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There really isn’t any shortage when it comes to finding those with fibromyalgia who use amitriptyline [1]. In the years since it was first approved for use, its prescription has only ever increased. Plenty of people swear by it for easing chronic pain, plenty more find the side effects make it unusable. Once again, when it comes to fibromyalgia, we’re left with something that helps a lot of people, and does very little for others. How familiar.
Medication isn’t something we deal with here at The Fibro Guy. The point of this article is to give you a rundown on amitriptyline and fibromyalgia, and the current research behind it, so you can make informed choices when you’re sitting in front of your doctor.
In this article we’ll break down some of the research jargon, look at the benefits and side effects, and dig into why it may work for some, but not for others.
What is Amitriptyline?
Amitriptyline is a tricyclic antidepressant, which in recent years has started being given to those with fibromyalgia. It was first synthesised in the 1950s and approved for medical use in the USA in 1961 by the pharmaceutical company Sandoz [2]. It’s a drug that took the world by storm.
Fun fact: amitriptyline gets the “tricyclic” name from its chemical structure, which is made up of three rings of atoms.
Despite being around for decades, the exact mechanism of how amitriptyline works is still up for debate. That’s not unusual. General anaesthesia has been used for nearly 200 years, gets used around 60,000 times per day in the States, and we still don’t really know how it works either.
The leading theory on how tricyclic antidepressants work is that they raise the levels of specific brain chemicals involved in regulating mood, things like serotonin and noradrenaline [3]. Now, fairly recently, that whole theory has come under serious scrutiny. People started to realise that the old “chemical imbalance theory” had a grand total of zero pieces of evidence behind it [4]. Somewhat alarming, really, especially when around 90% of the public still believes depression is caused by low serotonin or some chemical imbalance.
Amitriptyline has been around for literal decades, but historically it’s only ever been used for mental health conditions like depression and anxiety. Fairly recently though, it’s been found to be somewhat effective at reducing nerve pain, and even some of the pain associated with fibromyalgia.
With a long history and a relatively safe drug profile, amitriptyline became a staple in doctors’ offices around the world. Then, in 2000, the brand name version, known as Elavil, was discontinued by the Food and Drug Administration (FDA). The exact reason has never been clear, it’s mostly speculated to be down to side effects. The generic version of amitriptyline is still very much available. Sometime later in 2017, the FDA stated that the decision to discontinue the brand had nothing to do with safety or effectiveness.
Amitriptyline for Fibromyalgia
A lot of things tend to come along for the ride when you have chronic pain. Things like depression, anxiety, and fairly often, trouble sleeping [5]. It’s not uncommon for amitriptyline to be given to help with sleep, however the actual evidence for that is pretty thin [5]. In fact, a few studies have looked at daytime sedation with amitriptyline and found that it can disrupt natural sleep and wake cycles [6]. Anecdotally, we’ve worked with hundreds of clients before they came off the drug, and most would take their amitriptyline around 12 hours before they wanted to get up the next day, using the half life of the drug to get around that issue.
Amitriptyline is also often used for tension headaches and migraines, both very common in those with fibromyalgia. When it comes to migraines, surprise surprise, we still aren’t entirely sure how they’re caused either. The thinking is that low serotonin levels may contribute to migraines in some people, and that amitriptyline might prevent them by raising serotonin levels. It’s not concrete though. Tension headaches are usually put down to stress and muscle tension, they typically don’t cause nausea, vomiting, or the light sensitivity you see with migraines. The leading theory is that they come from muscle contractions in the neck and scalp, which can be triggered by stress, depression, head injuries, or anxiety. Low doses of amitriptyline, around 10mg, are often prescribed for those with fibromyalgia who get tension headaches and migraines, with reasonable results [7].
One of the main reasons amitriptyline gets prescribed to those with fibromyalgia, as you’ve probably already guessed, is pain. One of the newer studies into amitriptyline compared the effectiveness and safety of two well known antidepressants, duloxetine and amitriptyline [8]. The review looked at eight systematic reviews of clinical trials and found that amitriptyline had fairly low evidence for reducing pain, some moderate evidence for improving sleep and fatigue, and fairly high evidence for improving quality of life. Duloxetine had higher quality evidence for treating mood disorders, and higher acceptability, being safer for older people, whereas amitriptyline was safer for non elderly people. Both drugs could be useful in fibromyalgia for some people, the choice really depends on the symptom profile of the individual.
On top of partial effectiveness at reducing pain and possibly improving sleep, amitriptyline could have other benefits for those with fibromyalgia. Some studies have shown it can improve mood and reduce symptoms of anxiety and depression. That said, this could just as easily be attributed to feeling better because pain isn’t constant any more, rather than the drug itself. We also know chronic pain stops people from sleeping properly, and with a lack of sleep comes more pain. It’s not a stretch to think that someone sleeping better on amitriptyline would also see less pain as a knock on effect.
Over the years, amitriptyline has been used more and more off label. That essentially means the medicine is being used in a way that’s different to that described in the licence for its use. Some off label uses of amitriptyline include:
- Generalised anxiety disorders
- Migraine prevention
- Insomnia
- Bulimia
Dosage
Amitriptyline comes in three tablet strengths, and also in liquid form: 10mg, 25mg, and 50mg.
The usual starting dose for adults and older children is often around 10mg a day, but you may find your doctor asks if you want to increase it if it isn’t doing much for pain. The starting dose for younger children depends on weight and symptoms. The maximum dose for treating pain in the UK is 75mg a day, though this will differ from country to country.
