Amitriptyline and Depressions

Living reference work entry


Amitriptyline was the second tricyclic antidepressant to be introduced into practice in the United States. In a network meta-analysis, amitriptyline is equivalent to selective serotonin reuptake inhibitors (SSRIs) and is superior to trazodone, fluoxetine, and reboxetine in efficacy. Dropouts for reasons of adverse effects were higher than for most antidepressants particularly in the outpatient setting. Therapeutic drug monitoring improves clinical utility since there are wide individual differences in serum drug levels per dose. Drug interactions are a result of competitive inhibition with the mixed function oxidases CYP2D6 and CYP2C19. Amitriptyline is effective in treating melancholic depression and psychotic depression if combined with an antipsychotic in the latter instance but increases the risk of mania in bipolar disorders. Amitriptyline adverse effects are largely related to antimuscarinic side effects. Overdoses are highly lethal due to arrhythmias.


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Authors and Affiliations

  1. 1.Department of Palliative CareGeisinger Medical CenterDanvilleUSA

Section editors and affiliations

  • Gerd Laux
    • 1
  • Hans-Jürgen Möller
    • 2
  1. 1.Inst für Psychologische MedizinHaagGermany
  2. 2.Department of PsychiatryLudwig-Maximilians-University MunichMunichGermany

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