# amitriptyline and other TCA anti-depressants (sleeeepy)



## Melonfish (19 Dec 2013)

Tricyclic anti-depressants appear to all have a similar affect on the body, which is shortly after taking them you are asleep whether you are standing or not. they don't half knock you out, however it is the morning after that i'm seeking advice on. has anyone got any experience with them?

I've been off the bike for a good 4 months now, at first i thought i had labyrinthitis (turning into david bowie wouldn't be all that bad i guess) and so did the doc, but as it progressed it eventually turns out i suffer from a form of migraines known as Vestibular migraines (lots of investigations have been done, MRI, specialists etc etc.) in essence i'm drunk without being drunk, at least when i have an attack, which are frequent without the meds.
i have been prescribed 20mg of amitriptyline nightly which is an anti-depressant the way it works is by inhibiting serotonin absorption in the brain so you have more happy chemicals knocking around rather then being soaked up by your receptors and leaving you feeling like a deflated balloon full of the blackest black times infinity, the knock on effect of this is it prevents migraines, they don't know why but it does. all i know is it stops me from falling over and i'm not depressed about all the lovely foods i can't have anymore (trigger foods such as chocolate and caffeine!)

ok, the side effects are well known, you take them at night as they make you sleepy but the morning after is like waking up after a night drinking, it is Really, REALLY hard to get up which for me is a polar opposite to how i was before, i was usually awake before the alarm, i am now increasingly sleeping through it.
so i'm groggy in the morning, less alert, my hope is that jumping on my bike in the crisp air and dicing with the morning traffic will awaken my brain like it did before i was taking these, i do find that i am a bit zombie like for a while and you can imagine my trepidation of cycling 7.5 miles in the morning against idiot drivers.

has anyone got any experience of cycling on these meds and can they offer advise?
thanks!
Pete


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## fossyant (19 Dec 2013)

I have and will post more later when near a keyboard. It wasn't good for me.


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## fossyant (19 Dec 2013)

Right then, found a keyboard.

I was prescribed Ami for nerve pain in my left arm. This was during the time my shoulder was mashed from a RTA. Anyway, a few months after having my shoulder decompressed, I was still getting nerve pain. The Doc recommended trying Ami, so I started on about 20mg, building upto 60mg over a couple of months. Main side effects for me were dry mouth, and feeling like a zombie. As the dose increased it was imparing my ability to think straight, not great when your job is 'mentally challenging'. To top it off, I was out on a training ride that I'd done a couple of months earlier pre medication. On one climb I was taking it relatively steady, but my HR was maxing out. When I got home I compared the data from both rides side by side, and sure enough my HR was running 10 bmp higher for the same level of output. This got me worried.

I decided to come off them, but I went cold turkey, thinking that 60mg wasn't much. That was a mistake as I was violently sick. Went back on them and came down over a number of weeks.

The doc then tried me on gabapentin, and my god, it was like geting a frontal lobotomy. Felt like someone had slapped me hard on the forehead. Stopped these promptly. 

I was undergoing physio at the time, and the physio found tightness in my left hand side (trigger points) along the spine and in my trapezius. Long story short, pain clinic agreed to try steroid injections in the trigger points. My trapezius needed two injections to get it to come out of spasm. They worked. The main issue was the swollen trapezius pressing on the brachial plexus nerves, and in turn causing pain in my arm and hand.

I've been offered Ami again recently for my plumb problems, but I told them to shove it ! In my case the side effects were worse than the pain.


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## numbnuts (19 Dec 2013)

I'm on 75mg amitriptyline at night been on them for years after damaging my spine


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## roadrash (19 Dec 2013)

600mg gabapentin 3x daily and 50mg amitriptyline at night but combined with 50 microgrammes an hour fentanyl pain patch ,for spinal damage, was horrible at first for reasons as mentioned by @fossyant, got used to em now though , no longer any bad effects


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## fossyant (19 Dec 2013)

Flippin heck !


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## SatNavSaysStraightOn (19 Dec 2013)

yep - used to be on a large dose of it (75mg first thing am, 125mg a night, plus tramadol (2 & 50mg 4 times a day for pain) and sleeping tablets as well (under a psychiatrist and pain specialist at the time)) - for chronic pain after an arm injury damaging the nerves in my left wrist leaving them over sensitive to pain - needed 11 ops before the pain was manageable. The injury itself is what left me slightly paralysed down my left side of the body after trapping the spinal cord in the neck. 

