Should I ask for Amitriptyline to replace Mirtazipine?

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Hello can anyone tell me their experiences in a similar situation to me? I have Bipolar 1, on lithium and valproate, mirtazipine for current depressive episode, also have levothyroxine for lithium-induced hypothyroidism, PLUS i have severe degenerative joint disease of the spine which is increasingly debilitating and painful - i am now unable to walk further than about 50 yards without agonising pain. so im stuck in a recliner chair all day bored stiff and increasingly desperate. I read somewhere the other day that Amitriptyline has pain relieving qualities as well as Antidepressant... Would it be a good idea to suggest to my psychiatrist that i swap mirtazipine for Amitriptyline? HAs anyone tried a similar change of meds and how did it affect their depression and pain? im worried about i) relapse into mania/psychosis, ii)side-effects, and iii) will it exacerbate my NSAID-Ulcer and IBS? Sorry its so complicated! All medical personnel views welcome too!

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15 Replies

  • Posted

    G'day from down under Australia. I have degenerative disc disorder , scolliosis and SLE lupus. I am on a low dose of amitriptyline , as an additional part of my medication. You will need a higher dose to help with your level of pain , and to help with your depression. Amitriptyline (endep) does have some side effects , just as most medications do. Some side effects are , involuntary body jerking, your head feels a bit dizzy , and u can be a bit shaky on the inside. These side effects start to ease after a few weeks once your body has adjusted to the new meds. I have been on amitriptyline for 7 years now , and I still get some involuntary body jerking ( ticks) on the odd occasion. Everybody is different , so only you would understand your illness,and you know your own body and what u can and can not handle. Remember to be positive . Please let me know how you go , and what you decide. Message me any time. Good luck ,hope all goes well.
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    • Posted

      Hello tracey, thank-you so much for such a helpful answer. The side effects you mention dont seem any worse than those I get from all my other meds, in fact they sound quite similar to how I feel on the lithium, baclofen and mirtazipine. I was thinking that maybe i could take amitriptyline to 'kill two birds with one stone', that it could maybe replace mirtazipine AND one of my painkillers - but from the answers ive rec'd so far it sounds more likely that the doctor will add it alongside my other pills... I think I shall ask to give it a try -many people seem to feel it gives them amazing pain relief its got to be worth a go. Thanks again for your advice!
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  • Posted

    Personally I have found that Mirtaipine is a far superior Anti-depressent than Amitriptilyne.

    Then, I don`t think Mirtazipine has any pain `modifying effects`, I personally only find Amitriptilyne as a useful suppliment to more conventional pain meds, and on their own Ami only seems to help me a little with things like Tension Headaches (which I never had bere taking Ami!). I have found them next to useless for my major cause of pain, which I won`t bore you with here!.

    Though it must be said that many people swear by Amitriptilyne as a pain medication , and say "they don`t know how they could live without it" and so on,; basically, it`s whatever suits the idividual patient, "horses for courses" as some say.

    All The best

    Paddy

     

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  • Posted

    BTW you can take Mirtazipine (for depression) aswell as Amitriptilyne (for pain) at the same time. I am at the moment taking 45mg of Mirt, and 20mg of Ami. The best advice I have come across on the net regarding Amitriptilyne is "take it 12 hours before you plan to do anything", because if it effects you like me, you won`t be able to focus straight, and have lots of other side effects until your brain becomes accustomed to it.

    Usually then your GP will increase the dosage, and you`re back with the same side effects for a time again :-(

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    • Posted

      Thanks Paddy - it sounds so familiar, having to take more pills to deal with the side effects from other pills, then the whole rigmarole begins again whenever a dose has to be increased etc....I started out just on depakote and co-codamol. Now, my repeat prescription runs to three pages and I have an alarm on my phone every 2 hours to remind me its pill time and which pills to take... ! Think it may be worth giving Amitriptyline a try though  if theres a chance it might help me with my pain without my having to take stronger opiates (tramadol really disagrees with me so that limits the options). Thanks again for your advice.
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    • Posted

      If you are taking lots of different meds numerous times a day, I take a total of 20 different meds. Then I have found that sorting your pills into those pill dispensers (they are called "Dossettes" amongs other things), they were really invented for older people who got confused, but seeing as you can buy them from the £1 shop, it`s a lot easir to fill in a weeks worth of meds, then its just a matter of a handful of tablets morning, noon and night or whenever. Just a thought!
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    • Posted

      That sounds a very good idea TBH. I get confused because of all the mind altering drugs I would be filling it up with! Lithium, depakote, mirtazipine, painkillers, anti inflammatories, proton pump inhibitors, antispasmodics.... - the list gets longer by the month and each new pill ends up necessitating two or three more to deal with its side effects! 

