a confused or forgetful older senior woman

It is estimated that nearly two million people take the antidepressant amitriptyline every day. We suspect that most are not taking this drug to improve mood. That’s because amitriptyline (Elavil) has been around for decades. It is perceived as an old-fashioned antidepressant with lots of side effects. They include constipation, dry mouth, drowsiness, dizziness, blurred vision, urinary retention, confusion and forgetfulness. Many are symptoms of powerful anticholinergic drug activity. More about that at this link. These days, the antidepressant amitriptyline is probably prescribed more for off-label purposes than for depression.

Will Antidepressant Amitriptyline Short-Circuit Memory?

This reader is concerned about long-term reliance on the antidepressant amitriptyline, even if used for an off-label purpose:

Q. I have been taking amitriptyline before bed for at least 20 years. I have fibromyalgia and it helps me sleep.

I’ve tried to get off it twice, but the insomnia was unbearable. Most doctors don’t seem to know how to help lessen the symptoms resulting from discontinuing this drug. Cutting the dosage in half did no good at all.

My short-term memory is awful. I think it’s the drug, and I’ve lost my self-confidence. What can I do to lessen symptoms of withdrawal? Is there a safe substitute for amitriptyline? I would so appreciate any help I can get.

A. Amitriptyline (Elavil) was first marketed in the United States in 1961. The FDA has approved this drug only for treating symptoms of depression. Nevertheless, many health professionals prescribe it off label to treat insomnia, nerve pain, migraines, interstitial cystitis, PTSD, anxiety and fibromyalgia. Nearly 10 million prescriptions are dispensed annually.

Amitriptyline is a strong anticholinergic medication. That means it interferes with a crucial brain chemical called acetylcholine. A new study of more than 300,000 people found that those who take anticholinergic drugs like the antidepressant amitriptyline are more likely to develop dementia (BMJ, April 25, 2018).

We have listed many anticholinergic drugs that are generally inappropriate for seniors in our Guide to Drugs and Older People.

An editorial in the BMJ (April 25, 2018) notes:

“As suggested by guidelines, anticholinergics in general should be avoided in older adults.”

These experts are advising their medical colleagues to try and avoid anticholinergic drugs like the antidepressant amitriptyline unless it is absolutely essential.

Do NOT Stop Amitriptyline Suddenly!

Stopping amitriptyline or other antidepressants can trigger withdrawal symptoms (European Journal of Pharmacology, June 15, 2018). This has not been well researched, but we believe this is an under appreciated complication of the antidepressant amitriptyline. You may need many weeks or months of gradual dose reduction to taper off such medications.

A sleep specialist may be able to help you with nondrug sleep approaches such as progressive muscle relaxation and cognitive behavioral therapy for insomnia.

Reader Comments?

What has been your experience with amitriptyline or other anticholinergic medications.

One of our readers insists that:

“No one has found evidence that anticholinergic drugs cause dementia. I could do a study of dementia patients and show a link between aspirin, fiber cereal, denture paste or peanut butter. That doesn’t mean any of those things CAUSE dementia. Can anticholinergics cause drowsiness, short term memory loss, fuzzy brain when you take them? Absolutely. But alcohol, marijuana and sleep deprivation from chronic pain do too.”

Share your own thoughts in the comment section below.

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  1. Jim
    Williamsburg,VA
    Reply

    Like many of the other commenters here, I have been on amitriptyline for over 20 years, 50mg at night. Taking it for a groin pain that bothered me sleeping. It’s been a great help. I sleep soundly (thunderstorms don’t wake me up!). But now I worry about these results. I have had an issue with memory that is rather strange, and now maybe I can attribute it to this.

    I would think about a subject, then sort of tangent to another subject/issue based on the first. I would subsequently tangent to a third, then a fourth, etc. I’ve done this for years, especially when I am trying to get to sleep. And I could reverse the process, trying to retrace the steps to how I got to the current subject.

    Recently I noticed that I would go thru this thought process, but then I could not remember the most recent subject/issue! Completely lost the train that would get me back to the prior subject! And I could not reverse the process to get back to where this thought process started. I could remember some of the subjects, but not all!

    My neurologist says that this is not an issue, but I will be speaking to him in greater detail the next time I see him (in a few weeks). And send him this article and references.