The following day always interesting. I would wake up bright and breezy, manage about 60-90 mins and then it would hit me and I would find myself 'falling asleep' no matter what I was doing. It would also leave you feeling dizzy and spaced - coherent thought was not great and conversations with people during the 'dizzy/sleepy' period were not an option. Coming off ami was hard, seriously hard and had to be done slowly because of the dosage I was on - I quit my PhD (organic chemistry) because I could not manage it with the meds. Been back on it once since (for pain management) and won't do it again if I can avoid it.


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## Melonfish (19 Dec 2013)

Ok, so i should basically MTFU and get on with it hah. crikey some of the meds you guys are on i couldn't imagine functioning and here i am whining about feeling groggy in the morning from 20mg of amy!


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## Bam (20 Dec 2013)

Have you tried taking the Ami earlier in the day? when I was taking it at bed time felt like a Zombi for a couple of hours after I got up in the morning, so I started taking it around 6pm and seemed to be a lot better in the morning.


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## e-rider (20 Dec 2013)

I take 50mg Ami for nerve pain daily - dry mouth often, and occasional sleepiness but nothing major.


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## dan_bo (20 Dec 2013)

About 8 years ago I had an ami on a sunday afternoon. Came to wednesday teatime. Avoid if poss.


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## tuffty (20 Dec 2013)

I was given 20mg of ami as a muscle relaxant for a very stiff and painful neck. Its only an anti-depressant in larger doses - I was told 100mg up - at 20mg its just a mild muscle relaxant or should be (can see why that would work for migraines). I had no side effects at all and happily rode up the Tourmalet whilst on it. Sounds like maybe you are having an adverse reaction to it, might be worth a word with your doctor as I was told there were alternatives if it didn't work.


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## roadrash (20 Dec 2013)

some people react different to others, often when people hear what i take in a day they say bloody hell its enough to knock a horse out cold , but obviously i didnt start on such high doses, believe it or not,before i suffered spinal damage , a couple of paracetamol taken for a (rare) headache used to send me to sleep.


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## MrPie (22 Dec 2013)

Been suffering from 'migraine associated vertigo' for over a year now. Initially it was bloody awful and it took several months to diagnose. Cut a long story short, my neurologist prescribed nortriptyline as a potential remedy as ami and gabapentin meds are known to have intolerable side effects for some folks. Nortriptyline is better tolerated by most so it may be worth revisiting you neurologist. Started off on 10mg and increased in 10mg increments each week until I was comfortable with the effectiveness vs prophylaxis. I settled on 40mg taken at night.......after a couple of months the dry mouth disappeared and now all is well. I still have the odd migraine but frequency and intensity has greatly reduced.

I suspect my migraines started after coming off the bike in a chain gang at 25mph. There is a family history of migraines too but my symptoms are not the traditional flashing lights with headache, more supreme grumpiness, stiff neck and sleepiness with vertigo lasting up to 3 days. Vestibular exercise works too......the exercises are very simple yet very effective. I 'm now thinking of reducing my dose and finally getting off the meds gradually.

Don't let this beat you! There is lots of great information on the web with a bunch of support groups / forums for this condition.


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## ttcycle (22 Dec 2013)

If you're struggling with ami, speak to your doctor to see what alternatives there are as suggested above. Everyone responds to medication in different ways, I was put on it a few years ago and can remember the horribly sedating affects on the lowest dose so can feel your pain. 

Hope you get things sorted.


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## mrandmrspoves (26 Dec 2013)

I have been on Amitriptylene for about 6 months for chronic shoulder pain. I increased my dose weekly in 10mg increments and at first I felt like a zombie - to the degree that I took the bus to work as I felt unsafe to drive. Prior to starting the Ami I was only getting about 4 hours sleep at night - so at first I had lack of sleep and sedation. I maxed at 40mg and have had partial relief of my pain and now tolerate the side effects ok - so may ask the dr to push my dose up again.
it may be psychological - but since starting the tabs my average mph has dropped by about 4mph and I just can't seem to get it back.
Overall though, I have found the Ami benefits far outweigh the negatives.......and one advantage is I used to wake 2-3 times a night for a pee, and now I don't (I mean I can wait until morning - not that I pee the bed and sleep through it!)


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## Boredtotears (26 Dec 2013)

Hi, I take ami nightly 5mg to keep my migraines under control, I found taking it early in the evening, (once I was in and not needing to go back out) made it easier to get up on a morning.
Speak to your doctor thou, hope you get it sorted. I rarely have any migraines now


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## RichK (29 Dec 2013)

Was on 10mg for a while & found timing was important. 3 hours before bed... would then be OK in morning. Take it later & it "the hangover effect" (as my GP described it) would really kick in.


