken daily is 300 mg. In general, there is thought to be a relationship between dose of the drug you take and the severity of your withdrawal. Individuals who are on a lower dose such as 50 mg are thought to have an easier time coping with symptoms compared to those who were on the daily maximum of 300 mg.
3. Cold Turkey vs. Tapering
Did you quit taking Amitriptyline cold turkey (abruptly) or did you conduct a gradual taper? If you quit cold turkey, it essentially shocks your central nervous system because it will still have been expecting to receive the drug. In order to reduce withdrawal symptoms, the best method is to conduct a gradual taper based on how you feel to reductions in dosage.
To be on the safe side, experts recommend tapering by 10% of your current dose per month. If you feel this is too slow and/or you don’t notice any extreme withdrawals, you can tweak the percentage to suit your needs. Understand that if you are taking a sustained-release version of the Amitriptyline, you may want to talk to your doctor about counting the little “beads” or converting to the non-sustained release version while tapering.
4. Individual Factors
There are always other individual factors that can influence the difficulty of your withdrawal. Individual physiology tends to play a big role in determining how someone will react to withdrawal. Certain people may not experience many withdrawal symptoms, while others will experience every unwanted symptom imaginable.
It should also be noted that personal habits such as: diet, exercise, social life, productivity, etc. can also play a role in influencing how a person is able to cope with their withdrawal. Additionally if you are on any other medications, it may make the withdrawal process easier.
Amitriptyline Withdrawal Symptoms: List of Possibilities
Below is a list of possible symptoms that you may experience when withdrawing from Amitriptyline. Understand that you may not exhibit every symptom listed below during your withdrawal. This is just a collection of symptoms that people have reported, with the two most common being dizziness and headaches.
- Anger: During withdrawal it is common to experience increased anger. You may get angry at other people or angry with your circumstances. This is usually caused by neurotransmitter levels being abnormally low. As they increase, your anger should continue improving. Do your best to contain your anger and learn productive ways to cope with it.
- Anxiety: When withdrawing from this medication, you may notice that you feel more anxious than usual. This is due to the fact that your serotonin levels dropped after you stopped taking the medication. Low serotonin is thought to contribute to significant anxiety during the withdrawal period. Your serotonin levels and neurotransmission will eventually return to how they were prior to your usage of the drug.
- Appetite changes: Some people who take this drug report increases in appetite. If you experienced an increased appetite while on this antidepressant, your appetite may be reduced when you quit taking the medication, and vice versa. Appetite changes can lead to weight loss or weight gain when you stop taking the drug.
- Body aches: In some cases this drug can actually help to reduce body aches. When you stop taking it, you may feel achy all over for no apparent reason. Keep in mind that it may take a few weeks before the aches start to subside. In the meantime, consider getting a massage if this symptom becomes difficult to deal with.
- Crying spells: It is common to cry a lot when you withdraw from an antidepressant. Crying is considered a natural release of emotion and can actually promote healing. Most people that end up crying during withdrawal do so as a result of the increased depression that they initially experience.
- Depersonalization: Do you feel like you aren’t the same person that you were prior to taking the drug? It is common to feel depersonalized or as if our normal emotions and personality has been sucked out of our body. Understand that as you experience healing, your natural emotions and personality features will return.
- Depression: When you quit this drug, you may notice that your initial depression returns. For some individuals, they may notice that not only does the depression return, it actually increases in severity. Depression may increase in severity because your neurotransmitters are likely abnormally low and your brain has become vulnerable and sensitive. As you heal, your depression should either subside or return to how it was pre-Amitriptyline.
- Diarrhea: There have been reports of diarrhea upon discontinuation of this drug. If you have diarrhea, you may want to consider picking up some over-the-counter Imodium to help with your situation. Typically diarrhea should not last more than a week following your last dose.
- Dizziness: Feeling dizzy is perhaps the most common complaint people have when they stop taking Amitriptyline. You may feel lightheaded, as though you have balance issues, and uncoordinated as a result of the dizziness. It can be overwhelming, especially in cases of people who quit the drug cold turkey. Even though it may seem never-ending, just know that it will eventually get better.
- Fatigue: Another very common symptom is that of lethargy or fatigue. You may feel tired all the time and lack energy to complete even basic tasks. Keep pushing yourself through these feelings of tiredness, but honor them in times when you think a little extra sleep would be beneficial. It can be difficult to deal with this symptom, but your energy levels will eventually rebound.
- Flu-like symptoms: In some cases, people get really sick when they stop taking this medication. You may experience nausea, headache, fatigue, aches, and dizziness – leading to a set of symptoms that mimic influenza. If you gradually taper off of the medication, you will reduce your chances of feeling “sick” during the withdrawal.
- Headaches: Some people take this drug specifically to treat their migraine headaches. If you were taking it to treat headaches, you may notice that they reemerge when you stop taking the drug. In order to reduce your chances of dealing with bad headaches, it is recommended to always gradually taper.
- Hypersensitivity: During withdrawal you may notice that bright lights and/or loud sounds become very bothersome. Your visual and auditory processing may become hypertensive and moderately loud noises may sound extremely loud. As your nervous system heals and the parasympathetic functioning is restored, hypersensitivity should be reduced.
- Insomnia: Some individuals take this drug for insomnia and/or notice that it helps them fall asleep at night. When withdrawing, you may notice profound insomnia to the point that you cannot get a good night’s sleep. Understand that insomnia may be temporarily worsened during withdrawal and that you can cope with it by learning ways to lower your arousal.