  2. Dolly
    IA
    Reply

    It took me 5+ months to wean myself off of 50 mg amitriptyline. I started reducing 12.5 mg (1/4 of 50 mg tablet) every 3 weeks, which I soon realized was way too much of a decrease at one time. It made me very irritable and short-tempered. So I had my doctor write a prescription for 10 mg, and I lowered my dosage 2.5 mg (1/4 of 10 mg tablet) every 3 weeks. I still felt a little irritable the first few days, but then I leveled back to normal.

  3. Katherine K.
    FL
    Reply

    I take amitriptyline 20 mg at night for headaches of unknown origin. I am 77 and in good health but the warnings about these drugs scare me and also the fact that they are hard to get off them. My doctor says my dose is low so not problematic but i don”t know the normal dosage. What are the normal ranges?

    • Terry Graedon
      Reply

      According to the manufacturer, 75 mg per day in divided doses is the normal dose for depression. Older people should be given 20 mg or 30 mg. The prescribing information does not mention that amitriptyline is considered potentially inappropriate for older individuals because of its anticholinergic effects.

  4. Lora
    Seattle
    Reply

    I’m in the same spot as the person who wrote the question. I took 25 mg of Elavil for years at bedtime for sleep/fibromyalgia. It was an absolute miracle when I first began taking it back in the early 90’s. My fibromyalgia pain was 90% better for years. I could finally sleep.

    Gradually, the benefit reduced and memory problems began to plague me. I began reading about anticholenergic effects and decided to try to go off it. I quickly found out I’m effectively addicted, and attempting to go off gradually failed. I managed to drop to 12.5 mg but struggled with difficult symptoms: emotional instability, irritability, nausea, insomnia, headache, and just an overall feeling of high anxiety.

    I went through this for weeks, but have maintained the dose reduction. I’d like to drop further, but know I will face insomnia. Is there any better alternative that doesn’t have similar or worse side effects? We fibromyalgia sufferers are effectively between the Scylla and Charybdis.

  5. Janet
    York, UK
    Reply

    I went cold turkey on amitriptyline after about 20 years of use and had no problem except that I no longer had the benefits of taking it for my chronic headaches and insomnia.

  6. Judy
    FL
    Reply

    I was prescribed amitriptylîne for headaches at 73 yrs old, and I became dizzy, disoriented, and speech was affected. I immediately called neurologist and discontinued it. I would rather have the headaches than live in a world of confusion. Why do doctors prescribe these medicines that can do so much harm to an older person’s way of life?

  7. Christie
    Indianapolis, IN
    Reply

    I also take amytriptyline for sleep. I take 10 mg which my provider says is a child’s dose and she is surprised that it helps me. I am hoping that the low dose keeps me “under the radar” as related to dementia but I may be fooling myself. Is there an “average” adult dose?

  8. Mary
    Louisiana
    Reply

    I suffer from depression as did my mother. I’ve been on amitriptyline for 40 years. I started off at 150 mg once daily. After several years, I went down to 20 mg. Been at 20 mg daily for roughly 25 years. I’ve tried to taper off by taking 15 mg. I became very depressed after a few days so I went back to 20 mg. My GP told me I was on a very low dose so it was ok to take my normal dosage. My memory is not good, both short and long term but mostly short term. I wish I could get off but it is the only med that helps the depression. I tried SSRI but couldn’t tolerate them. Any suggestions?

  9. Donna
    TX
    Reply

    My husband swears amitriptyline started his Petit Mal seizures over four years ago. He was prescribed the drug for sleep as he has severe back pain. After four days, he began to have “sensations” so stopped taking the drug. Three years later, he began having convulsive seizures. None of his doctors seem to think these were a result of the drug, but they also didn’t believe the sensations were seizures. He recently underwent visual EEG testing over a five day period, and it was confirmed that those “sensations” are seizures. I don’t believe the drug caused the seizures, but wonder if it possibly could have altered the chemistry in his brain.

  10. Jimmy J.
    Cornwall UK
    Reply

    I took a 10mg dose of amitriptyline for about 15 yrs as a result of depression/insomnia. It worked, but I developed a throat-clearing problem that became unbearable. I stopped amitriptyline & it cleared up 85% within 10 days. My son had a similar reaction.

    I have suffered greatly with increased insomnia since stopping.
    I was always told that amitriptyline was a “safe” drug & that 10mg was given to babies. What rubbish! It is a serious medication that requires far more controls by the medical profession than are applied currently. It appears to be like Valium years ago, given for all sorts of ailments.

  11. Judith R.
    CA - California
    Reply

    Let’s remember that correlation is not causation. Let’s try to avoid post hoc reasoning.

    And as to off-label uses, I have a friend who has found nothing to help her sleep except amitryptiline.

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