Amitriptyline For Anxiety: How To Take & Side Effects 2024

Anxiety is a common condition with various available treatment options. You may be looking for additional help or would like to offer support to someone close to you. Many individuals are able to improve the management of anxiety symptoms with lifestyle changes, therapy services, and medications. Medication options include many different agents within several classes, each with unique advantages and disadvantages.

If you or your doctor have considered using amitriptyline for anxiety, you may be wondering how it works, whether there are side effects, and if there are other considerations to keep in mind while using the medication. Learning more about the medication will allow you to be more involved in your own care and better able to talk to your mental health provider about your successes or concerns.

Amitriptyline For Anxiety

Mechanism Of Action

The term mechanism of action refers to how a medication works in your body. Amitriptyline hydrochloride (brand name Elavil) is a tricyclic antidepressant (TCAs). Tricyclic antidepressants^[1] work by increasing serotonin and norepinephrine levels, which helps regulate mood.

The resulting buildup of serotonin and norepinephrine is similar to other antidepressants. These medications also regulate serotonin, norepinephrine, or both:

• Selective Serotonin Reuptake Inhibitors (SSRIs – Prozac, Paxil, Zoloft, Lexapro, etc.)
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs – Effexor, Cymbalta, etc.)
• Monoamine Oxidase Inhibitors (MAOIs – Nardil, Emsam, etc.)
• Buspirone

There are also other medications available that work in different ways. Some examples include benzodiazepines (Xanax, Ativan, etc), propranolol, and over-the-counter remedies like cannabidiol (CBD). If you choose to use an OTC product like CBD oil, it’s important to remember that these are not regulated by the FDA. The best way to ensure you use a reliable CBD product is to use a brand that submits to independent laboratory testing (CBDfx, etc).

Amitriptyline Indications

A healthcare provider uses the term indication to determine what amitriptyline has been approved to treat. Amitriptyline has been used since the late 1950s and has developed a number of clinical applications over time. Some indications are FDA-approved, while others have gained clinical support without specific FDA approval (considered off-label use). 

• FDA Approved Uses Of Amitriptyline:
  • Major Depressive Disorder (MDD).

• Off-label Uses of Amitriptyline:
  • Anxiety.
  • Post-traumatic stress disorder (PTSD).
  • Neuralgia (nerve pain).
  • Fibromyalgia.
  • Insomnia.
  • Migraine prevention.
  • Irritable bowel syndrome (IBS).
  • Bladder pain syndrome.

While amitriptyline was originally developed to treat depression, many healthcare providers are now prescribing amitriptyline for off-label purposes. This can be particularly helpful for patients who may be managing multiple disorders.

Use In Anxiety

First-line treatment for anxiety has shifted over time to focus primarily on SSRIs and SNRIs due to better tolerability or fewer side effects. The primary concerns with amitriptyline use are related to drowsiness and anticholinergic effects (dry mouth, constipation, etc). The medication becomes particularly useful for patients who are also managing symptoms of other disorders in addition to anxiety. 

When clinicians consider amitriptyline for anxiety, they may also intend to help with one or more of the following: 

• Neuropathic pain, including fibromyalgia.
• Migraines.
• IBS.
• Insomnia.

Taking amitriptyline for sleep and anxiety may be a good approach for some patients. Insomnia and anxiety often go hand in hand, and amitriptyline can support managing both conditions. Lifestyle changes to promote good sleep hygiene, along with using the medication can be particularly helpful.

Other Considerations

Age

Amitriptyline is generally not recommended for individuals over the age of 65.^[2] The concerns are related to increases in drowsiness, dizziness, and the potential for memory impairment. Individual risk factors can vary, and it’s always a good idea to talk to your doctor about any concerns. 

Pregnancy And Breastfeeding

Managing anxiety during pregnancy can be challenging. There have been some rare associated birth defects reported, but overall studies exploring the effects of amitriptyline during pregnancy are lacking. This means the pros and cons of use should be carefully considered, and there should be a clear benefit that outweighs the risks prior to using amitriptyline during pregnancy.^[3]

The most important thing you can do is tell your doctor about any concerns you may have about your own mental health and well-being. Your overall health – including mental health – is also very important for your baby! Together you will be able to develop an anxiety treatment plan that achieves the best balance for you and your baby.