Side Effects
Amitriptyline is generally well tolerated and has been around a long time, but just like all medications, it can cause side effects in some people [9]. Some of the more common ones are drowsiness, dry mouth, constipation, and dizziness. These are usually mild and often resolve on their own over time.
Other possible side effects of amitriptyline include:
- Blurred vision
- Changes in appetite or weight
- Changes in sexual function
- Changes in sleep patterns
- Confusion
- Dizziness or lightheadedness when standing up
- Drowsiness or tiredness
- Dry mouth
- Constipation
- Nausea or vomiting
- Sweating
- Urinary retention
- Weakness
In rarer cases, amitriptyline can cause more serious side effects. These include:
- Allergic reactions, such as rash, hives, or difficulty breathing
- Chest pain
- Difficulty urinating
- Fast or irregular heartbeat
- Hallucinations
- Seizures
- Unusual bleeding or bruising
As with any drug, everyone deals with side effects differently. The frequency and severity vary a lot from person to person. It’s always a good idea to talk through the potential side effects with your doctor before you start any medication, or before you make any changes.
Closing thoughts on Amitriptyline and Fibromyalgia
Looking at what’s currently available for amitriptyline and fibromyalgia, there really isn’t a great deal of high quality research behind its effectiveness for pain. So, where does that leave us?
Well, it actually gives us a lot to think about, when it comes to fibromyalgia and health in general. Pain is frustratingly complex, it’s caused by numerous factors all interacting together.
Why amitriptyline works for some and does nothing for others is most likely down to how complicated people are, rather than the drug itself. It’s a bit like giving pain education to two different people who suffer from headaches.
If person A believes their headaches are damaging, or they’re afraid to move because they think it’ll cause more headaches, then pain education could genuinely help reduce those headaches.
However, if person B has, let’s say, an elongated styloid process impinging on a carotid artery, then no amount of pain education is going to fix that, it’s likely going to require surgery.
Why pain education may or may not work comes down to three main factors: biological, psychological, and social. That’s an extreme example, but it’s there to make the point that treatments for pain often don’t work because of complex factors that get overlooked.
Biological, psychological, and social factors are all linked together, you really can’t have one without the other two. That’s just how we are as humans.
Biological factors can include: inflammation, arthritis, sleep, age, genetics, compression, and mast cell responses, to name a few.
Psychological factors can include: beliefs, fear, coping skills, trauma, and anxiety, to name a few.
Social factors can include: friends and family, money, global pandemics, and your environment, to name a few.
So, when we look at amitriptyline and fibromyalgia, the reason some people find it useful may have very little to do with its proposed mechanism for pain relief. It’s more to do with addressing underlying factors that increase pain in the first place.
Sleep is incredibly important when it comes to pain, and sleep disturbances only add to it. If amitriptyline can help someone get better, more rested sleep, then it removes a major contributing factor.
If someone’s pain is largely caused by another underlying factor like compression, then its effectiveness is going to drop very quickly. Because fibromyalgia is a syndrome, a collection of symptoms that commonly appear together, there isn’t a catch all fibromyalgia presentation with one exact mechanism as the cause. Pain is complicated because people are complicated. So when it comes to medications like amitriptyline and its use in fibromyalgia, the effectiveness is going to depend on the underlying factors driving that person’s pain in the first place.
As we said before, there’s a big jump in research still needed when it comes to amitriptyline and fibromyalgia. Hopefully it isn’t too long a wait.
— The Fibro Guy Team —
References:
- Thour, A. and Marwaha, R. (2023). Amitriptyline. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK537225/.
- Sandoz. (n.d.). Sandoz. [online] Available at: https://www.sandoz.com.
- NHS Choices (2021). Amitriptyline for Depression. [online] NHS. Available at: https://www.nhs.uk/medicines/amitriptyline-for-depression/.
- Moncrieff, J., Cooper, R.E., Stockmann, T., Amendola, S., Hengartner, M.P. and Horowitz, M.A. (2023). The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry, 28, pp.3243 to 3256. doi: 10.1038/s41380-022-01661-0.
- Sleepstation. (n.d.). Amitriptyline for sleep, is it a bad idea? [online] Available at: https://www.sleepstation.org.uk/articles/medicines/amitriptyline/.
- Holmberg, G. (1988). Sedative effects of maprotiline and amitriptyline. Acta Psychiatrica Scandinavica, 77(5), pp.584 to 586. doi: 10.1111/j.1600-0447.1988.tb05171.x.
- Jackson, J.L., Shimeall, W., Sessums, L., DeZee, K.J., Becher, D., Diemer, M., Berbano, E. and O’Malley, P.G. (2010). Tricyclic antidepressants and headaches: systematic review and meta analysis. BMJ, 341, p.c5222. doi: 10.1136/bmj.c5222.
- de Farias, Á.D., Eberle, L., Amador, T.A. and da Silva Dal Pizzol, T. (2020). Comparing the efficacy and safety of duloxetine and amitriptyline in the treatment of fibromyalgia: overview of systematic reviews. Advances in Rheumatology, 60(1). doi: 10.1186/s42358-020-00137-5.
- Mayo Clinic. (2025). Amitriptyline (oral route). [online] Available at: https://www.mayoclinic.org/drugs-supplements/amitriptyline-oral-route/description/drg-20072061.
The Full Body Fibro Tool Box
The tool box brings together education on pain and movement alongside a wide range of practical movement, stretching and sensory based resources. Rather than offering a single plan or set of rules, it gives you options you can return to and use as needed.
