A question to all who took amitryptiline
 

I'm taking amitryptiline now for almost 5 weeks. My sleep was very good in the first 2 weeks, but since then I only sleep about 7 hours a night.

What happened is that I am still very tired during the day, without beeing able to sleep. The tiredness is somehow sublinimal, meaning that I do not yawn all the time or my eyes keep shutting down, however I feel like a zombie.

Overall my mental condition is better than a few weeks before(less thinking fatiguing) but physically it started to develop into the opposie direction.
And what worries me the most is that, in some situations my speech becomes even slurred,because of the tiredness.

The point is I didn't have these feeling when I slept well in the first 2 weeks. Is it maybe the cumulative deprivation of sleep or a sudden intolerance of amitryptiline? My doctors couldn't tell excactly where it comes from.

Did anyone experience something similar?

Didn't do a thing for me except gave me hangover feeling in the morning, but I was only on 10mg. Anyway, I thought 7 hours sleep is a decent average for most folk?

Well I saw more people sleeping 12 hours a night than 7 hours on amitryptiline. I did that too, but only in the first 2 weeks.

And yes, I had also that feeling to be a bit drunk(when I had to get up without sleeping late).

You may be over-thinking this. Anxiety will cause fatigue. The amitrptyline is to help with head aches and getting to sleep. It is not to help you continue to sleep. As said, 7 hours is not bad. Many would love to get 7 hours sleep.

Taking a short nap during the day would be good.

Drugs like amytritaline are not meant to be taken for extended/regular lengths of time. I had similar to what you have described, and noticed that it made my mood more negative too. So I stopped taking it and felt better. My understanding is that this is a common reaction. Hopefully you are ready to forge your own sleeping/energy pattern, but if not your Dr will be able to discuss/prescribe an alternative.

(Those symptoms/advice should be printed on the inner label thingy)

Amitriptyline CAN be taken every day for extended lengths of time. It is an older tricyclic antidepressant that also works for nerve pain. I've been on 50 mg. at night for almost 5 yrs. I have had good results helping me fall asleep, and it helps my headaches and facial numbness feeling. That dopey daytime feeling went away with time.

Yes, in fact I was just reading something about Amitriptyline
that mrsD posted in PN forum earlier today and thought it very interesting.

The information concerned was in reference to this older post.

http://neurotalk.psychcentral.com/post529063-1.html

As you can read in my first post, the dopey daytime feeling just started after 3 weeks. This appears to be unusual. Maybe it's because of my sleeping behaviour, I can feel that 7 hours are definately not enough for me.

Another question: Since 2 weeks I didn't have headaches and the common debilitating fatigueness got reduced. I'm sure amitryptiline is also responsible for that, but it makes me feel like I could probably miss the point when I'm recovered, because the drug supresses the symptoms, meaning I start to stimulate again, without beeing fully recovered.

I was not able to get a high enough dose of amitriptyline to fully eradicate my headaches because of the side effects. It made me very dizzy, to the point that I was falling. I had to switch to Topamax. If you are having unwanted side effects, you might ask if there is another drug you could try.

My experience
 

I was prescribed 25mg tablets (one at bedtime) of Amitriptyline after my concussion as a sleep aid and to prevent headaches. It definitely knocked me out about 2 hours after taking one and seemed to help with the headaches over time. I took it daily for about a week but started getting unwanted side effects including sleepy during the day, a feeling of too much adrenaline (excess norepinephrine I would suspect) and muscle twitches and hand tremors. I discontinued use after that. I can see how it could be beneficial for some people but it really depends on the person's brain chemistry at the time of dosing induction. It has many different mechanisms of actions resulting in many side effects, some may be helpful, some may cause issues.

Also, it should be noted that amitriptyline is a tri-cyclic antidepressant that affects serotonin levels and SHOULD NOT be taken with any other serotonergic agents; Don't take amitriptyline with anti-depressant meds like SSRI, MAOI, drugs such as adderall, ritalin, or any stimulants, DXM (found in cough syrup), and definitely not with supplements like L-Tryptophan or 5-HTP. Mixing these substances can result in a life-threatening medical condition known as serotonin syndrome. This information is freely available on the internet and if you take any of these medications it would be wise to use the medication checker sticky located at the top of this forum. I have heard of some physicians mixing drugs in very irresponsible ways and in the end you should be the one who makes sure there are no interactions between medications.

Amitriptyline: the good,bad and ugly
 

If you talk to ten people about their experience with this drug, you'll get 10 different answers. Amitriptyline is a "dirty" drug in that it modulates many receptors in the body both inside and outside the central nervous system. On the one hand, it explains why it is used for so many different medical problems. It also explains the long list of side-effects.

Amitriptyline functions at higher doses as a Serotonin>Noradrenalin reuptake inhibitor and results in an increase in availability of these neurotransmitters in the brain (Dopamine may also be involved to a lesser extent). Hence the reason why this class of drug was the "go to drug" for depression and anxiety until the late 1980s.

They have also become popular for pain modulation because of their ability to modulate pain perception (many proposed mechanisms of action including its ability to block sodium channels, antagonize NMDA, reduce Substance P, modulate the GABA and opioid receptor, induce an anti-inflammatory effect via prostaglandins, etc....)

Unfortunately, it's the fact that this drug wears multiple hats that leads to the troublesome side-effects. This is especially true in its ability to modulate the anti-histamine receptors in the brain (drowsiness) and the anti-cholinergic receptors everywhere (dry mouth, constipation, perhaps even memory....which is why it's not commonly used in the elderly). It's the "anti- histamine" side-effect of drowsiness that is used therapeutically to help with sleep maintenance (as opposed to sleep induction).