      But shouldnt whinge given that all this is on the NHS - there are billions round the world who would weep with gratitude to have the services we take for granted. Trying to count my blessings ! Thanks again for advice!

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    • Posted

      I agree, for all the faults that the NHS has, and there are many, it is free (if you don`t count the Dentist which costs a bomb!), and when you get down to the basics, we get exactly the same meds as our cousins over in the USA, at a fraction of the price they pay (or even free if your lucky (??) like me).

      All the best

      Paddy

       

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  • Posted

    Hi Christine.

    I was on mirtazapine a while bck and now on amitriptyline. I struggle with most meds which is part of my condition. I couldnt get on with mirtazapine and to be honest really couldnt cope with the side effects. 

    amitriptyline does have some side effects as Tracy above pointed out. I also agree with what she said to you regarding the dose. You would require more than 20 mg for the amount of pain your're in and depression. I also suffer with ibs and it has helped that tremendously. 

    As for the concerns regarding the bipolar I would personally ask your psychiatrist. 

    Good luck with what you decide to do :-) 

     

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    • Posted

      Hello Alison -  thank-you, another very helpful answer! [I am so glad I found this website, the medical pages are really informative and there are such nice people on the forum discussions!]

      I was especially interested to read that you find amitriptyline has actually HELPED with your IBS - I was very worried that it might exacerbate mine. I never had any problems with my digestive system until 6 months ago - the Naproxen finally took its toll, then I managed to catch 2 different breeds of norovirus 3 weeks apart, which removed all the friendly bacteria in my gut. Its left me with an incredibly over sensitive stomach, lots of pain under my ribcage, nausea, absolutely terrible bloating, constipation and zero appetite. At the moment all I can reliably eat without upsetting my tummy is: probiotic fruit yogurts, spicy ginger biscuits, shredded wheat, toast, and Coke. Hardly a healthy diet! but everytime I try to reintroduce other foods I end up with agonising pain. Any tips? I take pre- and pro-biotic tablets (high dose), lansoprazole (proton pump inhibitor) and milk of magnesia to ease my symptoms - would amitiptyline work better than, or, alongside these? [This IBS is all new to me - I used to have a stomach like cast iron, until now th only only time I had tummy troubles was morning sickness during pregnancy!]

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    • Posted

      Hi Christine.

      I do believe that amitriptyline is used to treat ibs. I have suffered with it for years.

      I was actually put on amitriptyline for anxiety/ depression but its used off label for many other reasons. I discovered not long after taking it it was actually helping my ibs ( spasms, alternating between diarrhoea and constipation, nausea, lack of appetite etc) 

      I have actimel yoghurt drinks in the morning which I swear by too.

      have you ever been given fibogel? Ive had that for ibs before and wrked for me. 

      if you do decide to try it id like to know how you get on :-) 

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    • Posted

      hello Alison - I am so pleased to hear Ami can be used to treat IBS!

      It seems like this drug will kill three birds with one stone - if it works for my back pain, depression and my IBS itll be fantastic!!

      I have just made an appointment to discuss it with my psych and am seeing my GP in 3 weeks about vitamin D and will ask about amitriptyline too. 

      I seem to live on probiotic yogurts just now! They are marvellous when you just cant tolerate anything else. ITs really annoying as I am pretty much vegetarian and used to live on salads, vegetables, fruit - now pretty much every veg and fruit upsets my tummy. typical!

      Doc said to avoid fybogel just now til things have settled down - it was one of the first things i suggested, but he said you have to be a bit careful of it if you get a lot of bloating.

      will defo let you know how it goes! x

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  • Posted

    G'day . So glad to hear back from you. I have found that I am using my walking cane less often now. I am walking by myself further every day. 

    I thought that this may be of some motivation for you.  Don't hesitate to give me a buz whenever u feel u need to. Glad to help. Let me know how you are going. God bless.

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    • Posted

      Wow, if Ami helps enough to help you walk without a cane, that would be fantastic! I cant walk further than about 100 yards with my walking stick without having to stop and rest my back cos it goes into muscle spasms as well as the joint pain. I keep being offered a 'walker' like a zimmer frame on wheels with a shopping basket and a seat. It looks very useful - but I am too stubborn and proud to be seen with it - i am only 44! how shallow and vain is that. So I just take taxis everywhere or stay indoors (thank goodness for the internet!)!

      I think I wil ask my psychiatrist to put me on a low dose of Ami to see if i can tolerate it, and gradually phase it in whilst phasing out my mirtazipine.  Same here - message me if you every want a chat! Take care of yourself tracey x

       - Also - Big thanks to everyone who replied to this post  - great to be able to get some real life experiences before making a decision! 

       

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