My detailed experience with amitriptyline and withdrawal advice
I have been on this for the last 6 years at a dose of 50 initially for neuralgic pain then went down to 25 and stabilised there. I have been dropping amitriptyline further from here for the last year since fluctuations in dose due to generics caused unknowingly withdrawal symptoms that at one point because almost incompatible with working.
The main issue I had on a higher dose of amitriptyline was relative gastroparesis and very slow motility that had me looking into SIBO/IBS trying to understand what I was experiencing. Within a few months of starting the drug I because quite bloated and gained weight. I suddenly could not eat pulses or i would balloon and have bad reflux that kept me up at night coughing. I also had palpitations that were sometimes a bit alarming.
On going down, i started to experience itchiness at night and allergy like symptoms I had never had (but not true allergies once tested), congested nose that stopped me from sleeping well and mouthbreathing, reflux that became a bit worse temporarily to my baseline, poor sleep with nightmares and no deep sleep, and whooshing tinnitus/ pounding in my ear at night. It took me a while to realise this connection, but I can now identify it as a reliable constellation of symptoms with every drop in dose. My withdrawal symptoms peak at 2-3 weeks which apparently makes sense with the effect to be felt in the neurotransmitters fully, and stabilise by 5-6 weeks on the dose.
I have worked out why this happens. Apparently amitriptyline is a “dirty” drug that targets multiple neurotransmitters (not selective) : serotonin, noradrenaline, acetylcholine and histamine.
It blocks acetylcholine (which moves the bowels, produces secretions in the body such as stomach acid and saliva and activates muscle and is key for concentration and cognition), histamine (which is important for wakefulness and arousal as well as itchiness/ immune response in response to irritants), reduces noradrenaline (responsible for fight or flight and stress/ activation response) and increases serotonin(which regulates mood, again gut).
When ami is introduced, serotonin is increased which somewhat helps mood. It numbs the nerves and the acetylcholine mediated parasympathetic systems, which helps with nerve and visceral pain, and suppression of noradrenaline contributes calmness
BUT
histamine is also very heavily suppressed - this is the main cause of the sleepiness and sedation side effect (this was great for me actually as I needed the sleep), and it can also reduce mast cell activation and allergies in those who suffer them.
acetylcholine suppression is the main effect that may contribute to dementia in older patients, as this block can cause confusion and absent REM sleep.
It also slows down your digestive system and urinary system (difficulty emptying bladder) as well as dry out secretions such as saliva (causing dry mouth for example). This was my personal nightmare with the drug - gastro effects gave me awful reflux keeping me up at night, constipation and a very bloated belly).
When ami is tapered, the opposite happens. The systems that regulate histamine, noradrenaline and acetylcholine rebound up and become temporarily over active. Result : stress over activation, excessive REM sleep to the point of nightmares and lack of deep sleep, insomnia, diarrhoea, vasodilation and oversecretion of mucosas (stuffed nose), possible itchiness (lots in my case), muscle tension. I have all on withdrawal though my bowels working a bit faster each time is a blessing. The itchiness was very disconcerting until I realised it was linked to the drop in dose (at one point I thought I had bed bugs).
I have been on a slow taper for the last year and just made it to 17 mg. Every half miligram is felt and rather than struggling, I am opting for minimising discomfort since i am very dependent on sleep to function at my job and cannot afford to go off sick. But I don’t know how long it will take to drop to 0 at this rate, and often wonder if it would be the same cutting down bigger chunks each time.
This is my story, and I wondered- does this happen to anyone else?