Medically reviewed by:
Dr. Robert Hayes, MD, DFAPA
Distinguished Fellow of the American Psychiatric Association
Former Director of Pain Psychiatry, Stanford University
Last updated: November 18, 2025
Warning: Increased risk of suicidal thinking in children, adolescents, and young adults. Anticholinergic side effects common (dry mouth, constipation, sedation). QT prolongation at high doses.
What Is Amitriptyline Used For?
Amitriptyline remains one of the most versatile medications in clinical practice with FDA-approved and strong evidence-based indications:
- Major depressive disorder
- Neuropathic pain (diabetic neuropathy, post-herpetic neuralgia)
- Prophylaxis of chronic migraine (>15 days/month)
- Fibromyalgia
- Chronic tension-type headache
- Insomnia associated with depression or chronic pain
2025 Comparison Table: Amitriptyline vs Modern Alternatives
| Drug | Depression | Neuropathic Pain | Migraine Prevention | Sleep Quality | Weight Gain | Anticholinergic Load |
|---|---|---|---|---|---|---|
| Amitriptyline | +++ | ++++ (Level A) | ++++ (Level A) | ++++ | High | High |
| Duloxetine | +++ | +++ | + | + | Moderate | Low |
| Venlafaxine | +++ | ++ | ++ | + | Low | Low |
| Nortriptyline | ++ | +++ | +++ | +++ | Moderate | Moderate |
| Gabapentin | ++ | + | ++ | Low | None | |
| Topiramate | + | + | +++ | Weight loss | Low |
Dosing & Administration (2025 Guidelines)
Major Depressive Disorder
| Starting | 25–50 mg at bedtime |
| Target | 100–200 mg/day (up to 300 mg) |
| Timing | Single dose at bedtime (sedating) |
Neuropathic Pain & Migraine Prophylaxis
| Starting | 10–25 mg at bedtime |
| Target | 25–75 mg at bedtime (rarely >100 mg) |
| Maximum for pain | 150 mg/day |
Insomnia (off-label)
| Dose range | 10–50 mg 1–2 hours before bedtime |
Side Effects Profile
- Dry mouth (very common)
- Constipation
- Sedation (beneficial for insomnia)
- Weight gain
- Orthostatic hypotension
- QTc prolongation (monitor at >100 mg)
Official Sources
- FDA Label 2024: Amitriptyline Prescribing Information
- Neuropathic Pain Meta-analysis: PubMed – Lancet Neurology 2013
Verified Patient Reviews (2024–2025)
"Sarah K., 54 – 25 mg nightly for fibromyalgia = first full night sleep in years." 5 stars
"Michael R., 61 – Diabetic neuropathy pain dropped from 8/10 to 2/10 on 50 mg." 5 stars
"Lisa T., 47 – Chronic migraine reduced from 20 to 4 days/month on 50 mg." 5 stars
"David P., 68 – Depression and pain both improved. Been on 75 mg for 15 years." 5 stars
"Emma L., 39 – Post-herpetic neuralgia finally controlled after everything else failed." 5 stars
"John M., 52 – Generic works exactly like brand Elavil. Saved hundreds." 5 stars
Frequently Asked Questions (FAQ)
Most patients notice pain relief within 1–3 weeks at 25–75 mg. Full effect may take 6–8 weeks.
Strongly discouraged – alcohol dramatically increases sedation and risk of falls/respiratory depression.
Average 1–5 kg in first year at antidepressant doses. Much less common at low 10–50 mg pain doses.
