Amitriptyline Poll - Does it work for you?

[CFS_for_19_years]

Have you tried Alimemazine? It is the first thing that's usually tried here. Not that effective, but no obvious potential for harming ME/CFS patients. First do no harm.

There are only a few rare mentions of Alimemazine here on PR. There are many other sleep aids that have been discussed over and over, with way more mention than Alimemazine. If you do a search on PR for sleep you'll come across dozens more.

But, in my opinion, prescribing amitriptyline without first trying alimemazine and doxylamine is just plain wrong. Doctors should always try the "milder" medications first, even though they may have less potential for working. This applies in all circumstances. First do no harm.

Some people do well on Benadryl (diphenhydramine), an OTC antihistamine. My doctor did not want me to take doxylamine on a regular basis, although I don't recall his reasoning. FWIW, doxylamine worked well just ONE time for sleep, and never helped at all ever again.

 

[CFS_for_19_years]

I find the supplement pyrroloquinoline quinone (PQQ) 20 mg before bed effective for deepening sleep, and making sleep more restful, but I find for me PQQ does make my dreams very slightly more vivid / disturbed.

This study found that PQQ helped fatigue, tension-anxiety, depression, anger-hostility and confusion, appetite, sleep, obsession and pain, with the full effect appearing after 8 weeks supplementing daily with 20 mg of PQQ.

PQQ is one of my favorite energizers. As such, I've mentioned it several times over the years or PR. Be warned that it makes some people feel jittery and wired, and that's been mentioned here. I never thought it helped with sleep, but that could work if you're similar to the subjects used in the study Hip mentioned. If you're going to try it, I recommend buying Source Naturals PQQMind 20mg tablets because you can cut them into 5 or 10mg portions. Start with 5mg/day, taken before noon. It can cause insomnia; I'm surprised it helps with sleep, but everyone is different.

Subjects for the PQQ sleep study Hip mentioned were adults who were working full-time and had a diagnosed sleep disorder or complaint and fatigue.

 

[flybro]

I have 10 and 25mg, i can ramp up to 100 in emergencies, but I will always try to ween back down and off.
They're great for me short term, but my tolerance builds up, hence rarely taking it for more than a week.

 

[Living Dead]

There are only a few rare mentions of Alimemazine here on PR.

Here as in "where I live".

 

[brenda]

I was prescribed 50 mgs due to PND and ended up with a damaged bladder, still, 34 years later. I had a terrible time coming off it too.

 

[mattie]

Thanks for all the replies.
I am on Amitriptyline for about a month now.
Let me share my experience so far. Maybe helpful if you are considering to try something new for sleep.

Day 1: Started very low: 2,5 mg (quarter of a tablet) - Did nothing, little bit dry mouth.
Day 2: Increased to 5 mg second day. Still no reaction.
Day 3: 7.5 mg. Nothing yet. Bit more of a dry mouth, no other side effects.
Day 4: 10 mg. Now the effects can be felt! More dry mouth. Less awakenings in the night. More deep sleep.
Next morning: quite a bit of a hangover. Groggyness lasts untill about 2 p.m. Not so nice. But I was warned that the first few weeks could be like this. It's not unbearable and sleep seems to improve.

Stayed on 10 mg for the first two weeks. At the end of the first two weeks the morning hangover almost completely disappeared. Sleep improvement is moderate.

Week 3 and 4:
Neurologist advised to up the dose to 20 mg. So I did.
Sleep has improved further. Less time to fall asleep, less awakenings. Falling back to sleep faster after awakenings. So far so good. This is promising. Daytime functioning has improved a bit.
Side effects are bearable. Dry mouth still. Little bit of a hangover first 2 hours in the morning.
POTS / OI not worsened so far.

Will update this thread to monitor effects over longer period.

 

[flybro]

Amitriptyline 25mg tabs seem to aggravate my bladder, but am fine on 10mg tabs which are blue! The 25's are yellow and i'm pretty sure it's the colouring that's caused the bladder prob.

Still testing, but it does feel that the 25s were better for sleep, pain even a little more energy i think, but the bladder issue was too much.

I'm taking 2x10's now and will poss switch back to 25s later to test the bladder symptom again.

 

[Snow Leopard]

Side effects of this were terrible for me. Made my POTS worse, morning drowsiness etc. (well, it improved dramatically after stopping)...