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## numbnuts (29 Dec 2013)

mrandmrspoves said:


> one advantage is I used to wake 2-3 times a night for a pee, and now I don't (I mean I can wait until morning - not that I pee the bed and sleep through it!)


Amitriptylene is also given to children to stop bed wetting.


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## fossyant (29 Dec 2013)

Looks like I might be going back on it as it seems the only option I have for my pain. The tramadol is way too strong with side effects


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## doog (29 Dec 2013)

I have been on amitriptylene for about 18 months. I've had two spinal surgeries and these things are brilliant. Im not the only one who thinks they are, many people in the health profession dont have a bad word to say about them. 

Im only on about 10/20mg a night, simply to get me through that 4am back pain. As stated above it does prevent you from going to the loo in the night which is a bonus. I have heard in that in much larger doses they were used as an anti depressant ? On my low dose, there is no difference...im still a miserable sod  

However its important to take these tablets *12 hours* before you want to get up, or you will feel a bit like a zombie......not much just slightly 'detached'....


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## doog (29 Dec 2013)

fossyant said:


> Looks like I might be going back on it as it seems the only option I have for my pain. The tramadol is way too strong with side effects



Have you tried diclofenac or Naproxen for your nerve pain ? Takes about 5 days to kick in . I didnt do well with Tramadol, although gapapentin worked better I think they are both for drop dead type pain, similar to morphine / Oramorpth.....short term / high impact and you suffer the side effects. Long term both diclo or Naproxen plus amiltriptyline at night have done the job..


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## fossyant (29 Dec 2013)

Not so sure if it's nerve pain, but Ami, Gaba, and pregablin all treat pain for a longer term. Not happy, but I'm not getting any less pain from my under carriage and it's been suggested a few times. Back to the consultant on NYE so hope to have a way forward. Tramadol is, as you say, short term fast impact, although the pain has been that bad, it's only just took the edge off. I've been terribly dizzy all day and only just coming round as I haven't taken any since breakfast.

I can't carry on using the tramadol, and ibuprofen and paracetamol aren't cutting it. I'm also unable to ride now.

Got to keep the Ami dose low though this time as it sent me doo-Lally last time.


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## roadrash (29 Dec 2013)

good luck, i feal your pain (so to speak)


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## mrandmrspoves (29 Dec 2013)

fossyant said:


> Not so sure if it's nerve pain, but Ami, Gaba, and pregablin all treat pain for a longer term. Not happy, but I'm not getting any less pain from my under carriage and it's been suggested a few times. Back to the consultant on NYE so hope to have a way forward. Tramadol is, as you say, short term fast impact, although the pain has been that bad, it's only just took the edge off. I've been terribly dizzy all day and only just coming round as I haven't taken any since breakfast.
> 
> I can't carry on using the tramadol, and ibuprofen and paracetamol aren't cutting it. I'm also unable to ride now.
> 
> Got to keep the Ami dose low though this time as it sent me doo-Lally last time.



Good luck in getting the pain sorted. If Tramadol works for the pain but has too many side effects you may find a slow release form helps. Alternatively Codeine Phosphate +/- Parecetamol can be useful in tailoring the dose as you could go anywhere from 8mg, 15mg, 30mg or 60mg up to four x daily.
Another possibility would be transdermal patches of Fentanyl or Buprenorphine or similar.


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## roadrash (30 Dec 2013)

fentanyl patches are brilliant for me


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## fossyant (30 Dec 2013)

Patches sound a possibility. Currently in bed as I feel so dizzy and due my next one soon. I only view tramadol as short term. I am back in work next week.


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## vickster (31 Dec 2013)

Fentanyl is a pretty hard core opiate. I think you'll need a pain specialist to initiate, not a GP. If under pain management, you could also ask about oramorph (and a stool softener!)


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## fossyant (31 Dec 2013)

Started on ami. Bollock has 3 month stay of execution. If not setting by April, chop chop.


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## vickster (31 Dec 2013)

Ouch, hope it gets better!


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## fossyant (31 Dec 2013)

vickster said:


> Ouch, hope it gets better!



So do I. Specialist said its scar tissue. I said I was expecting less not more tissue in there after my operation. Fortunately he said its nothing nasty, but if the pain doesn't settle, they will need to remove it. 

I should be OK to get back on the bike, although it may be rather painful. Bugger all else I can do other than look after myself, take the Ami to help pain and sleep and just take ibuprofen and paracetamol to control it, and hope it settles.

All from a little operation. The specialist said it was a mess in there and was a difficult procedure to remove my plumbing.


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## vickster (31 Dec 2013)

Was this from the snip? Ouch


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## fossyant (31 Dec 2013)

vickster said:


> Was this from the snip? Ouch



It was from the snip, and this is a second op. Had the snip 15 months ago, then had to have an epididymectomy 3 months ago to repair (remove) the mess.


