Amitriptyline, also known as Elavil®, is a medication first introduced in the 1960s, which is part of a class of medications called tricyclic antidepressants (TCAs). It has a number of common uses, but it should be noted that the only use for which the US Food and Drug Administration (FDA) approves it is to treat depression. It has not been investigated by the FDA for the many off-label uses the drug presently has, but the off-label uses have often been shown to be efficacious. These unofficial uses of amitriptyline include treatment for insomnia, chronic pain conditions, migraine prevention, posttraumatic stress syndrome, post-herpetic neuralgia, irritable bowel syndrome, anxiety disorders, attention deficit and hyperactivity disorder (ADHD), and eating disorders like bulimia.
Probably the most clinically approved uses of amitriptyline are for psychiatric conditions. There is significant literature associating depression with anxiety disorders and a number of antidepressants are useful in treating conditions like panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and obsessive-compulsive disorder. It’s theorized that the mechanisms that regulate mood also regulate stress response, and it thus makes sense to consider a medication like amitriptyline because it prevents both serotonin and norepinephrine reuptake.
Each antidepressant works differently though, and the most common uses of amitriptyline in mental disorders involve its prescription for depression, generalized anxiety disorder, and posttraumatic stress. It has also been used to treat bulimia and there are some reports on its effectiveness in this respect. A number of antidepressants are now considered alternate treatment for ADHD, and amitriptyline falls into this class, though it is not recommended for children under the age of 12.
In addition to having a beneficial effect on mood for some patients, amitriptyline also appears to improve response to pain in some chronic pain conditions. People who have post-herpetic neuralgia, which is lingering and pronounced pain caused by shingles, may respond well to amitriptyline. Other times, it’s been prescribed for chronic pain issues like those associated with multiple sclerosis (MS), or to reduce movement disorders that MS can cause. Conditions like fibromyalgia may respond to the drug, too. Some patients use amitriptyline on a regular basis to prevent frequent migraines, although it doesn’t appear to work if it is only taken when people experience a migraine.
One reason drug manufacturers sought replacements to TCAs is because they have a heavy burden of side effects. One of these side effects is sleepiness, and this may translate to the logical use of amitriptyline for insomnia. It may not only cause drowsiness, but the drug has a long half-life that could reduce premature waking. TCAs are also known for potential to create stomach upset, but their changes to digestive workings may play to their advantage to treat conditions like irritable bowel syndrome.
In all, the potential uses of amitriptyline are multiple. In most cases, a TCA doesn’t represent first line treatment to a condition. In contrast, uses of amitriptyline may be a first treatment choice, and such uses are often credible.