Amitriptyline belongs to the group of antidepressants. More precisely, it belongs to the group of tricyclic antidepressants. Together with the substances imipramine, clomipramine, desipramine and doxepin, amitriptyline is one of the best known and most frequently prescribed drugs in this group of substances.
Every second a release of so-called messenger substances occurs between the opposing nerve endings. These messenger substances include adrenaline, noradrenaline, serotonin, dopamine and several others. Through this release the nerves communicate with each other.
This is the only way that stimuli can be transmitted and the brain can think and control mood and emotional sensations. Antidepressant drugs target the sensitive balance of the release of these neurotransmitters. The amount of neurotransmitters released can be influenced in different ways.
After they are released, they are absorbed from the gap between the nerves, rendered ineffective and then released again during a subsequent nerve action. This neurotransmitter absorption can be blocked. As a result, they remain longer between the nerves (synaptic cleft) and can have a longer effect there.
With regard to the mechanism of action, acute effects must be distinguished from long-term effects. When administered for a short period of time, tricyclic antidepressants lead to an inhibition of the aforementioned reuptake mechanism for norepinephrine, serotonin and dopamine. Prolonged administration of amitriptyline leads to a reduction of receptors to which the neurotransmitters bind and act (beta-receptors).
At the same time alpha-receptors are more highly regulated and made more sensitive to the neurotransmitters. This leads to a general increase in drive. Furthermore, the activities of the messenger substance gamma-amino- butyric acid are increased in the frontal brain when the drug is used for a longer period of time. It is assumed that, among other things, this activity is reduced in depression and amitriptyline can thus have a depression-relieving effect. Amitriptyline has a calming (sedative) effect from the first week, a stimulating (thymeretic) effect from the second week and a mood-lifting (thymoleptic) effect from the third week.
Side effects of Amitriptyline
When using amitriptyline are the most common side effects: Also, it lowers the threshold for seizures. This can trigger a seizure (epilepsy) under amitriptyline. At the heart, it can trigger arrhythmia (cardiac dysrhythmia) and cardiac insufficiency.
In addition, it can lead to skin rashes, an increase in liver values, blood formation disorders, appetite and weight gain, increased hair growth and sleep disorders and daily tiredness (burnout syndrome) and concentration disorders. More about the side effects of Amitriptyline can be found here: Side effects of Amitriptyline
- Dry mouth
- Difficulty urinating
- Constipation, heart rate increase and
- Increase in intraocular pressure (glaucoma). Like many other psychotropic drugs, amitriptyline has several side effects, but these do not necessarily occur to the same extent in every patient.
While some patients experience almost no side effects even after many years of taking amitriptyline, other patients suffer from several simultaneously occurring side effects of amitriptyline. Particularly frequent is an increase in weight when taking amitriptyline, which is caused by repeated attacks of hunger and the resulting increased food consumption. Overall, weight gain is a common side effect of amitriptyline, i.e. one in ten patients is affected.
Some patients develop diabetes mellitus, i.e. the so-called diabetes, due to the weight gain and the increased food intake. Another common side effect of amitriptyline is fatigue. This occurs mainly at the beginning of treatment and can also be used therapeutically if patients have problems falling asleep.
In this case, amitriptyline can be taken before going to bed and thus help the patient to get back to rest. Nevertheless, fatigue is an unwanted side effect of amitriptyline as it can quickly turn into a lack of drive, which is not at all desirable in depressed patients. In general, so-called central nervous disorders (i.e. side effects affecting the brain) are common and occur in every tenth patient.
In addition to fatigue as a side effect of amitriptyline, headaches (cephalgia), dizziness (vertigo), aggressions and increased tremors (tremor) can also occur. Side effects in the eye caused by amitriptyline are also possible. In this case, the pupils in particular may be altered.
These may no longer react adequately to stimuli from far away or near by taking amitriptyline and so-called adaptation disorders of the eyes (accommodation disorders) may occur. In general, however, central side effects are to be feared above all, i.e. those side effects which are controlled by the brain. These include movement disorders (ataxia), the aforementioned fatigue and drowsiness, confusion, concentration disorders, increased anxiety, strongly euphoric moods (mania), insomnia, nightmares and rarely hallucinations.
A side effect of amitriptyline feared by many male patients is the loss of sexual desire and potency (loss of libido up to loss of potency). Over 10% of all patients also suffer from side effects of amitriptyline that affect the heart. These include heart stumbling (palpitations), a too fast heartbeat (tachycardia) and problems with the circulation (orthostatic hypotension).
In addition, amitriptilyne can increase or even worsen heart failure due to the side effects. Very rarely a so-called AV block, i.e. a conduction disorder of the heart, occurs, which the patient then perceives as a disturbance in the heart rhythm. Due to the side effects of amitriptyline on the heart, regular examination of the heart with an ECG is obligatory.
The gastrointestinal tract is also affected by amitriptyline, and constipation, nausea and dry mouth (xerostomia) are more common. This can become so unpleasant for the patient that he/she can only eat food with liquid because there is no longer sufficient saliva in the mouth. Side effects on the skin caused by amitriptyline are rather rare, but patients still sweat more, which is very unpleasant for many patients.
Sensitivity disorders (paresthesias) are also among the side effects of amitriptyline which can affect the skin. In general, at the beginning of treatment with amitriptyline (about the first 2 weeks) the side effects predominate and the antidepressant effect only sets in after about 2 weeks. After these first two weeks, when the body has become accustomed to the new drug, the side effects should be weaker and the actual antidepressive effect of amitriptyline should be stronger.
Weight gain under amitriptyline therapy is one of the most common side effects of psychotropic medication. Over 10% of all patients gain weight while taking amitriptyline. On the one hand, this is due to the fact that amitriptyline can impair digestion and thus lead to more frequent constipation, and on the other hand, many patients suffer from attacks of ravenous hunger while taking the psychotropic drug.
As a result, amitriptyline can lead to weight gain. On the other hand, some patients lose weight by taking amitriptyline because they suffer more from nausea and vomiting. Other patients, on the other hand, complain of neither weight gain nor weight loss when taking Amitriptyline. However, if a patient notices that he/she has a strong weight gain due to Amitriptyline, it is urgently necessary to decide with the attending physician (psychiatrist) whether another psychotropic drug can be used, since the weight gain can also lead to the development of diabetes mellitus (diabetes) or to heart problems (coronary heart disease).