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Amitriptyline Withdrawal

Vicky Davis

Medically reviewed by Vicky Davis, FNP

Written by Our Editorial Team

Last updated 8/28/2022

If you have a form of depression such as major depressive disorder (MDD), an anxiety disorder that causes panic attacks, or a chronic pain condition, your healthcare provider may prescribe a type of medication called an antidepressant to control your symptoms.

Amitriptyline is a type of tricyclic antidepressant, or TCA. Although it typically isn’t prescribed as a first-line treatment option for depression, it’s often used when other antidepressants aren’t fully effective.

Like other antidepressants, amitriptyline typically works well as a treatment for depression when it’s used consistently. However, it can potentially cause withdrawal effects if you abruptly reduce your dosage or stop taking it.

These side effects, referred to as amitriptyline withdrawal effects, vary in severity and often feel similar to the flu. In some cases, they can even involve a relapse of your depression.

Below, we’ve explained what amitriptyline is, as well as how stopping amitriptyline abruptly can cause withdrawal effects.

We’ve also shared how you can avoid withdrawal symptoms when stopping treatment with any type of antidepressant, including amitriptyline.

What is Amitriptyline?

Before we get into the specifics of amitriptyline withdrawal symptoms, let’s cover the basics of what amitriptyline is and how it works as a treatment for depression. 

Amitriptyline is a prescription drug that’s approved by the FDA to treat major depression. As a tricyclic antidepressant, it does this by stopping the absorption of serotonin and norepinephrine, so that there are greater levels of these neurotransmitters in your brain. 

Like most antidepressants, amitriptyline is intended to be taken orally. Often, you will be started at a dodge of 25mg and told to take it at bedtime. From there, depending on how you react, your healthcare provider may adjust your dose of amitriptyline.

As for its efficacy, one systematic review of almost 200 randomized controlled trials published in the British Journal of Psychiatry compared amitriptyline to other tricyclic antidepressants, as well as selective serotonin reuptake inhibitors (SSRIs). 

The authors found that people who used amitriptyline had slightly better outcomes when it came to their depression than those on the other types of medications.

However, they also found that amitriptyline caused more adverse effects than other medications for depression

Because of its efficacy, your healthcare provider may prescribe amitriptyline if other medications used to treat depression, like SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs) are not quite fully effective for you.

They may also prescribe amitriptyline off-label if you have anxiety, post-traumatic stress disorder or a form of neuropathic pain, such as diabetic neuropathy or fibromyalgia.

Potential Side Effects of Amitriptyline

Like other antidepressant medications, amitriptyline can cause side effects. Most side effects of amitriptyline are mild and transient (meaning they gradually become less severe), but some can be persistent and/or bothersome.

Potential side effects of amitriptyline include:

  • Nausea

  • Vomiting

  • Drowsiness

  • Confusion

  • Dry mouth

  • Headaches

  • Physical weakness

  • Unsteadiness

  • Tiredness

  • Confusion

  • Nightmares

  • Blurred vision

  • Constipation

  • Difficulty urinating

  • Excessive sweating

  • Changes in appetite 

  • Changes in weight

Amitriptyline can also cause sexual side effects, including a reduced libido and changes in your sexual function.

Although uncommon, amitriptyline can cause more serious adverse effects. These can include an irregular heartbeat, slowed speech, chest pain, skin rashes and fainting. If you notice any of these issues while using amitriptyline, contact your healthcare provider as soon as possible.

What is Amitriptyline Withdrawal?

Many antidepressants can cause unwanted effects -- referred to as antidepressant withdrawal symptoms -- when they’re stopped abruptly. 

Amitriptyline is no exception, and stopping amitriptyline without warning may cause you to deal with a range of mental and physical symptoms. 

Common symptoms that can occur after abrupt withdrawal of amitriptyline include:

  • Flu-like symptoms. It’s common to experience general flu or cold-like symptoms after stopping an antidepressant suddenly, including fatigue, lethargy, muscle pain, diarrhea and headaches.

  • Insomnia. Antidepressant withdrawal may also involve psychological symptoms, such as sleep issues. You may find it more difficult to fall asleep, or stay asleep consistently throughout the night.

  • Nausea. After stopping treatment with amitriptyline, you may feel nauseous throughout the day or after eating. Other gastrointestinal symptoms include abdominal cramps and pain, appetite disturbances, vomiting and diarrhea.

  • Imbalance. Some people going through antidepressant withdrawal experience balance issues, including ataxia (poor muscle control), dizziness, vertigo and a general feeling of lightheadedness.

  • Hyperarousal. You may feel more stimulated and/or anxious if you abruptly stop using amitriptyline or a similar antidepressant. Common hyperarousal symptoms include low moods, agitation and persistent feelings of anxiety.

Some antidepressants can also cause sensory disturbances, such as blurred vision, numbness and electric shock sensations after abrupt discontinuation. However, these symptoms are less common with tricyclic antidepressants such as amitriptyline.

Not everyone experiences uncomfortable symptoms after stopping treatment with amitriptyline or a similar antidepressant. According to research published in American Family Physician, 20 percent of people who abruptly stop antidepressants develop withdrawal symptoms.

Most of the time, the symptoms of antidepressant discontinuation syndrome occur within three days of stopping treatment. It’s normal for symptoms to gradually improve over the course of one to two weeks. 

