Elavil (generic name: amitriptyline) is the hoary, white-bearded grandfather of tricyclic antidepressants; it’s been around forever, and we know lots about it. It helps the body increase both serotonin and norepinephrine, and studies have repeatedly shown that Elavil is an effective medicine for depression. Patients say it stops them from overthinking on negative topics and dulls all their emotions, providing a rest from depression. Although it is not licensed for this use, Elavil is often used to treat diabetic pain, to treat muscle and joint pain, or to prevent migraine headaches (although it will not stop a migraine after it has started).

At doses high enough to treat depression, Elavil always makes you feel very sleepy. There is a feeling of distance from events around you, like the feeling Sylvia Plath wrote about in The Bell Jar (see Appendix A, Resources). It’s been described as looking at the world through the wrong end of a pair of binoculars. This feeling is very much like the side effects of antihistaminic allergy or cold medicines. The effect decreases with time, but it may never go away entirely.

Most people find that Elavil makes them both thirsty and constipated. Weight gain is another major side effect of Elavil. Sometimes it seems that just walking past a bottle of it is enough to add on a few pounds. Elavil is also well known for causing falls if you should sit or stand up too quickly (postural hypotension). Falling is especially important to avoid in elder adults, who may break their hips or experience other life-threatening consequences after a fall.

Elavil comes in 10-, 25-, 50-, 75-, 100-, and 150-milligram tablets. It is usually started at a low dose of 25-50 milligrams at bedtime, because of the strong side effects it causes. I rarely see doses above 150 milligrams, for the same reason. The first dose of Elavil takes about four hours to reach its maximum concentration in your body, and it stays in your bloodstream for about two and a half days after your last dose.

Despite the fact that Elavil is a popular antidepressant with doctors, it has too many strong side effects for most patients.