Is Amitriptyline Addictive?

In the last couple of decades, addiction to prescription medication has grown from a minor story into a major one. Addictive medications ruin families, destroy lives, and often cause damage far beyond the benefits they deliver.

If you’ve seen any of those stories, it’s fair to question if certain medications are addictive before you start treatment. 

Amitriptyline is an antidepressant medication that’s used to treat major depressive disorder and a range of other conditions. It’s usually prescribed as antidepressant therapy when other drugs, such as SSRIs, aren’t fully effective at controlling the symptoms of depression.

Is amitriptyline addictive? There’s no research that suggests that amitriptyline is an addictive or habit-forming medication, or that it has significant potential for abuse. 

However, like with other common antidepressants, stopping treatment with amitriptyline abruptly can potentially cause withdrawal symptoms.

The good news is that these symptoms are generally easy to avoid by talking to your healthcare provider before stopping treatment and carefully following their instructions.

Below, we’ve explained what amitriptyline is, as well as how it and similar medications work for the treatment of depression.

We’ve also covered what you should know about using amitriptyline to treat depression safely, from the typical dosage to potential side effects and more.

Amitriptyline is a medication that’s used to treat depression. It’s part of a class of prescription drugs called tricyclic antidepressants, or TCAs.

Tricyclic antidepressants such as amitriptyline are generally effective at treating depression in most people. In fact, a systematic review published in the British Journal of Psychiatry in 2001 found that amitriptyline reduced depressive symptoms more than most other medications.

However, TCAs such as amitriptyline typically aren’t used as first-line treatments for depression today, as they have a higher risk of producing side effects than newer antidepressants, such as selective serotonin reuptake inhibitors (SSRIs).

Your mental health provider may prescribe amitriptyline if you’ve tried other antidepressants with poor results. They might also prescribe it off-label to treat other conditions, such as chronic pain, anxiety or insomnia.

Amitriptyline is available as an oral tablet. Your healthcare provider will likely prescribe a dosage of 25mg per day to start with, which is typically taken at bedtime. 

Your dose of amitriptyline may be adjusted to a maximum dose of 150 to 300mg per day based on your symptoms and response to this medication.

Our guide to amitriptyline for depression goes into more detail about using amitriptyline to treat and manage depressive symptoms. 

Tricyclic antidepressants like amitriptyline work by increasing the levels of certain chemicals in your brain and body, referred to as neurotransmitters.

More specifically, amitriptyline increases levels of serotonin and norepinephrine, which are both involved in regulating certain aspects of your moods, thoughts and behavior.

Serotonin is involved in regulating your mood, happiness and levels of anxiety. Although the link between serotonin and depression isn’t fully understood, low serotonin levels appear to have at least some involvement in depression, anxiety and other mood disorders.

Norepinephrine is an adrenal hormone that plays a key role in regulating your heart rate, blood pressure and blood sugar levels. It also manages your sleep-wake cycle, as well as your ability to focus on specific tasks.

Low levels of norepinephrine appear to make the symptoms of depression, anxiety and related mood disorders worse. 

Experts believe that amitriptyline’s effects on these neurotransmitters may reduce the severity of some depressive symptoms, letting you enjoy a higher quality of life and make progress towards recovery from depression.

Although amitriptyline is most commonly used to treat depression, it’s also a common off-label treatment for certain forms of pain, including diabetic neuropathy and fibromyalgia.

When you hear the words “pain medication,” it’s understandable to have worries about abuse, addiction and other negative impacts. 

Luckily, despite amitriptyline’s effects on pain, this medication isn’t addictive and doesn’t cause dependence over the long term.

However, like other prescription antidepressant drugs, amitriptyline can cause some symptoms if treatment is stopped abruptly. These are referred to as “antidepressant discontinuation,” and they typically occur if you suddenly stop taking amitriptyline without tapering your dosage.

When you stop taking a maximum dose of amitriptyline, your body doesn’t crave it the way you crave food when you’re hungry, water when you’re thirsty or chemically addictive drugs such as opioids after getting clean. 

Instead, you experience withdrawal -- a condition often used interchangeably with addiction, but technically not related.

About 20 percent of people who use antidepressants experience withdrawal symptoms after an abrupt cessation of treatment. The common side effects will typically begin appearing between two and four days from the day you last your medication, if they occur at all.