- Irritability: You may become increasingly irritable during the early weeks of withdrawal. You may feel like lashing out at other people and as though you have taken on a mean persona. This is usually a result of neurochemical changes that you are dealing with during withdrawal. If you feel irritable, you may want to practice some sort of relaxation technique and/or exercise.
- Itching: Feeling itchy is a very common side effect of this particular drug, but a less common withdrawal symptom. If you feel itchy, it could because you are in early stages of withdrawal and still have the drug in your system. Realize that once you stop the drug, the itching should subside within a week.
- Joint pain: In addition to feeling body aches, you may notice some joint pain. This could be a result of norepinephrine changes – a neurotransmitter linked to pain processing. Realize that the pain you are experiencing may be temporarily more severe during the early stages of withdrawal.
- Memory problems: Some people report issues with memory retrieval and feel as if their short and/or long term memory has worsened. If you are having difficulties with your memory, just know that this drug is not associated with any long term memory damage. In other words, as your brain heals itself, your memory should return to normal functioning.
- Muscle pain: This drug is sometimes prescribed off-label to treat people with various types of pain. It can reduce muscle pain while a person takes it, but when they come off of it, the pain may be even worse. This is due to the fact that norepinephrine levels drop when a person quits the medication. It can take awhile for them to stabilize and the increased pain sensitivity to subside.
- Nausea: You may feel nauseated if you quit this drug cold turkey. Nausea occurs because your body has gotten used to receiving the drug on a daily basis and was incorporated in its functioning. When you stop taking the drug, nausea is a common response from the body.
- Panic attacks: Since this medication affects serotonin levels, when you stop taking it, your serotonin levels can drop. This can result in increased levels of anxiety, which in turn can cause a person to experience panic attacks. Panic attacks experienced during withdrawal will subside once our serotonin levels are restored and when we learn to relax.
- Poor concentration: Many individuals report that withdrawal from Amitriptyline takes a toll on their ability to focus. Completing work-related tasks, schoolwork, and/or taking tests may become extra difficult. Additionally doing something simple like reading a newspaper may seem tough. Understand that you may temporarily experience poor concentration, but your brain will eventually restore its natural ability to focus.
- Restlessness: Some people report feeling restless when they initially stop taking this drug. They are unable to sit still and are fueled by inner agitation and anxiety. If you feel restless, you may want to engage in some sort of relaxation exercise to calm your nerves and/or get some exercise to burn off energy.
- Sleep changes: During withdrawal, your sleep cycle can easily get thrown out of balance. You may find it difficult to fall asleep at night and/or difficult to stay asleep at night. You may have weird dreams, nightmares, and feel tired all the time. Many people report feeling unable to fall asleep at night, and extremely lethargic during the day. Understand that as your brain recovers, your sleep cycle should eventually normalize.
- Suicidal thoughts: During withdrawal it is relatively common to feel suicidal and increasingly depressed. If these thoughts become overwhelming, be sure to seek immediate medical attention. Understand that the potency of suicidal thoughts tends to increase during withdrawal because your serotonin levels are low and neurotransmission tends to be chaotic. The longer you have been off of the drug, the less these thoughts should occur.
- Sweating: Many individuals note that they sweat profusely when coming off of this antidepressant. Increased sweating is common when a person quits taking a drug that their body has become accustomed to receiving. When the drug supply is cut, sweating is a physical reaction that many people have. Sweating may occur throughout the day and/or at night.
- Vomiting: Although vomiting is an extreme withdrawal symptom, it is one that is sometimes reported. Usually those who report vomiting were on a high dose, quit cold turkey, and ended up feeling very sick with high nausea. Just know that vomiting should not last more than a few days.
- Weight changes: Some people gain a fair amount of weight while taking Amitriptyline. In the event that your weight gain was caused by the drug, you should lose the weight that you gained while taking it. Additionally if you lost weight while taking this drug, you may gain some weight back that you lost while taking it.
Note: It is understood that amitriptyline stays in your system (along with its metabolites) for a period of 4 to 21 days after discontinuation; suggestive of high interindividual variability. Some users will eliminate the drug quicker (in around 4 days) than others (nearly 21 days). As a result of variability in elimination speed, severe withdrawal symptoms may emerge sooner or later depending on how long your body retains amitriptyline (and its metabolites) in your plasma.
How long do Amitriptyline withdrawal symptoms last?
There’s no telling exactly how long Amitriptyline withdrawal will last. For some people who were on a low dose for a short-duration, it may only take a few weeks before they feel 100% back to normal. For others that were on the drug for an extended period of time at a high dose and/or those who quit cold turkey may end up dealing with withdrawal symptoms for months following their last dose. It is important to avoid getting caught up in comparing how quickly you recover to how quickly someone else recovers – everyone is different.
In order to speed up your recovery, it is recommended to engage in healthy activities such as: getting adequate exercise, eating a healthy diet, getting proper sleep, forcing yourself to socialize and stay productive, and seeking the help of a professional if you need it. The less stress you have to deal with in your environment and the more you push yourself to engage in healthy activities, you will increase the speed of your recovery. Although withdrawal symptoms may be overwhelming at times, continue pushing through them and realize that in time they will get better.
Withdrawing from an antidepressant can be a frustrating experience, especially if you didn’t know what to expect. Do your best to talk to other people about how you feel and consider seeking the help of a therapist if you lack social support. If you have gone through Amitriptyline withdrawal, feel free to share your experience in the comments section below. You may really help someone else who is going through the same thing.