Can Amitriptyline makes you feel more awake

instead of drowsy?

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Got put on amitriptyline, 25mg a night for mild depression, anxiety and insomnia. I've been
taking it for almost two months now. The first month or so it worked really good, I'd take it before
going to bed and it'd help me sleep better. I still didn't sleep as good as I would like, but still it
helped.
Around the second month though I noticed that it stopped making me drowsy at all. I would take
it and feel no drowsiness at all. Most of the time when i take it now i just feel normal, no extra
drowsiness to help me go to bed fast. As a matter of fact, i can swear that it kinda makes me
feel more awake for some reason on few occasions. There have been a few times where I'm
tired as hell, took it, and an hour later I don't really feel as tired anymore. This doesn't really
affect my sleep much, but it does make it harder for me to fall asleep. Could this be a symptom
after taking it for awhile, or is it just my mind messing with me just making me think that it's
making me feel awake when it really isnt?

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Mathieu answered 4 years ago
Joe is not exactly correct.

Firstly just to give you a basic idea of how amitriptyline, and other tricyclic antidepressants
(TCA's), work is primarily by blocking the serotonin transporter (SERT) and the norepinephrine
transporter (NET).

Amitriptyline is also an antagonist of the H1 and H2 histamine receptors and thus acts as an
antihistamine which is responsible for the sedating effects.

There are a couple of problems with your situation 1) The amount of amitriptyline you take is a
sub therapeutic dose to treat anxiety or depression. 2) Although amitriptyline is commonly used
as a sleep aid and is the third most prescribed drug for sleep it is not approved to treat insomnia
and there is very little evidence it is at all effective, particularly for more than 2-4 weeks.
Amitriptyline also has a high incidence of side effects.

So it is not helping the depression or anxiety (and it is likely they are the cause of your
insomnia) and it is normal for amitriptyline to become ineffective for insomnia, if it ever helps.
The typical starting dose for depression and/or anxiety is 50-75 mg at night, typically increasing
to a dose between 150-300 mg/day, typically given at night or in divided doses.

I can actually tell you exactly what is happening and why you feel more awake after taking it.
When amitriptyline and similar drugs are used for insomnia they are intentionally used at a low
dose because you get the sedating effects primarily due to the antihistamine actions but you
don't have much of an increase in the levels of serotonin or norepinephrine (which is
stimulating).

Also it typically takes 4-6 weeks for it to help depression/anxiety. So as the time has gone on
there have been some minor changes with serotonin and norepinephrine and that is very likely
why it makes you feel more awake. That is part of the reason why people who do benefit from
the sedation typically find it becomes ineffective. There may also be some tolerance to the
sedation itself. I hope that makes sense.

What I would recommend is that you make an appointment with your doctor and talk about
actually treating the depression and anxiety.

Just to give you some evidence based information (ie well documented, proven information)
about the treatment of mild depression, anxiety, and insomnia. I have listed the evidence level
of various treatments with level 1 indicating the highest level of evidence based upon multiple
randomized controlled trials (RCTs). I have also indicated if a drug is a recommended first-line
treatment, based on clinical guidelines from The Canadian Psychiatric Association/LAssociation
des psychiatres du Canada which take into account efficacy and tolerability.

Mild depressive disorder: Paxil has shown the highest efficacy in treatment although few
specific clinical studies have been done with most drugs for mild depression. Paxil has level 1
evidence of efficacy and is a first-line treatment although among SSRI's Paxil has the most
incidence of side effects (which is still low).

In studies of people with "anxious" depression Paxil, Prozac, Zoloft, and Effexor XR
(venlafaxine) have demonstrated level 1 evidence and are first-line treatments. Adjunctive use
of Ativan or Xanax with an antidepressant has demonstrated level 1 evidence and has a higher
rate of efficacy, a faster onset of action, and reduced incidence of side effects. Both Xanax and
Ativan are FDA approved to treat anxiety associated with depression along and for the
management of an anxiety disorder.

I don't know what type of anxiety you have but I assume generalized anxiety disorder (GAD).
Paxil, Effexor XR, and Lexapro/Cipralex have level 1 evidence and are first-line treatments. In
addition the following drugs also have level 1 evidence but are second-line treatments because
of issues with tolerability, although benzodiazepines (the last four drugs) can be used at any
time with or without an antidepressant and are better tolerated than antidepressants- Tofranil
(imipramine), BuSpar (buspirone), Lyrica (pregabalin), Xanax, Ativan, Valium (diazepam), and
Lectopam (bromazepam).

Lastly recommend first-line treatments for insomnia are FDA approved short-intermediate acting
benzodiazepine receptor agonists (BzRAs) particularly Ambien (zolpidem), Ambien CR
(zolpidem extended-release), Lunesta (eszopiclone), or Restoril (temazepam).
Source:
M.D., C.M. psychiatry, internal medicine (Qubec)
Hons. BSc in pharmacology

The Canadian Psychiatric Association
LAssociation des psychiatres du Canada

The American Academy of Sleep Medicine

http://pn.psychiatryonline.org/content/4...

I have taken amitriptyline and I have depression and panic disorder.
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Other Answers (1)

John Doe answered 4 years ago
The answer to your question is simply absolutely. Your body will first become drowsy after
taking it, perhaps because it agonizes Serotonin receptors, although that is just my guess as to
why this initially happens. However Amitriptyline also works on Norepinephrine (NorE) and
increases your blood level of NorE which is chemically similar to Epinephrine, otherwise known
as Adrenaline. Norepinephrine is one of the Neurotransmitters that keeps people awake and
alert. Hence Amitriptyline is apparently prescribed for certain cases of Chronic Fatigue
Syndrome.
Source(s):
I take this med for Migraine prevention