Amitriptyline dose increases and side effects

Hello everyone, I'm new here. I've been reading things on the forum for a while but never joined until now, when it occurred to me it might actually be a useful thing to do! Googling things often doesn't work; hearing the stories of people who've been through the same as you and understand is so much better.

By way of introduction, I'm 30 and suffer from anxiety tinged with slight OCD tendencies (my compulsions are mental rather than manifesting themselves in actions). I had a patch of anxiety in my early 20s and was put on citalopram, which I took for years after that even though I was ok. About a year ago I stopped the citalopram; I was happy, happier than I'd ever been really and didn't see the need for them. However, I came off them too quickly and then the problems started. I had a horrid anxiety flare up in January and was put back on the citalopram. The start up side effects were indescribably terrible. I was so anxious I was utterly terrified and had no clue what was happening to me. I got over that in a couple of days and things settled down a bit. I was fine from about February to June and then things started going wrong again. The GP decided in his wisdom to switch me to sertraline but I believe made the switch far too quickly with not enough tapering/titrating. Cue more horrendous anxiety. I went to a different GP who told me to come off everything as SSRIs clearly do bad things to me. I then went to see a specialist as I was sick of poor advice. The long and short of it is that he ended up putting me on amitriptyline. I've been increasing the dosage slowly, 10mg for three days, 20mg for three days and so on. I was by this point feeling SO much better, very much like my old self again and often actively happy. However, after I'd been on 40mg for a couple of days I had a big anxiety spike, along with the dry mouth that TCAs are known for. This lasted a couple of days and then I was fine again. I've now been on 50mg for a couple of days and am experiencing the same. I'd been fine all day today then suddenly I was an anxious wreck. I also feel like my head doesn't belong to my body and my hands and feet feel strangely sensitive and tingly (that's not quite the right word but I can't think what is). I wonder whether when I reached 40mg I had some kind of reaction as I was then at a dose which was making some impact on me mentally, rather than being on 10/20/30 which really doesn't act on the brain at all. And perhaps I'm going to get a bit of a reaction every time I increase it.

So, has anyone else experienced anything like this? Has anyone had a period of increased anxiety after either starting or increasing amitriptyline? My doctor seems to think I have a brain which is extraordinarily sensitive to any chemical change and I can't seem to find anywhere on the web which suggests my experience is common. At what dosage did people start to feel a benefit, and how long after reaching that therapeutic dosage did it take? I'm feeling pretty fed up as I was so good compared to how I was a couple of months back. I hoped I'd never have to experience an attack like this again!

Firstly, a warm welcome to the forum.

As for amitriptyline, my experiences so far mirror yours.

I have the odd bad day where the anxiety is high, but I've started (with GPs approval) splitting the dose.

I take 50mg about a couple of hours after getting up then the other 50 after evening meal.

I find that helps to even out the good effects.

I don't feel as good as I did on some other drugs, but this drug lowers my background anxiety, so the spikes aren't as bad.

Like you I didn't get on with SSRIs or SNRIs - I find the side effects much less on this drug.

Hope it works well for you.

Thank you Mark, for your welcome and your reply! So I'm not the only one then...obviously I wouldn't wish such issues on anyone but it's a relief to know I'm not alone. Splitting the dose is something I could try so thanks for that idea. Unfortunately my doctor is away at the moment and getting hold of him to ask things is problematic. After I got over an initial blip I felt good on 40, but with 50 I just cannot seem to get used to it. I've been on 50 for five days and yesterday was just a nightmare with horrid intrusive thoughts that just wouldn't leave me alone. I haven't experienced anything as bad in quite a while. I felt an emotional wreck when I went to bed last night and this morning I'm really not sure how I got into work; I felt like I was sleepwalking. I have to teach a course this afternoon and have no idea how I'm going to get through it. I almost dropped back to 40 last night but I kept thinking that maybe I'd get through it and I'd better stick at it. If I still feel this bad tonight though I shall be going back down to 40. I felt SO GOOD just a few days ago. I've had enough of this! This is the fifth drug I've taken and they've all made my anxiety worse. What is wrong with me?! Maybe a lower dosage was enough...

I think it's just trial and error with these drugs. My GP has prescribed me all the main types over the years, and now we're probably at the end of combinations.

It's not just the types of drug either, I've found that mirtazapine is great (especially for sleep) at 15mg but on 30mg I'm so wired and emotional.

At my request, my GP just gives me a dosage maximum for amitriptyline (ie I was on 50mg, but stepped up to 100mg in steps of ten).

This arrangement is to stop me turning up at his surgery every 2 weeks :)

It makes me feel more in control of my health though.

Hope you find the drug / dosage that works for you.

Mark

I've just started out this week on 20mg and I am sleeping much better but feeling spikes of anxiety too. It's nothing like the type you get with an SSRI though thank goodness. Annoying more than anything and just prickly. I might split my dose and see if that helps. DO you think 40mg could have been enough for you or did your anxiety flare up again at that dose, which is what made you move up to 50mg? I've just read your post but still have brain fog,lol. I will go back and read it again. ;)
I know every time you increase a meds you do get side effects choose what it is but this drug is so much easier as I'd probs be having panic attacks on Sertraline, where as as I said, this is just feeling a bit on edge and like my skin is tingling a bit.

How do you feel now Leonore? I had a spike of anxiety this afternoon on 20mg? I did a day at ten, then went straight to 20mg. This is easy compared to SSRI's but I have had anxiety for so long now, I am just fed up more than anything. I'm praying this works as it's kind of my last resort meds now.

I am on day 4 at 20mg and split my dose with 10 last night and 10 this morning. Right now I have slept ok (till 5am) but I feel some anxiety and really quite flat, plus I have headache and bit of ringing in my ears, all normal I know. I just wish I could curl up and sleep again really but I'm at my parents and it's only one bedroom, so I have been on the sofa all night. I just want to get through these first couple of weeks,let things settle and then go up another dose. Mornings are always hardest for any one I think when starting new meds, I know we shouldn't wish time away but roll on bed time, or later tonight when I will be nice and chilled and my mood will have lifted. I don't normally have depression until I go on medication but I guess that is the chemicals doing things in my brain and hopefully the meds calming me down from my manic high.

I'll be going up to 40 tonight. I think took my 30mg too early last night as I fell asleep by 8pm and then was awake at 1-30 but very dizzy and a bit sickly. I took a Lorazepam and managed to sleep till 6 but then didn't want get up until 9. Anxiety is low today but it tends to hit me around lunch time any how at the moment so we shall see and I'll take the plunge and go up to 40mg tonight as my doctor swore I would feel calmer not more wired up but I've heard that a million times from doctors, so I'll see what happens. Last night I was feeling very panicky and worried and just thought I have to do this or stay ill another 17 months. Slight headache today and some drowsiness but nothing major yet. Does anyone else think about their anxiety so much it's like willing it to come on, if I lots of good days I' stop even thinking about it but it's such early days I guess so the irrational thoughts are still very much with me xx.