There’s limited research, but some evidence shows that tricyclic antidepressants have a higher risk of causing antidepressant discontinuation than other antidepressants if they aren’t stopped correctly.

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How to Avoid Withdrawal Symptoms From Amitriptyline

If you’re prescribed amitriptyline and want to stop taking it due to side effects, it’s important to talk to your healthcare provider before making any sudden changes to the way you take your medication. 

Antidepressant discontinuation symptoms occur when you stop using amitriptyline or another type of medication for depression abruptly.

To reduce your risk of experiencing antidepressant withdrawal symptoms, your mental health provider may recommend one of the following approaches:

  • Adjusting your dosage of amitriptyline. If you have side effects from amitriptyline, it may be better to reduce your dosage than to stop taking your medication. Your mental health provider may recommend gradually adjusting your dose over a week or two.

  • Gradually tapering your dosage. If it’s okay for you to stop taking amitriptyline, your healthcare provider may suggest gradually reducing your dosage to lower your risk of developing abrupt withdrawal symptoms.
    You may need to continue using your medication for six to eight weeks at a gradually lowered dosage to completely avoid any withdrawal side effects.

  • Switching to a different antidepressant. In some cases, your healthcare provider may suggest switching from amitriptyline to a different medication that will reduce the severity of your depression symptoms without the same risk of side effects.

If you develop any withdrawal effects after stopping treatment with amitriptyline, it’s important to understand that they won’t continue forever. 

Most clinical effects from amitriptyline withdrawal gradually fade away over the course of one to two weeks as your body adjusts to the effects of the reduced dosage of your medication.

If you have severe or intolerable side effects, your healthcare provider may suggest using your medication again at a lower dosage or continuing treatment with amitriptyline at the same dose as before.

They may also suggest over-the-counter treatments and healthy daily habits that you can use to reduce the severity of withdrawal symptoms as they occur. 

Alternatives to Amitriptyline for Depression

Although amitriptyline is generally effective for the treatment of depression, it’s far from the only option that’s available if you’re depressed.

These days, newer antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are more commonly used as first-line medications for depression and anxiety due to their lower risk of causing side effects. 

If you have side effects from amitriptyline and think you may benefit from switching to a different type of antidepressant, you may want to consider talking to your healthcare provider.

We offer several SSRis online, including fluoxetine (the active ingredient in Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®) and escitalopram (Lexapro®).

These medications are available via our online psychiatry service, following an evaluation with a licensed psychiatry provider who will determine if a prescription is appropriate. 

We also offer several serotonin-norepinephrine reuptake inhibitors (SNRIs), including duloxetine (Cymbalta®) and venlafaxine (Effexor®), as well as atypical antidepressants, such as bupropion (Wellbutrin®)

Like amitriptyline, these medications can cause withdrawal symptoms. However, as they’re less likely to cause side effects during treatment, you may find them easier to use over the long term if you have clinical depression or an anxiety disorder. 

You can find out more about your options for treating depression and anxiety using our full list of antidepressants, which covers everything from early depression medications to new options that are less likely to cause adverse effects and interactions. 

You can also access a range of other evidence-based treatments for depression with our online mental health services, including online therapy and anonymous support groups

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Understanding Amitriptyline Withdrawal Symptoms

Like other antidepressants, amitriptyline can produce withdrawal symptoms if you stop taking it abruptly. 

Suddenly stopping treatment could also cause your depression symptoms to return or become more intense -- a potentially serious problem if you had severe symptoms of depression before using medication.

If you use amitriptyline and want to stop taking it, make sure to talk to your healthcare provider before you make any changes to the way you use your medication.

They’ll be able to assess your needs and let you know about your options, including adjusting your dosage or switching to a different type of antidepressant. 

Interested in learning more about dealing with depression? Our complete guide to dealing with depression goes into more detail about your treatment options, while our mental health content and resources share actionable strategies that you can use to cope with your symptoms.

6 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. Thour, A. & Marwaha, R., (2022, May 15). Amitriptyline. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537225/
  2. Barbui, C. & Hotopf, M. (2018). Amitriptyline v. the rest: still the leading antidepressant after 40 years of randomised controlled trials. The British Journal of Psychiatry. 178 (2), 129-144. Retrieved from https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/amitriptyline-v-the-rest-still-the-leading-antidepressant-after-40-years-of-randomised-controlled-trials/149B8AB17D99C548445A9E40986FADF3
  3. Amitriptyline. (2017, July 15). Retrieved from https://medlineplus.gov/druginfo/meds/a682388.html
  4. Warner, C.H., Bobo, W., Warner, C., Reid, S. & Rachal, J. (2006). Antidepressant Discontinuation Syndrome. American Family Physician. 74 (3), 449-456. Retrieved from https://www.aafp.org/pubs/afp/issues/2006/0801/p449.html
  5. Zwiebel, S.J. & Viguera, A.C. (2022, January). Discontinuing antidepressants: Pearls and pitfalls. Cleveland Clinic Journal of Medicine. 89 (1), 18-26. Retrieved from https://www.ccjm.org/content/89/1/18
  6. Chu, A. & Wadhwa, R. (2022, May 8). Selective Serotonin Reuptake Inhibitors. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554406/

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

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