Last Updated on January 3, 2022 by melissanreynolds
Amitriptyline for fibromyalgia and chronic pain is a bit of a sticky subject for me. It was the only thing I had for years. It was a blessing and a curse. Here I share what it is, the benefits and my experience on and off it.
What is amitriptyline for fibromyalgia
Amitriptyline (elavil) is a tricyclic antidepressant that, when taken at a lower dose, can help with the sleep disorder and the pain associated with Fibromyalgia.
It is a common first line treatment when a person is complaining of poor sleep and constant pain.
Yet this review found:
Amitriptyline has been a first‐line treatment for fibromyalgia for many years. The fact that there is no supportive unbiased evidence for a beneficial effect is disappointing, but has to be balanced against years of successful treatment in many patients with fibromyalgia. There is no good evidence of a lack of effect; rather our concern should be of overestimation of treatment effect. Amitriptyline will be one option in the treatment of fibromyalgia, while recognising that only a minority of patients will achieve satisfactory pain relief.Amitriptyline for fibromyalgia in adults (2015)
In many places amitriptyline is being replaced with the recommended fibromyalgia medications (like Lyrica, Gabapentin and Savella).
This article explains its mechanism of action:
“Amitriptyline and other tricyclic drugs are thought to increase the amount of the neurotransmitters serotonin and norepinephrine that your brain can use. They do this by slowing down a process called “reuptake,” which is when specialized cells absorb used neurotransmitters so they can be re-used elsewhere.”Amitriptyline for Fibromyalgia & Chronic Fatigue Syndrome (2020)
Side effects of amitriptyline
There are quite a few. But, bear in mind, that many side effects do not occur for most people. However some of them are very off putting.
- Weight gain (off putting!)
- Dry mouth
- Drowsiness (when taken at bedtime this can be helpful)
- Constipation and/or difficulty urinating
- Headaches (yet, I was offered this to try and help with migraine)
This article summarises all of the side effects, including the more serious ones.
Basically, it is one of several drugs that doctors have in their arsenal for fibromyalgia, but the percentage for whom is works is low, the side effect profile is high and the evidence is not great.
My experience with amitriptyline for fibromyalgia and insomnia
I had been on it for years before I was diagnosed. A locum general practitioner prescribed it when he saw my history of insomnia and pain (as a teenager). I saw him once and never again. I wish to know if he knew about fibromyalgia and suspected it or not. That would have saved me years of heartache.
After several years on it, I was struggling with restless nights (losing 50-70 minutes a night to awake/restless times), I asked my doctor what else may help and he suggested I increase my dosage. But I didn’t want to do this.
I also wanted to be sure it worked, I had a fear of being stuck on it forever, without really knowing it worked. It was also a scary proposition to go off it and not sleep.
Tapering off amitriptyline
I sucked up the fear and started my experiment in November 2015 and tapered off by 5mg at a time. In the reductions from 50mg down to 30mg my sleep actually improved. But the fatigue increased, I became very fatigued and struggled to stay awake during the day.
By the time I got to 10mg at the beginning of January 2016, I was sore, sensitive and (more) exhausted. My sleep was light and it was difficult to get to sleep and back to sleep when woken.
On my first night completely off it, it took a little while to get to sleep, I slept deeply (I think, I didn’t take my Fitbit on holiday) from 12-6.30am and then my son got up. I was exhausted and sore.
As I continued it took longer and longer to get to sleep, except for the few nights when I was so miserable and exhausted I fell asleep fast and slept like the dead.
I tried 5-HTP and SleepDrops and lavender massage oil. All of the usual sleep hygiene recommendations did not help, keeping the same bedtime routine did nothing, hot baths and no caffeine after lunch. I tried meditation, yoga and any pillow set up possible (oh the money I have spent on pillows).
I was experiencing more wide spread pain, near constant headaches and worsening fatigue. I wasn’t coping.
Going back on amitriptyline
I went back onto 25mg of amitriptyline and had a big sleep on the first night. And a normal sleep, albeit with a six hour block on the second night.
Within a week I was back to getting to sleep well, sleeping restlessly (mostly due to pain), but getting (a broken) eight hours. This doesn’t seem like a win, but it was the same situation as before with half the dose of amitriptyline, which is a win. The headaches mostly receded and the generalised, all over pain quietened. The fatigue was more manageable.
A couple of years after this experiment, I started the experiment that would change my life. Low dose naltrexone. You can read all about that here in my four year review. It has changed everything.
After a couple of years of holding stable with low dose naltrexone, Yoga Nidra guided meditation (for rest and calming the central nervous system), pacing, gentle yoga and more, I decided to go off amitriptyline.
I am still off it.
While I am thankful that it was something (the only thing) I had to help me for the time before I knew nothing else. It is also great to be off a medicine with such a high side effect profile that wasn’t causing great results.
Tell us: Have you tried amitriptyline? Did it help you? What was your experience?