Amitriptyline is a tricyclic antidepressant. It is used to treat a number of mental illnesses: major depressive disorder and anxiety disorders, and less commonly attention deficit hyperactivity disorder (ADHD) and bipolar disorder.
Some evidence suggests amitriptyline may be more effective than other antidepressants, including selective serotonin reuptake inhibitors (SSRIs). It is used in addition to other medications for pain: migraine prevention, also in cases of neuropathic pain disorders, fibromyalgia and nocturnal enuresis.
Amitriptyline is a popular off-label treatment for irritable bowel syndrome (IBS), although it is most frequently reserved for severe cases of abdominal pain in patients with IBS because it needs to be taken regularly to work and has a generally poor tolerability profile, although a firm evidence base supports its efficacy in this indication. Amitriptyline can also be used as an anticholinergic drug in the treatment of early-stage Parkinson's disease if depression also needs to be treated. Amitriptyline is the most widely researched agent for prevention of frequent tension headaches.
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Orally, the initial dose is 25-50 mg before sleep. Then, within 5-6 days, the dose is individually increased to 150-200 mg. If there is no improvement during the second week, the daily dose is increased to 300 mg. If the signs of depression disappear, the dose is reduced to 50-100 mg and therapy is continued for at least 3 months.
In elderly patients with mild disorders, the dose is 30-100 mg, usually 1 time before sleep, after reaching the therapeutic effect, switch to the minimum effective dose - 25-50 mg.