Amitriptyline for Anxiety: Is It Effective?

If you’re thinking about using the medication amitriptyline for anxiety, it’s helpful to understand a few facts about anxiety. 

First, anxiety is a common issue that can affect people of all ages and backgrounds. In fact, for many, it’s a recurring or serious problem that interferes with daily life and doesn’t go away over time, even in peaceful situations that normally shouldn’t cause feelings of anxiety. 

According to data from the ​​National Comorbidity Study Replication (NCS-R), an estimated 31.1 percent of US adults will suffer from an anxiety disorder at some point in life.

And if you’ve been diagnosed with an anxiety disorder, your healthcare provider may suggest using medication to improve your thoughts, feelings and other symptoms, including the impact that anxiety can have on your quality of sleep.

Several different types of medications are used to treat anxiety, including benzodiazepines and antidepressants. One antidepressant that’s occasionally used to treat anxiety is amitriptyline -- an older medication that belongs to a class of drugs called tricyclic antidepressants (TCAs). 

Amitriptyline isn’t approved by the FDA to treat anxiety, and it generally isn’t used as a first-line treatment. However, in certain cases, your healthcare provider may suggest using amitriptyline for sleep and anxiety, to help control your symptoms and reduce the severity of your anxiety.

Below, we’ve explained what amitriptyline is, as well as whether or not it’s effective for reducing anxiety. We’ve also discussed several important potential side effects and drug interactions that you should be aware of if you’re prescribed this medication.

Finally, we’ve shared some other treatment options your healthcare provider may suggest if you’ve been diagnosed with an anxiety disorder.

Amitriptyline is a type of tricyclic antidepressant. It’s sold under the brand name Elavil® and is also available as a generic medication.

The FDA has approved amitriptyline to treat major depressive disorder (MDD). It’s also widely used off-label to treat post-traumatic stress disorder (PTSD), insomnia, anxiety, irritable bowel syndrome, interstitial cystitis (bladder pain syndrome) and sialorrhea (drooling).

Like certain other tricyclic drugs, amitriptyline is occasionally prescribed off-label as a treatment for several common forms of neuropathic pain (nerve pain), including chronic pain that’s caused by diabetes complications or fibromyalgia.

In some cases, amitriptyline is used to treat post-herpetic neuralgia (pain that can develop due to shingles infection).

As an antidepressant, amitriptyline works by increasing levels of serotonin and norepinephrine in your brain and body. These naturally-occurring chemicals, called neurotransmitters, help regulate your moods, thoughts, feelings and certain aspects of your physical health. 

For example, serotonin is thought to regulate happiness and feelings of anxiety. Low levels of serotonin are associated with some mental illnesses, including obsessive-compulsive disorder, depression and anxiety.

Norepinephrine is an adrenal hormone and neurotransmitter that plays a role in regulating your blood pressure and heart rate. It’s also involved in your mental function, such as your ability to focus on tasks, and form memories.

Like serotonin, norepinephrine has emotional effects. Low levels of norepinephrine are linked to attention deficit hyperactivity disorder (ADHD), lethargy (lack of energy) and may be involved in the symptoms of depression.

Antidepressant drugs such as amitriptyline are thought to reduce the severity of depression and other mood disorders by stabilizing levels of these neurotransmitters.

Amitriptyline is quite an old antidepressant. Although it was first developed for the treatment of depression, it’s largely been replaced as a first-line treatment by newer drugs such as selective serotonin reuptake inhibitor medications (SSRIs).

Although antidepressants are typically thought of as medications for depression, many are also used to treat anxiety disorders. 

For example, several SSRIs, monoamine oxidase inhibitors (MAOIs) and other antidepressants are approved by the FDA as treatments for generalized anxiety disorder and panic disorder.

Although the FDA hasn’t approved amitriptyline as an anxiety medication, some studies suggest that it may lower anxiety levels and have beneficial effects for people with anxiety disorders that are related to depression.

For example, a study published in International Clinical Psychopharmacology in the late 1990s found that amitriptyline produced similar effects to fluoxetine (an SSRI approved by the FDA to treat panic disorder) in people with depression that involved symptoms of anxiety.

However, the researchers found that amitriptyline was more likely to produce adverse reactions, and that the adverse effects associated with amitriptyline were typically more severe.

A very small, non-comparative study published in the 1970s also found that people with anxiety and sleep disturbances often experienced improvements in their symptoms. 

Because amitriptyline is an older antidepressant, many of the studies that look at its anti-anxiety effects are several decades old, with quality varying from one study to another. 

More recent research has looked at the effects of amitriptyline in combination with other drugs to treat some complications of anxiety, such as gastroesophageal reflux disease (GERD).

In a small study published in the journal Gastroenterology Research in 2017, researchers tested a combination of amitriptyline and pantoprazole (a proton pump inhibitor) on people affected by gastroesophageal reflux disease and anxiety.