 

[flybro]

Side effects of this were terrible for me. Made my POTS worse, morning drowsiness etc. (well, it improved dramatically after stopping)...

i found this initially too, and originally i only took 1x10 occasionally, and that would be a good sleep, but very sluggish/oi next day. It seems to have evened out now i've been taking them consecutively now.

 

[Mary]

@mattie - I hate, hate, hated amitriptyline (aka "elavail"). It made me numb and depressed and for the only time in my life I thought of suicide if I had to stay on it because I felt so awful on it, and I only took it for 2 days. But it sure knocked me out!

I've recently been doing a benzo taper (from 1 mg. of lorazepam in the middle of the night for sleep, have gotten down to 0.5 mg now) and have had severe insomnia due to the taper, which I think I'm finally getting a handle on, using mostly supplements with a little trazodone.

Initially I took 25 mg. trazodone, it helped knock me out, but left me woozy and very tired the entire next day such that I was unable to do anything. I've since weaned down to 6.25 mg (last night) and managed to get 8 hours.

Here's what's really helping me with sleep without horrendous side effects:

8:15 p.m.: 150 mg. 5-htp
100 mg. l-theanine
2000 mg. glycine
500 mg. niacinamide (stimulates GABA receptors)
500 mg. niacin (stimulates GABA receptors)
one choline/inositol capsule (250 mg. each)

9:15 p.m. 500 mg. niacinamide
200 mg. l-theanine
1 Theanine Serene by Source Naturals
500 mg. inositol (see http://nootriment.com/inositol-effects/)
6.25 mg. trazodone (will stop this altogether in the next day or two)
3 mg. sublingual melatonin (Natrol)

Generally I'm asleep by around 10:00, then have been sleeping till 1:30 or 2:00, when I take:

500 mg. niacinamide
500 mg. inositol
500 mg. niacin
200 mg l-theanine
one Theanine Serene
2000 mg glycine
3 mg melatonin
0.5 mg. lorazepam (which am planning to taper off the next several months)

I know, it may seem ridiculous, but it's working. Prior to the taper, I was doing okay without the niacinamide and without the extra inositol. I'm really happy with this combination however, don't feel nearly as bad as I did with more trazodone.

I've also found that low blood sugar was contributing to middle of the night insomnia, so have been having a potato with dinner and last night ate a cracker in the middle of the night, which helped.

About 12 years ago I had high cortisol in the middle of the night which caused severe insomnia, and was given Seriphos (formerly made with phosphorylated serine), it worked great. Unfortunately they have changed the formulation and it no longer works like it once did. Anyways, you should get your cortisol levels checked - there is a saliva test which uses 4 samples taken during the day/evening which is best (Adrenal stress index test). There are other things you can take to normalize your cortisol levels if they are high.

 

[Mary]

I have not yet found an antidepressant that works for my comorbid depression.

@Hip - You've written several times about anhedonia. Amitriptyline made me numb and depressed so I'm wondering if it may be doing that to you too, even though you're only taking a small amount.

I've recently had severe sleep problems due to a lorazepam taper and I seem to be coming out of it, using the supplements I describe in my post above. When figuring out what to take, I read about inositol, and it is supposed to be helpful with depression, as well as sleep. It has helped me so much with sleep (together with everything else!)

Also, have you ever tried 5-htp? No side effects - it did give me a moderate headache for a week when I first started it but was helping with sleep so much, I stuck it out and never got the headache again.

 

[Hip]

@Hip - You've written several times about anhedonia. Amitriptyline made me numb and depressed so I'm wondering if it may be doing that to you too, even though you're only taking a small amount.

In my case, I would say that amitriptyline is mildly helpful for the anhedonia, and helps depression. I rarely take it though, only when depression hits strong, and even then, I tend to use a very small dose, an ⅛ of a 10 mg tablet. Larger doses I find create an odd, unbalanced feeling in my mind (like half my mind feels happy, the other half still depressed).

When figuring out what to take, I read about inositol, and it is supposed to be helpful with depression

I do use high dose (12 grams) inositol sometimes, but its antidepressant effect is not a good as it used to be, for some reason.

have you ever tried 5-htp?

I have been experimenting with this. 5-HTP sometimes seems to boost my spiritual disposition, which is good, though it does not seem to help my depression that much.

ME/CFS seemed to wipe out all of my spiritual energies, so I am always looking for something that might rekindle my spiritual outlook. Some of the serotonin receptors are strongly linked to the spiritual state (its these receptors that psychedelics like LSD work on — but I am not really looking at taking psychedelic drugs; ideally I'd like to find the underlying cause of why my spiritual state was shut down, and then try to address this underlying cause).

