Alternative Low Dose Anti-Depressants to Amitriptyline

138/365 amitriptyline 30mg

I currently take low dose of Amitriptyline (30mg) for pain and migraine relief.  I’ve been looking at alternative low dose anti-depressants for use in ME/CFS to help with pain and if possible aid sleep also.

I apologise for lack of links to evidence for my findings. I compiled this document for personal use as I researched but it struck me it may be useful for other people, particulalry with ME/CFS, to see the list too. Where I found a tricyclic was not sedating or had a bad reputation heart wise I didn’t research it any further.

If I were to switch tricyclic I’d like to try Doxepin or Trimipramine. Doxepin is supposed to be effective for IBS. eczema, chronic pain and to aid sleep – all useful for me. Trimipramine is good for chronic pain and very effective at sedating without disrupting REM sleep.

Amitriptyline works well for me but I do have a fast heart rate. My GP does not think this is due to the amitriptyline as it’s such a low dose but I’ve heard from other ME/CFS people that even a 10mg dose can effect heart rate.

TRICYCLICS

Tricyclics like amitriptyline are sedating and good for pain. But side effects can include heart problems, although many doctors say this is not so on low doses but some patients (particularly ME/CFS patients sensitive to medications) say it does.

Tricyclics can interact with morphine, tramadol and antibiotics.

Amitriptyline is cheap and very commonly prescribed. Alternative tricyclics include:

  • Doxepin (Sinequan, Aponal, Adapine, Deptran, Sinquan)  Sedating so useful as an aid to sleep. Can be useful for IBS (lessen gut activity and secretions). Used for insomnia as Silenor. Good for chronic pain & tension headaches. Used for eczema. Helps with itching.  Used in fibromyalgia. The typical dose is 10-50mg daily.
  • Trimipramine (Surmontil, Rhotrimine, Stangyl) is the most sedating tricyclic. More effective sedation as aid for sleep than amitriptyline and it doesn’t suppress REM. Good for chronic pain. Typical dose is 5-75mg daily.
  • Duloxetine (Cymbalta, Ariclaim, Xeristar, Yentreve) sedating. Has been studied in use for ME/CFS and a study for FMS at 60mg study showed good results. Duloxetine is thought to enhance the nerve signals within the central nervous system that naturally inhibit pain (in diabetes feet, leg and hand pain). Might cause high blood pressure and OI problems. Can cause sexual dysfunction which can persist after treatment has stopped for months or years. 
  • Trazodone (Desyrel, Molipaxin, Trittico, Thombran, and Trialodine) (SARI) Is sedating so good to aid sleep. Typcially has less side effects than other tricyclics. Effective for sleep but less effective for pain. Sometimes taken in conjuction with sedating tricyclic like Nortriptyline.
  • Dothiepin (previously known as Prothiaden, Dosulepin) Sedating so could aid sleep but danger of long term toxicity to the heart
  • Imipramine (Sormontil, Antideprin, Deprimin, Deprinol, Depsonil, Dynaprin, Eupramin, Imipramil, Irmin, Janimine, Melipramin, Surplix, Tofranil) Is not sedating.
  • Nortriptyline (Pamelor, Allegron) Is not sedating but good for pain so can be effective combined with another sedating tricyclic.
  • Protriptyline (Vivactil) Is not sedating.
  • Clomipramine (Anafranil) Is not sedating. Can’t be combined with SSRI.
  • Despipramine (Norpramin, Pertofane) Not for patients with a family history of dysrhythmias.

New tricyclics which generally have less side effects but are more expensive:

  • Gamanil, Lomont (lofepramine) Is not sedating
  • Motipress (Nortriptyline + Phenothiazine)
  • Motival (nortriptyline + fluphenazine)
  • Triptafen (amitriptyline + phenothiazine)  Only tends to be prescribed short term.

SSRI’s

SSRI’s like Prozac are  not as effective for pain but do energise.  But this can be problematic with ME/CFS possibly due to abnormalities involving serotonin transmission. Dr Cheney urges against the use of SSRI’s and other stimulant medication as it effectively fries the brain and “taken over a period of 10 years or so, can lead to a loss of brain cells, causing neurodegenerative disorders” . But another study showed SSRI’s are effective in improving numbers of natural killer cells.

