Medical Review by Jennie Stanford, MD, FAAFP, DABOM
Summary
- Amitriptyline is a tricyclic antidepressant (TCA) often used off-label to prevent migraines by blocking the reabsorption of the naturally occurring brain chemicals serotonin and norepinephrine.
- Common side effects include dry mouth, constipation, dizziness, and drowsiness. These typically improve as your body adjusts to the medication.
- Serious side effects can include suicidal thoughts, an irregular or fast heartbeat, mania, and angle-closure glaucoma. These all require prompt professional medical attention.
- Younger individuals (under 24) are at higher risk of suicidal thoughts during the initial months of treatment or after a dosage change.
- Always consult a healthcare provider about any new or worsening side effects, and take amitriptyline only according to the guidance of a qualified medical professional.
Here’s what you need to know as you start taking amitriptyline
Amitriptyline is a generic medicine that belongs to a class of drugs called tricyclic antidepressants (TCA). While it’s FDA approved to treat depression, it’s also commonly prescribed off-label to help prevent migraines.
Studies show that people using TCAs like amitriptyline have a 50% or greater reduction in migraines compared to those taking a placebo.
In this article, we’ll dive deeper into amitriptyline’s side effects, and explain why they happen, how they can affect your body, and when to seek help from a healthcare professional if you’re using it or about to start.
How amitriptyline works for managing migraines
Amitriptyline works by inhibiting the reabsorption of serotonin and norepinephrine in the brain. This not only affects mood, but also helps with pain. If you are seeking help for depression, you can learn more about online depression treatment here.
If you’re using amitriptyline for migraine prevention, you should know that its effectiveness tends to increase the longer you take it. Sticking with it over time can make a big difference in managing your migraines.
However, like any medication, amitriptyline can come with side effects, so it’s important to understand them before starting the treatment. We’ll learn about those next.
Common side effects
When you start taking amitriptyline, it’s common to experience some side effects as your body adjusts. This medication is known for having strong anticholinergic effects, meaning it blocks the action of the neurotransmitter acetylcholine throughout your nervous system.
Acetylcholine plays a key role in your “rest and digest” functions—so when it’s blocked, you may notice side effects like:
- Dry mouth
- Constipation
- Dizziness
- Drowsiness
A 2023 study found that people taking amitriptyline were about seven times more likely to experience these side effects compared to those on a placebo. While these symptoms can be frustrating, they often improve over time as your body gets used to the medication.
Dry mouth
Dry mouth (xerostomia) is one of the most common side effects of amitriptyline. It occurs when your salivary glands produce less saliva, leading to a dry or burning mouth, difficulty swallowing, or changes in taste.
Normally, acetylcholine stimulates salivary glands to release saliva to help digest food in the mouth. Since amitriptyline blocks acetylcholine, saliva production decreases. Studies have shown that people taking amitriptyline are about 11 times more likely to experience dry mouth compared to those taking a placebo.
Constipation
Acetylcholine promotes movement in the digestive tract so in blocking its action, this slows down bowel movements leading to constipation. Research shows that people taking amitriptyline are about three times more likely to become constipated than those taking a placebo.
Drowsiness and sleepiness
Drowsiness, also known as somnolence, means feeling sleepier than usual during the day. If you’re drowsy, you might unexpectedly fall asleep when you don’t want to.
A review of 13 clinical trials found that people taking amitriptyline were 5.5 times more likely to experience drowsiness or sleepiness compared to those taking a placebo.
Dizziness
Research indicates that people taking amitriptyline are nearly three times more likely to experience dizziness compared to those taking a placebo. Dizziness may be a spinning sensation or lightheadedness, impacting your balance and coordination.
Serious side effects
Suicidal thoughts or attempts
All antidepressants come with a warning of a higher risk of suicidal thoughts. Young people aged 24 and under have a higher risk of suicidal thoughts and behaviors, especially in the first few months of starting an an antidepressant (like amitriptyline) or after a dose change. The exact reason for this is not fully understood.
Studies show that for those under 18, there are 1.4% more cases of suicidal thoughts and behaviors compared to those on a placebo. For those aged 18-24, the increase is 0.5%.
Heart risks
Amitriptyline has been reported to produce changes in the electrical activity of the heart, leading to an irregular or faster heartbeat. Drugs like amitriptyline have also been linked to heart attacks or strokes.
A clinical study found that those taking amitriptyline were nearly four times more likely to experience a faster heartbeat. If you have a heart condition, it’s important to be closely monitored while taking this medication.
Mania
Mania is a time period of at least one week when a person has a major change in behavior that greatly affects their daily life.
Signs of mania include:
- Increased talkativeness and rapid speech
- Less need for sleep
- Racing thoughts and distractibility
- Upbeat and over-excited
- Mood swings, impulsivity & irritability
It’s important you check for any personal or family history of bipolar disorder. Many people with bipolar disorder first show depressive symptoms, so you could have an underlying bipolar disorder. If you have bipolar disorder, there’s a 20-40% risk that an antidepressant could trigger mania.
Angle-closure glaucoma
Angle-closure glaucoma is a serious eye problem where pressure builds up quickly inside your eye because the fluid that keeps your eyes nourished can’t drain properly. Antidepressant drugs can cause your pupils to dilate (get larger), which can lead to the iris (the colored part of your eye) blocking the eye’s drainage system.
This blockage causes the fluid to build up, increasing eye pressure, and potentially leading to permanent damage if not treated quickly.
Angle-closure glaucoma often comes on suddenly and can cause severe symptoms, including:
- Intense eye pain
- Blurred or reduced vision
- Rainbow-colored halos around lights
- Nausea and vomiting
When to seek medical help
If you have any new or worsening symptoms while taking amitriptyline, let your healthcare provider know right away. This includes common side effects like dry mouth, dizziness, constipation, or drowsiness. Your healthcare provider can help manage these side effects and adjust your treatment if needed.
For serious side effects, such as thoughts of self-harm, a racing heartbeat, symptoms of mania, or sudden vision problems—seek in-person emergency care immediately.
Find your amitriptyline support system with Lemonaid Health
While side effects from amitriptyline can occur, staying in communication with your healthcare provider is the best way to help you manage them effectively. Side effects often improve over time, but if you experience anything serious, seek help immediately. It’s important to inform your healthcare provider about any side effects you notice.
Our team at Lemonaid Health can help. Set up a virtual visit with a qualified US-based health professional who can help you understand any side effects and find appropriate solutions, including FDA-approved medication in clinically indicated cases.
