However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.

Be sure to keep all appointments for office visits with your doctor.The doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with amitriptyline. Most people complain about constipation and dry mouth, but amitriptyline can cause all kinds of other complications. However, you should not flush this medication down the toilet. JAMA 1979; 241(23):2530-2533.Antidepressant Medicines, Depression and other Serious Mental Illnesses, and Suicidal Thoughts or ActionsTalk to your, or your family member’s, healthcare provider about:What is the most important information I should know about antidepressant medicines, depression and other serious mental illnesses, and suicidal thoughts or actions?Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant.

Furthermore, whenever one of these other drugs is withdrawn from co-therapy, an increased dose of tricyclic antidepressant may be required.

In some patients, 40 mg per day is sufficient. J Nerv Ment Dis 1964;139:370-375.Hordern A, Burt CG, Holt NF: Depressive states: A pharmacotherapeutic study, Springfield study. Pharmacologically, this action may potentiate or prolong neuronal activity since reuptake of these biogenic amines is important physiologically in terminating transmitting activity. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Be cautious of: benzodiazepines, such as diazepam (Valium), … Eight out of 10 who received TCAs received amitriptyline, considered by many to pose the most risk for patients over age 65 years. Amitriptyline HCl, a dibenzocycloheptadiene derivative, is a white, or practically white, odorless, crystalline compound which is freely soluble in water and alcohol. Although a causal relationship has not been established, there have been a few reports of adverse events, including CNS effects, limb deformities, or developmental delay, in infants whose mothers had taken Amitriptyline during pregnancy.There are no adequate and well-controlled studies in pregnant women. It is usually taken one to four times a day. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality.Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient’s presenting symptoms.A major depressive episode may be the initial presentation of bipolar disorder.

Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. Available for Android and iOS devices. She is a Fellow of the Society of Applied Anthropology. It should be noted that Amitriptyline hydrochloride is not approved for use in treating bipolar depression.Amitriptyline hydrochloride may block the antihypertensive action of guanethidine or similarly acting compounds.It should be used with caution in patients with a history of seizures and, because of its atropine-like action, in patients with a history of urinary retention or angle-closure glaucoma. South MedJ 1970;63:1492-1493.Hollister LE, Overall JE, Johnson M, et al: Controlled comparison of Amitriptyline, imipramine and placebo in hospitalized depressed patients.