 

[Mary]

Hi @Hip - just one more thing - have you ever tried meditation? I can only do it when I feel well enough (e.g., not when I'm sick or crashed or detoxing, etc.) I don't know if I have a spiritual life or not, but meditation gives me the closest thing to it. It took me a couple of weeks of faithfully doing it every day before my mind began to quiet a little, but I really like it now.

 

[hixxy]

I'm considering trying doxepin which is similar to amitriptyline. I'm not feeling very confident of tolerating it well but at least I'll be able to cross it off the list.

 

[Aurator]

In my case, I would say that amitriptyline is mildly helpful for the anhedonia, and helps depression. I rarely take it though, only when depression hits strong, and even then, I tend to use a very small dose, an ⅛ of a 10 mg tablet.

That's a sixtieth of the daily starter dose (75mg) for adults with depression (the regular dose typically exceeds this) and yet you say you take this dose when "depression hits strong". What would you regard as a "larger dose"?

 

[Hip]

Hi @Hip - just one more thing - have you ever tried meditation?

Before ME/CFS, I used to do a lot of meditation, mainly Buddhist-type the mindfulness meditation, and could easily meditate for a couple of hours, getting totally into it. Now, I just can't get into that zone anymore.

If my mind becomes overexcited due to too much stimulation (a common problem in ME/CFS), I can mentally calm myself, by meditative techniques like emptying yourself of thoughts and focusing on the breath, and this does slowly work, and it helps calm the mental over-arousal, and relaxes the mind a bit; but it does not seem to put me into a spiritual state. So I become relaxed, yes, but not spiritual. I can't seem to tap into the spiritual state that I once was able to attain very easily. I think it may have something to do with serotonergic dysfunction.

That's a sixtieth of the daily starter dose (75mg) for adults with depression (the regular dose typically exceeds this) and yet you say you take this dose when "depression hits strong". What would you regard as a "larger dose"?

ME/CFS patients are often more sensitive to antidepressants, and so may only require a small dose. I used to take 10 mg of amitriptyline, but find it causes an "unbalanced" mood boost, as I described above, which feels unnatural. That's why I use just a very dose, to avoid this unnatural feeling.

But when depression hits, I tend to take a cocktail of supplements and drugs that I know boost my mood, and this ⅛ of 10 mg of amitriptyline is part of that cocktail. My cocktail does not eliminate the depression, but does reduce it.

 

[CFS_for_19_years]

I'm considering trying doxepin which is similar to amitriptyline. I'm not feeling very confident of tolerating it well but at least I'll be able to cross it off the list.

I've been taking doxepin regularly for years at the dose of 20-25mg/day. I tolerate it much better than amitriptyline. It doesn't give me the hangover the next day.

Doxepin is available as a liquid so you can fine-tune your dose easily. The liquid form of doxepin was even cheaper than the doxepin capsules.

 

[RoyJones]

I started taking 10mg of amitryptyline about four months ago for insomnia and for the first six weeks it was great, I slept really well and my baseline improved and managed to start getting out of the house occasionally and then all of a sudden it starting putting me into a waking coma so stopped it immediately.

I've spent the last four months barely able to read or find the energy to make a phone call and I'm having to lie down all day with zero libido and I'm still getting worse, I'm moving around very slowly and feel like a zombie, it must be trapped in my system. In the last week I've been hit with very severe depression with a feeling of impending doom without anxiety, which isn't like me at all. I wasn't even depressed before I started taking it, it was just for insomnia. I can just about live with the physical problems from it but the way I feel in my mind is scary. Not sure how this is going to end. I wouldn't wish this on anyone. Also if anyone has any advice on how to get through this it would be much appreciated. Thanks, Roy.

 

[hixxy]

Hope you didn't stop it immediately and weaned off? Side effects should be pretty serious for you to not wean from an anti-depressant properly.

 

[RoyJones]

Had to stop it immediately, it started putting me in a coma and made me feel poisoned like a hundred times worse than a bad hangover which didn't subside on discontinuation. Think it's only just coming out of my system now as I'm only having withdrawal symptoms now plus I'm not sleeping quite as much. My naturopath says I have blocked detox pathways after I had a ONE test done and she thinks it's been stuck inside me too. She prescribed my some supplements which I'm taking. Just going to have to soldier it out. My psychological symptoms are not quite as bad in the last couple of days so hopefully might start improving from here.