Sertraline (Zoloft) in some studies show major improvement in ME/CFS. Prozac, Zoloft and Paxil (paroxetine) have been shown in controlled, blinded studies to improve autonomic function.

Prozac, Zoloft and Paxil are most likely to suppress libido.

OTHER LOW DOSE ANTIDEPRESSANTS

Venlafaxine affects serotonin and noradradrenaline levels. It activates energy levels but may interfere with deep sleep. May be effective in increasing pain levels. May possibly reverse immunological disturbances involving natural killer cell activity but other studies have shown it has little benefit for ME/CFS.

Wellbutrin increases dopamine. It can be taken alone or with another antidepressant.

MAOIs raises levels of noradrenaline, dopamine and serotonin but need major dietary restrictions that can otherwise produce a potentially fatal reaction.

USEFUL LINKS

Sleep in CFS – Dr David Bell

Using Antidepressants to Treat Chronic Fatigue Syndrome – Dr Charles Lapp

Treating CFS Sleep Dysfunction – Sue Jackson

Trazodone in Chronic Fatigue Syndrome (ME/CFS) Treatment

Doxepin helps itching, why;?

Amitrityline – Mingraines (useful info about side effects even at low doses)

Amitriptyline – Netdoctor

SSRI and Stimulants: Frying the Brain – compiled from notes between Carol Sieverling & Dr Cheney 2000

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4 Responses to “Alternative Low Dose Anti-Depressants to Amitriptyline”


  1. 1 Cusp June 2, 2011 at 4:23 pm

    Well as you know I was on Sertraline (Lustral/Zoloft) for 7 years and weaned myself off about 3 or 4 years ago. I have to say that initially it was quite helpful. When I started taking it my sleep pattern was completely turned round, my sleep quality was appalling and my IBS was abyssmal, panic attacks were constant and off the scale BUT once it had all quietened down…after about 3 months the effets of the Lustral really kicked in. For me they were very subtle and some of them only really became apparent once I had stopped taking it. I never felt sedated but I felt ‘calm’…and not in a good way. Looking back I lost all sense of purpose and drive. I seemed focused but I wasnt. Coming off wasnt that hard (mega slowly…4 times slower than recommended by GP)apart from last few weeks when I was very, very crabby but then I suddenly realised that all my senses were becoming more acute again. Later I found/felt I had lost the ability to cope with every day ups & downs on my own ….in the sense that the paniccs returned and it was a real struggle to cope without going back on the drugs…but I did.

    My GP says that Sertraline is ‘all there is for M.E. !!!! I disagree and would rather put up with some of the other discomforts that ever go back o taking them

    • 2 rachelcreative June 4, 2011 at 5:00 pm

      That’s really interesting thanks Cusp. Was that a low dose or full on anti-depressant dose I wonder? I used SSRi’s (Prozac for me) in the past with depression though it didn’t do much with my last (biggie) bout of depression but since reading Dr Cheney’s theories about SSRI’s it does make me a little cautious. Certainly long term. I also had a month on amitriptyline full on depression dose back in uni and it was awful. Low dose is such a differewnt experience for me. My depression drug of choice which really helped was Venlaflaxine – horrible to withdraw from but benefitted me greatly in that last big bad depression which ended 2001. Interesting to know if Cheney and others suspect the ‘bad’ anti-depressants are still bad in low doses.

      I agree there are lots of options but “lack of evidence” holds so much back GP and NHS wise. I certainly can’t agree with your doc saying it’s all there is.

      • 3 cusp June 4, 2011 at 5:58 pm

        Only just seen your reply. It was a low dose..lowest you can get…think it was 25mg. Wasnt for depression –even my useless GP has recognised I’m not depressed !!…but more for the beneficial effects on IBS and sleep disturbance

  2. 4 Hoping for Better Days February 24, 2012 at 7:18 pm

    Did you manage to find an alternative to amitripyline ? Having worked wonders for me for the past 8 months amitripyline is no longer working for me ..I have raised the dose to 60mg and am unable to tolerate more due to side effects but unfortunitly it seems to have lost its effectiveness..I need to look into alternatives or a combination treatment for my migraines and neuropathy and wonder if you managed to find an alternative that worked for you?


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