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Thread: Escitalopram and amitriptyline together

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    Escitalopram and amitriptyline together

    Hi I suffer with GAD and had been doing really well but I could feel myself slipping. I spoke to the doctor today and he recommended going back on 10mg Escitalopram. He also has prescribed me 10mg of amitriptyline to take at night to help until the escitalopram kicks in. As usual I have stupidly consulted Google and it says these two tablets should not be taken together. Does anyone else have any experience of taking these at the same time please?

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    Re: Escitalopram and amitriptyline together

    Quote Originally Posted by Worry_wort View Post
    Hi I suffer with GAD and had been doing really well but I could feel myself slipping. I spoke to the doctor today and he recommended going back on 10mg Escitalopram. He also has prescribed me 10mg of amitriptyline to take at night to help until the escitalopram kicks in. As usual I have stupidly consulted Google and it says these two tablets should not be taken together. Does anyone else have any experience of taking these at the same time please?
    As is so often the case, Dr Google is wrong (as are many drug interaction websites). Amitriptyline is too weak a serotonin reuptake inhibitor to precipitate serotonin syndrome/toxicity (SS/T) even when combined with MAOI class ADs which are the most prone to triggering SS/T. That's not my opinion, but that of Dr Ken Gillman, one of the two leading serotonin syndrome/toxicity experts. To quote:

    It is safe to combine amitriptyline with an MAOI without precipitating serotonergic side effects or ST (Gillman 1998). If an overdose of amitriptyline is taken, ST symptoms do not occur

    P. Ken Gillman, A Review of Serotonin Toxicity Data: Implications for the Mechanisms of Antidepressant Drug Action, 2006 [PDF]

    See also: Demystifying serotonin syndrome (or serotonin toxicity)
    Plus 10mg amitriptyline is too low a dose to have much affect on serotonin anyway.
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