Common amitriptyline withdrawal symptoms include:

• Flu-like symptoms, such as fatigue, lethargy, diarrhea, muscle pain and headaches.

• Sleep issues, such as difficulty falling asleep and/or staying asleep during the night.

• Gastrointestinal problems, such as nausea, vomiting, abdominal pain or discomfort, appetite disturbances and changes in your body weight.

• Balance and coordination issues, such as dizziness, lightheadedness, difficulty with muscle control and vertigo.

• Hyperarousal issues, such as anxiety, poor mood, agitation and a feeling that you’re overly stimulated.

Usually, one to two weeks of symptoms is all you can expect, but in some cases, they may stick around for a year or longer. 

Discontinuation symptoms -- the physical and psychological symptoms that can occur when you abruptly stop using amitriptyline -- aren’t the same for everyone, meaning your experience might be more or less severe based on the dosage you’re prescribed and other factors. 

Here’s the easiest question we’ll answer here today: Should you stop taking amitriptyline? Even if you’re starting to develop adverse effects from amitriptyline, it’s important not to suddenly stop taking it. 

Because stopping amitriptyline abruptly can cause these symptoms, it’s important to talk with a healthcare professional before making any changes to the way you use this medication.

They’ll inform you about how to safely reduce your prescribed dose of amitriptyline to limit your risk of experiencing any unusual side effects.

For most people, stopping amitriptyline means slowly tapering your dosage to reduce your risk of adverse effects. Your healthcare provider may suggest gradually reducing your dosage step by step over the course of several weeks or months.

If you’re switching to a new antidepressant, they’ll also inform you about how to start using your new medication while limiting your risk of dangerous side effects or drug interactions.  

Our guide to amitriptyline withdrawal goes into more detail about the potential withdrawal issues you might experience after stopping amitriptyline, as well as how you can stop taking medication for depression safely. 

Although amitriptyline isn’t addictive, it does have some downsides as an antidepressant. As an older tricyclic antidepressant, it has a higher risk of causing certain side effects than SSRIs and other more modern antidepressants, including unwanted sedating effects.

As such, it’s normal to consider alternatives if you’re currently taking amitriptyline or have been recommended this medication by your healthcare provider.

Currently, the most common first-line medicines for depression are SSRIs. These medications are more selective within your body than amitriptyline, giving them a lower risk of causing some negative effects during treatment.

Switching to an SSRI may be an option worth considering if you get sedative effects while using amitriptyline, such as drowsiness and/or reduced coordination. 

We offer several SSRIs online via our online psychiatry service, including fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®) and escitalopram (Lexapro®).

We also offer several serotonin-norepinephrine reuptake inhibitors (SNRIs), including duloxetine (Cymbalta®) and venlafaxine (Effexor®), as well as atypical antidepressants, such as bupropion (Wellbutrin®). These medications may be more likely to cause side effects than amitriptyline. 

In addition to antidepressants like amitriptyline, depression also often improves with talk therapy, or psychotherapy. 

Numerous forms of therapy are commonly used to treat depression and other behavioral health conditions, including cognitive behavioral therapy (CBT).

We offer therapy online, allowing you to connect with a licensed therapy provider and take part in individual treatment from your home, all without having to drive to and from appointments. 

Psychiatric conditions, drug interactions, addiction and risk of overdose are all understandable concerns when you start using a new medication. It’s important to understand this stuff, too, as many medications do have the potential to be habit forming.

Luckily, although amitriptyline is used to treat neuropathic pain and other forms of nerve pain, it isn’t an addictive drug like opioid pain medications. 

This means that you don’t need to feel worried about becoming dependent on amitriptyline if it’s prescribed to you for depression, pain or a related medical condition. 

If you’re nervous to go on this medication, make sure to bring up your concerns to a healthcare professional. They’ll be able to inform you about how amitriptyline works, as well as what you’ll need to know before taking it.

In some cases, they may suggest an alternative medication that’s a better fit for your symptoms and needs.

Interested in learning more about improving your mental health? You can access our full range of mental health services online to speak to an expert about depression, anxiety and any other mental health concerns you have.

You can also find out more about your options for dealing with common mental health concerns using our free online mental health resources.