They found that the combination of drugs significantly lowered the severity of GERD and anxiety symptoms in the study participants over the course of four weeks of treatment.

Other research has found that many physicians prescribe amitriptyline for sleep issues such as insomnia. Difficulty falling asleep, staying asleep or feeling restless are common symptoms of some anxiety disorders.

Overall, while there’s some evidence that amitriptyline can help with anxiety in certain situations, there isn’t a large, high quality body of research on its effectiveness as an anxiety treatment like there is for other anxiety medications. 

Like other antidepressant medications, amitriptyline can cause side effects. Most side effects of amitriptyline are mild and transient, meaning they’ll improve on their own, but some issues may be severe or persistent. 

Common side effects of amitriptyline include:

• Weight gain

• Dizziness

• Headaches

• Xerostomia (dry mouth)

• Somnolence (drowsiness)

• Gastrointestinal issues, such as constipation

Amitriptyline can also cause sexual side effects, including changes in your sexual desire and/or sexual performance.

In some cases, amitriptyline may cause more severe side effects, allergic reactions and adverse events, including the following:

• Orthostatic hypotension, dizziness and sedative effects

• Increased appetite and changes in eating habits

• Tachycardia (fast heart rate) or arrhythmia (irregular heartbeat)

• Acute angle-closure glaucoma (sudden-onset eye pain)

• Confusion and/or delirium

• Reduced threshold for seizures

• Increased risk of bone injury

• Numbness or weakness in your limbs

• Slowed speech or difficulty speaking

• Severe chest pain

• Urinary retention

Amitriptyline may cause issues for people with existing mental health disorders or other medical conditions that require drug therapy. 

For example, medications that alter the action of the CYP3A4 enzyme may affect the activity of amitriptyline. Although uncommon, amitriptyline may induce mania when taken by people with bipolar disorder or a family history of mania.

As an antidepressant, amitriptyline may cause serotonin syndrome when used with other drugs that increase serotonin levels. Make sure to tell your healthcare provider about all pre

Although amitriptyline may be useful for treating anxiety in certain situations, there’s not a lot of evidence to support its use as a medication for most anxiety disorders. Because of this, as well as its considerable side-effect profile, it’s rarely used as a first-line treatment.

If you think you have an anxiety disorder, you can get help by asking your primary care provider for a mental health referral, connecting with a mental health provider locally or from home using our telepsychiatry services. 

Most of the time, anxiety disorders are treated with medication, psychotherapy (talk therapy) or a mix of different approaches.

Medications for Anxiety

Common medications for anxiety include benzodiazepines, more modern antidepressants such as SSRIs and, in the case of performance anxiety, beta-blockers like propranolol.

If you’re prescribed medication, make sure to take it as directed by your health professional. If you’re prescribed any type of antidepressant, note that it can require several weeks to produce noticeable relief of symptoms from an anxiety disorder.

We offer numerous SSRIs online, including several that can treated anxiety disorders, such as fluoxetine (the active ingredient in Prozac®), sertraline (Zoloft®), escitalopram (Lexapro®) and paroxetine (Paxil®).

We also offer buspirone (the generic version of Buspar®), an FDA-approved anxiety treatment that’s often used due to its decreased side-effect profile compared to other medications.

Our guide to medications for anxiety goes into more detail about how anxiety treatments work, their potential side effects and more. 

Psychotherapy

Anxiety often improves with psychotherapy. Your mental health provider may recommend that you take part in cognitive behavioral therapy (CBT), exposure therapy or a similar form of talk therapy based on your symptoms, type of anxiety disorder and personal needs.

Like medication, psychotherapy needs time to work. You may need to take part in therapy for several weeks or months to experience improvements in your symptoms. 

Habits and Lifestyle Changes

Making small changes to your habits and lifestyle can often make it easier to deal with anxiety and reduce the severity of your symptoms. These may include exercising more or using stress management techniques to gain more control over your feelings and thoughts.

Our guide to calming anxiety shares simple, effective lifestyle choices and techniques that you can use to reduce anxiety and improve your quality of life. 

If you’ve been diagnosed with an anxiety disorder, using an antidepressant can help reduce the severity of your symptoms. While some research suggests that amitriptyline can be an effective treatment for anxiety, it’s also associated with a range of potential risks and side effects.

Because of this, if you have an anxiety disorder, your healthcare provider will usually suggest a more modern medication, such as an anti-anxiety drug or an SSRI.

Anxiety can have a serious impact on your quality of life, making it important to talk to a mental health provider if you’re not feeling your best. Our online mental health services allow you to easily connect with a licensed provider from home for personalized help and care. 

You can also learn more about dealing with anxiety, depression and other common issues with our free mental health resources.