Amitriptyline is one of the first-line antidepressants, on the market since the early 1960s. It is administered primarily for depression associated with anxiety disorders. Another area of use is pain management.
What is amitriptyline?
Amitriptyline is administered primarily for depression associated with anxiety disorders. The antidepressant amitriptyline was first manufactured in 1960 and introduced to the market two years later. Until the introduction of serotonin reuptake inhibitors, amitriptyline was the most prescribed antidepressant worldwide. And today, this active ingredient is still one of the psychotropic drugs most frequently prescribed in Germany. Amitriptyline is a tricyclic antidepressant that has a characteristic chemical structure with three anellated rings. The drug, which is known as a mood elevator, is prescribed primarily for psychological complaints in which anxiety or a bad mood are in the foreground. Amitriptyline also has a depressant effect on the psychomotor system of patients. The drug is therefore also administered for sleep disorders, which are often among the symptoms of depression.
Pharmacologic effects
Like all tricyclic antidepressants, amitriptyline affects brain metabolism by inhibiting the reuptake of the neurotransmitters norepinephrine, dopamine, and serotonin in nerve cells. This is intended to compensate for the lack of neurotransmitters that is characteristic of depressive patients. This is because the neurotransmitters play an important role in brain metabolism in that they control all nerve reactions. The messenger substances are usually located in small vesicles at the ends of the neurons, where they are released as soon as the nerve is excited. This allows the messenger substances to reach the receptors of other nerve cells and pass on the stimulus. Subsequently, the neurotransmitters are broken down by enzymes or returned to the original store via a special transport system. Amitriptyline occupies the receptors of the neurotransmitters, thereby altering brain metabolism. In addition, the active ingredient prevents the return transport of the neurotransmitters. This allows them to remain at the site of action longer, increasing their effectiveness. In this way, amitriptyline can relieve states of tension and anxiety and lift depressive moods. The condition of chronic pain patients can also be improved. Because here, too, the cause is often a disturbed processing of pain signals in the brain, in which the neurotransmitter serotonin plays a key role.
Medical application and use
Various preparations containing the active ingredient amitriptyline can, in principle, be administered against all forms of depression because of their mood-lifting effect. Preferably, they are used for forms of depression that are accompanied by feelings of restlessness and anxiety. Because it is often difficult to determine which symptom is the cause and which is the consequence of mental illness, amitriptyline is also administered for anxiety disorders. This is because these can have a negative effect on mood, resulting in symptoms that can also be associated with depression. In addition, because the drug generally has a calming effect, amitriptyline is administered for pathological and chronic sleep disorders. Because of the sedative effect that the drug exhibits in all indications, it should generally be taken in the evening. Another area of application for amitriptyline is chronic pain. In many cases, this also has a psychological component. The active ingredient covers a relatively wide range of pain, from mild to very severe pain. Typical examples of applications in pain patients are the treatment of headaches in migraine patients or the musculoskeletal pain from which fibromyalgia patients suffer.
Risks and side effects
Patients administered the drug very often complain of side effects such as dry mouth, dizziness, fatigue, disturbances in the cardiovascular system, headache, irritability, speech disorders, as well as weight gain. A feeling of thirst, inner restlessness, impaired taste or lack of concentration are also among the frequent side effects, as is a loss of libido. Occasionally, side effects such as high blood pressure, diarrhea or changes in blood count may occur.In addition, there are a variety of other possible side effects. Therefore, the approximately two-week adjustment to the preparation should be made under medical supervision. If the side effects are too severe, it may be necessary to switch to another preparation. In addition, the side effects should largely subside as soon as the discontinuation phase is completed. Weaning when discontinuing the drug should also be slow and gradual.