One has to also remember that the same dose can cause different degrees of "drowsiness" which can persist for different amounts of time for different people. There are many explanations for this phenomenon. For one, Amitriptyline is metabolized through the liver through a special enzyme pathway called the P450 cytochrome system. Within that system, there are many enzymes (proteins that help break down or deactivate a drug). In the case of Amitript., the enzymes 2C19 and 2D6 do most of the work. Anything that affects the function of these 2 enzymes will affect the blood levels of the drug and thus the side-effects.

The most common example of this is when other medications are used that affect the way 2C19 and 2D6 work. The result can be higher or lower levels of Amitriptyline in the blood stream. We also know that people can genetically have different levels of efficiency to their cytochrome enzymes again resulting in higher or lower blood levels for the "same" dose. (An example is the pain-killer "codeine" where almost 20% of the population are genetically "rapid-metabolizer". What they will tell you is that when they take the drug, it does nothing for their pain.) People may also have a sensitivity to this drug for reasons we can't explain yet.

Bottom line: Amitriptyline is a reasonable choice for assisting people with sleep difficulties in the setting of mTBI (especially if headaches are present). People generally do not develop tolerance to the anti-histaminic effect (sedation) hence the reason it can be used long-term without having to escalate the dose. However, it will not be suitable for everyone. The reasons for this are multi-factorial. One might however try smaller doses to determine if their intolerance is dose-dependent.

Cheers, Canadoc

I didn't like it because it made me very tired, and I was fatigued to start with. Prefered using an SNRI and then Lyrica.

Canadoc, thanks for your good explanation.

If I understood you right, amitryptiline can on the one hand supress TBI symptoms (because of it's effect on the receptors), but on the other hand it also acts sedative. This means that some people could indeed miss the point where they healed their TBI because the drug makes them still feel tired, exhausted or dazed(I often heard the term 'zombie feeling').

At the moment, I feel like I'm in no man's land, because I feel like a zombie, not knowing wether it comes from my injury or the drug.

And because of that I'm definately planning to stop taking the drug by slowly reducing the dose over a few weeks. (how long does this sedative effect last, after one has stopped to take it?)

You talked about genetic factors. Well my father also took it, maybe he had the same feelin as I have. I will talk to him.

Hey guys,

I'm about to start taking amitriptyline, hope you don't mind me asking a few quick questions.

What specific improvements have you noticed since taking it?

I'm being prescribed this for post traumatic migraines (which i don't think I'm getting, but I'm willing to try), my neuropsychologist thinks it's this because of my light/sound sensitivity. Has anyone noticed improvements in these after taking it?

Sorry for hijacking....

Abilee,

If it's any use to you I had headaches and light/noise sensitivity and took Imigran (Sumatripen) for this and it really helped.

Been on a 100 mg for over a year. Just stopped taking it and noticed no difference incept for being in a better mood. Was supposed to be helping my migraines and sleep and did neither.

Also please don't complain about sleep 7 hours is a ton. Im lucky to get a half hour to an hour even on meds like klonopin

I am on amitriptyline to help with sleeping. I am almost unable to sleep without taking it. I have been on it for a year at a low dose of 100 mg. I found that most of the fatigue went away after 2-3 months.

It takes about an hour for me to feel sleepy. I also need to fall into a deep sleep, it stopped the running dream feeling I had. I went weeks feeling like I never slept until the doctor gave me amitriptyline.

I take 100 mg of Topamax for the headaches (again a low dose).

This are both clear cut for me. I don't sleep without the amitriptyline and I have daily headaches with the Topmax.

Oh the jealousy I have for you all.

I didn't do it long because obviously it's counterproductive for my other issues but for about a two weeks straight I took 40mg melatonin, 6 zzzquills and two unisoms plus normal scripts. Still couldn't fall asleep. Never got over 2 hours sleep in that time frame either.

It's weird. I average ill say an hour a sleep for a 24 hr period but I never feel tired. No clue why. But it's been this way for a while. I wish I could say it is anxiety and im thinking but its not. Sure doesnt help that when I close my eyes it looks like a laser show is going off. Yet again cluster headaches at 930 at night a few times a week dont help.

Can I ask what you mean by running dream feeling? I've been having vivid, emotional dreams what feels like all night every night and it's really messing with my head, finding it hard to distinguish some stuff which happens in my dreams with what has actually happened in reality.
Has anyone found that amitriptyline helps this?

ABSOLUTELY HATED THIS DRUG!!

Slept the entire nest day, was wicked out of it, and that feeling lasted way too long to be an effective employee the following day! Not to mention I had VERY disturbing dreams that night before and didnt like it at all- even after dropping the dose down in half i still didnt feel good the next day. This is NOT the drug for me at all. NO WAY !

The sedating side-effects should all but disappear after 24-36 hours unless you are taking another medication that is slowing down the metabolism of amitriptyline (unlikely). If you are still feeling drowsy after 36 hours, I would for another cause.
P.S. you are correct in saying that some people may misinterpret medication side-effects for persistent mTBI symptoms. The only way to find out is to do a trial discontinuation of the drug (under the guidance of your physician of course).

another thought on Amitriptyline
 

If mTBI sufferers are experiencing relief of pain symptoms with this drug but are troubled by oversedation, an alternative is to try Nortriptyline. In actual fact, when Amitriptyline is metabolized in the liver, it becomes Nortryptiline. Eventually Nortryptiline is itself metabolized by the liver on its way to be deactivated. Just a thought. Cheers, Canadoc

Canadoc, I will see my neuro on tuesday. Then I will discuss with him how we should proceed with the drug.

Thanks for your help!