Amitriptyline does cross over into breast milk. The most common effect observed in breastfeeding infants is sedation. The effects are generally milder for infants older than two months. While generally considered safe, a continued discussion with your doctor about whether the benefits of amitriptyline continue to outweigh potential side effects for you and your infant is advised.

Amitriptyline Dosage For Anxiety

You may wonder: “How much amitriptyline should I take for anxiety?” Effective doses can vary by individual, so the answer to this question would be “the lowest effective amitriptyline dose.” Amitriptyline prescriptions are available as oral tablets, with available strengths of 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, and 150 mg.

A lower dose is usually selected first and may be increased over time depending on how well you feel it is working. Amitriptyline 10mg for anxiety can be a good starting point for some individuals. The maximum daily dose of amitriptyline is 150 mg daily for most patients.

How To Take Amitriptyline For Anxiety

Amitriptyline can cause drowsiness. For this reason, the best time to take the medication is at bedtime, regardless of whether you are taking it to help with sleep.

Consistent daily dosing is important for amitriptyline to be effective for anxiety. If you find yourself forgetting doses, setting an alarm on a phone, or placing the medication near routinely used items like a toothbrush may be helpful. Do not take an additional dose to make up after a missed dose.

If you plan to stop taking amitriptyline, it should be tapered slowly with the help of a healthcare professional to avoid withdrawal symptoms. These symptoms most commonly include headache, dizziness, nausea, irritability, and insomnia.

Additional Support

Many patients taking prescription medications like amitriptyline for anxiety also benefit from therapy services. Cognitive behavioral therapy (CBT) is the most common form of anxiety therapy, offering a structured approach to identifying patterns of thought and individualized methods of management. In some cases, these include meditation, breathing exercises, or other forms of self-regulation.

Many individuals choose to see a therapist in person at a local clinic. For those who are unable to attend appointments in person, therapy has become much more easily accessible in recent years, with many services available online. Examples include Talkspace, Calmerry, and Betterhelp.

Amitriptyline Side Effects

As with any medication, amitriptyline can cause adverse effects. Clinicians often refer to anticholinergic effects, which are a primary concern when considering amitriptyline. Cholinergic receptors regulate various bodily functions, including mucus secretion (saliva production, for example) and smooth muscle contraction (responsible for keeping stools moving through the intestines). Anticholinergic effects are responsible for some of the more common side effects of amitriptyline:

• Dry Mouth.
• Constipation.
• Drowsiness.
• Dizziness.
• Memory impairment (of particular concern for elderly patients).

Amitriptyline can cause drug interactions as well. Some of these interactions have to do with how the medication is processed by the liver, and others relate to additive side effects. Particularly if you see multiple doctors, it is very important that each of your providers knows which medications you are currently taking if they are considering adding something new. 

If you are taking other medications that regulate serotonin, it can cause an unsafe buildup of the neurotransmitter, potentially leading to serotonin syndrome.^[4] This includes over-the-counter supplements like St. John’s Wort. Serotonin toxicity is considered rare overall, but because these combinations of medications can be fairly common in practice, it is helpful to be aware of the potential signs:

• Shivering.
• Restlessness or irritability.
• Sweating profusely.
• Heart palpitations.
• Involuntary muscle movements or twitching.
• Diarrhea.

If any of these symptoms are associated with confusion or a fever, seeking medical attention quickly is advised. A question that comes up during patient reviews of amitriptyline for anxiety is, “Can amitriptyline cause anxiety?” Some serotonin syndrome symptoms overlap with anxiety symptoms. A possible explanation for worsening symptoms is a serotonin imbalance, particularly if someone takes more than one serotonergic medication. 

Conclusion

Amitriptyline is a tricyclic antidepressant, a class of medications that regulates serotonin and norepinephrine. This activity has beneficial effects for anxiety management. Because of the potential side effects, many patients treating anxiety alone may do better with other medications like SSRIs or SNRIs. 

Amitriptyline does have the ability to help with a variety of other conditions, particularly for those patients who are trying to manage nerve pain, IBS, migraines, or insomnia, amitriptyline can be a helpful option.

---