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Elavil (amitriptyline) is a tricyclic antidepressant used to help treat a variety of mental illnesses, as well as helping with pain management and in numerous other conditions.

First introduced in the 1950s, Elavil has since been replaced to some extent in treatment of mental conditions by newer classes of drugs, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and norepinephrine reuptake inhibitors (NRIs). It still sees regular use, however, as some patients respond better to tricyclic antidepressants.

Treatment Basics

Elavil is used in a very large range of complex mental and physical conditions. Because of this it is very difficult to generalize treatment; dosage, frequency of doses, and duration of treatment will vary tremendously depending on the condition being treated, other medications being taken, other major medical conditions that might be present, individual variables like age and weight, and of course patient response to treatment. As a very rough overview:

• In adults, treatment typically starts on 50 to 100 mg per day, with 75 mg per day being average. Children and elderly patients are usually started on 5 to 20 mg per day.
• Total dosage may be taken all at once or divided into up to 4 smaller doses taken throughout the day, depending on doctor instruction.
• Full effects will not be realized for 3 to 4 weeks. After that time, dosage may be adjusted in increments of 25 to 50 mg until desired results are achieved or 150 mg per day is reached. Doses of greater than 150 mg per day are unusual outside of hospital settings.
• Treatment may continue for as long as benefit is received and complications do not develop.
• If treatment is discontinued it should be gradually tapered off; abrupt cessation can produce withdrawal symptoms.

It is not uncommon for patients to develop tolerance to this medication, which will reduce its effectiveness unless dosage is increased. If this happens the patient will likely be transitioned to a different medication; side effects become a concern at higher doses.

The Many Uses of Elavil

As previously mentioned, this is a versatile medication that sees use in a staggeringly large range of conditions, just some of which are listed below:

• Depression
• Post-traumatic stress disorder
• Obsessive-compulsive disorder
• Headaches, including migraines
• Tourette syndrome
• Attention-deficit hyperactivity disorder
• Irritable bowel syndrome
• Schizophrenia
• Fibromyalgia
• Chronic hiccups
• Parkinson's disease
• Neuropathic pain
• Chronic pain
• Internal cystitis
• Smoking cessation
• Various eating disorders
• Various mood disorders
• Various personality disorders
• Various anxiety disorders

...and many more. It is very often used in combination with other medications, and as with any medication, interactions with these other drugs is possible; in fact other medications are often a significant factor in dosage calculation. It is very important to check with doctor before adding, removing, or adjusting dosage of any medications during treatment with Elavil.

Warnings & Side Effects

As would be expected in a medication that treats such a wide range of conditions, Elavil can produce a wide range of side effects. Fortunately most are mild and very often transient, meaning they'll gradually improve and eventually fade away completely as the body adjusts to treatment. Some of the more common side effects include:

• Dry mouth, nose, and/or eyes
• Blurry vision
• Difficulty urinating
• Constipation
• Drowsiness
• Dizziness or lightheadedness
• Stomach upset
• Mild confusion
• Weakness
• Restlessness
• Low blood pressure
• Appetite changes

The above side effects are generally not cause for concern unless severe enough to be disruptive or persistent past the first few weeks of treatment.

Rarely serious side effects develop which warrant immediate medical attention:

• Severe confusion
• Eye pain, swelling, redness or hallucinations
• Fainting
• Severe abdominal pain
• Blood in urine, stools, or vomit
• Seizures
• Pain or swelling in breasts
• Severe or persistent heartburn

Like most antidepressant medications, Elavil can worsen depression and suicidal behavior in patients who suffer from depression. This is most likely to happen in patients aged 24 or younger, and usually starts near the beginning of treatment. Close monitoring should be considered during the first several weeks of treatment.