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## vickster (31 Dec 2013)

Double ouch, all the best for a speedy recovery


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## Melonfish (2 Jan 2014)

just got back to this thread, ouch.
so christmas was fun, couple of migraines i figured i would have due to eating naughty foods. sleeping in really helped i must say, didn't wake up as groggy @doog i think you're right on the 12 hours thing so i'm going to give that a bash and see how i get on.
i have noticed something new is my sense of smell, it gets randomly powerfull. things that normally smell nice make me want to heave. hence when i went in the shed over christmas and picked up an old innertube just wow. it was like i'd been skunked up the nostril hah!

@MrPie glad to see i'm not the only one with MAV! i have heard of the vestibular exercises but i am yet to try them, i did go and see a neurologist but he was about as useful as a paper towel at a wet t-shirt contest, the nhs are somewhat hit and miss aren't they?


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## fossyant (17 Jan 2014)

Back off it ! The Ami knocked me out a bit during the holdifays, but, and it's a big BUT, brought back my 'restless legs syndrome' and caused night sweats. My 'restless legs' are generally not too bad, usually in summer when it's hot and I get itchy feet and a twitch as I'm going to sleep. Well it came back with a vengeance, so I came off the tablets this week. Left with achy 'bits' again, but no twitchy legs. Might get better sleep. It's not for me ! Grrrr !


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## Ajstradey (2 Jun 2014)

Melonfish said:


> Tricyclic anti-depressants appear to all have a similar affect on the body, which is shortly after taking them you are asleep whether you are standing or not. they don't half knock you out, however it is the morning after that i'm seeking advice on. has anyone got any experience with them?
> 
> I've been off the bike for a good 4 months now, at first i thought i had labyrinthitis (turning into david bowie wouldn't be all that bad i guess) and so did the doc, but as it progressed it eventually turns out i suffer from a form of migraines known as Vestibular migraines (lots of investigations have been done, MRI, specialists etc etc.) in essence i'm drunk without being drunk, at least when i have an attack, which are frequent without the meds.
> i have been prescribed 20mg of amitriptyline nightly which is an anti-depressant the way it works is by inhibiting serotonin absorption in the brain so you have more happy chemicals knocking around rather then being soaked up by your receptors and leaving you feeling like a deflated balloon full of the blackest black times infinity, the knock on effect of this is it prevents migraines, they don't know why but it does. all i know is it stops me from falling over and i'm not depressed about all the lovely foods i can't have anymore (trigger foods such as chocolate and caffeine!)
> ...





Melonfish said:


> Tricyclic anti-depressants appear to all have a similar affect on the body, which is shortly after taking them you are asleep whether you are standing or not. they don't half knock you out, however it is the morning after that i'm seeking advice on. has anyone got any experience with them?
> 
> I've been off the bike for a good 4 months now, at first i thought i had labyrinthitis (turning into david bowie wouldn't be all that bad i guess) and so did the doc, but as it progressed it eventually turns out i suffer from a form of migraines known as Vestibular migraines (lots of investigations have been done, MRI, specialists etc etc.) in essence i'm drunk without being drunk, at least when i have an attack, which are frequent without the meds.
> i have been prescribed 20mg of amitriptyline nightly which is an anti-depressant the way it works is by inhibiting serotonin absorption in the brain so you have more happy chemicals knocking around rather then being soaked up by your receptors and leaving you feeling like a deflated balloon full of the blackest black times infinity, the knock on effect of this is it prevents migraines, they don't know why but it does. all i know is it stops me from falling over and i'm not depressed about all the lovely foods i can't have anymore (trigger foods such as chocolate and caffeine!)
> ...





Melonfish said:


> just got back to this thread, ouch.
> so christmas was fun, couple of migraines i figured i would have due to eating naughty foods. sleeping in really helped i must say, didn't wake up as groggy @doog i think you're right on the 12 hours thing so i'm going to give that a bash and see how i get on.
> i have noticed something new is my sense of smell, it gets randomly powerfull. things that normally smell nice make me want to heave. hence when i went in the shed over christmas and picked up an old innertube just wow. it was like i'd been skunked up the nostril hah!
> 
> @MrPie glad to see i'm not the only one with MAV! i have heard of the vestibular exercises but i am yet to try them, i did go and see a neurologist but he was about as useful as a paper towel at a wet t-shirt contest, the nhs are somewhat hit and miss aren't they?


hi melon fish I was googling ami and cycling and came across this forum, the symptoms you've got sound exactly the same as mine, down to chocolate and caffein to name a few setting it off, iv also had tests for everything including MRI, saw a neurologist a few weeks ago and he prescribed ami starting 10mg going up to 70mg, I do a few sportives but when iv got an attack which seem to be getting worse iv got no strength to cycle and then on other days a good day I'm back to full throttle, do u think the ami has slowed your performance on one of you good days iv only just started to take it and the more I read about it the less it seems like a good idea. 
Anthony


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## Andrew_P (12 Oct 2014)

Well I remember reading this and thinking bloody hell sounds like a shoot situation for these fellas, and here I am staring down the barrel of a prescription for Amitriptyline, and I don't even believe I have what has been diagnosed as Atypical (Of Unknown Origin) Facial Pain been off the bike mostly since the 27th of June, probably only done 300 miles in that time. All started after some crown work and then three infected teeth. Been and still on load of antibiotics.

Everything I read about them makes me not to want to even start, but I am starting to feel, and I think be treated like by the health profession as loon as I do not accept the diagnosis, so any good positive stories?


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## roadrash (12 Oct 2014)

they are normally prescribed as a mild anti deppressant, or as a muscle relaxant, they can have some pretty nasty side effects.


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## SatNavSaysStraightOn (12 Oct 2014)

Amitriptyline has a well documented side affect of suppressing nerve pain so it comes down to how much pain you want to be in verses how well you can cope with the side effects of Amitriptyline. What dosage have you been prescribed?


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## Andrew_P (12 Oct 2014)

SatNavSaysStraightOn said:


> Amitriptyline has a well documented side affect of suppressing nerve pain so it comes down to how much pain you want to be in verses how well you can cope with the side effects of Amitriptyline. What dosage have you been prescribed?


10mg starting rising to 20mg over 2 weeks via the GP, or nortriptyline up 40mg via maxillofacial consultant.


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## Drago (12 Oct 2014)

They tried my Missus on these recently for MS pains. Within a few days she'd put on a load of weight and her legs stopped working.

I periodically get some chuffing unpleasant pain in my titanium elbow from damage to the ulnar nerve and they want to put me on Ami, but they can jog on.


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## mrandmrspoves (12 Oct 2014)

roadrash said:


> they are normally prescribed as a mild anti deppressant, or as a muscle relaxant, they can have some pretty nasty side effects.



Amitryptyline is not a mild anti depressant, it is quite potent in larger doses, but it does have a large side effect profile that restricts its use in many people. Tricyclic anti depressants have been around for decades and have been largely superseded by Selective Serotonin Re-uptake Inhibitors (SSRI's) which tend to have less side effects.
Amitryptiline is NOT a muscle relaxant.

Although Amitryptiline is often used for neuropathic (nerve) pain , it is not actually licensed for this use.


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## SatNavSaysStraightOn (12 Oct 2014)

Andrew_P said:


> 10mg starting rising to 20mg over 2 weeks via the GP, or nortriptyline up 40mg via maxillofacial consultant.


I don't remember having an issues with that dosage. Mine was significantly higher (in the order of 375mg at the worst and then I did have issues with the side effects, mostly sudden onset drowsiness after being up for around 90 mins in the morning, it would just hit me like a sledge hammer - probably the morning dose). I'm glad I am off it, but I needed it at the time along with tramadol 100mg 4 times a day) - ended up having the various branches of the ulnar nerve severed and a segment removed so that it could not try to heal again... I came to the conclusion I would rather live with a semi numb hand than permanent, chronic pain! It was for me the correct move.


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## Andrew_P (12 Oct 2014)

WOW 375mg is that not way over the max?? Everything I have read about it is quite dangerous at high dose that would have scared the crap out of me.

Not that many positives yet then!


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## SatNavSaysStraightOn (12 Oct 2014)

Andrew_P said:


> WOW 375mg is that not way over the max?? Everything I have read about it is quite dangerous at high dose that would have scared the crap out of me.
> 
> Not that many positives yet then!


not sure about what the max was, but that was what I was prescribed back then +20 years ago.


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## fossyant (13 Oct 2014)

Tried 60mg of Ami. Was off me head. Never again. Bloody GPs sticking plasters over a bigger issue.


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## mrandmrspoves (13 Oct 2014)

fossyant said:


> Tried 60mg of Ami. Was off me head. Never again. Bloody GPs sticking plasters over a bigger issue.



That's not quite fair - use of
Co-analgesics is for many a great relief. Side effects of Amitriptyline are often relatively well tolerated after a few weeks, so worth trying before resorting to surgical interventions etc.
(Which doesn't mean that your GP is not a useless knob!)


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