Why has my GP prescribed amitriptyline for me?

[Eddy001]

I'm a 66-year-old male, sick of needing to go to the loo two or more times during the night because it deprives me of deep sleep, and sometimes it takes an hour or so before I can get back to sleep! Up until about 18 months ago the urge to wee came with painful tension in the groin, and after peeing the tension remained and stopped me sleeping, until after about an hour the pain went away.

I've had all the bladder and flow tests done at the local hospital. They have found my bladder to be normal size, visually in good shape, with normal capacity and flow. The consultants reckon there is simply some kind of signalling problem between my bladder and my brain. For example, last night I was wakened twice but peed no more than half a tea-cup in total! Basically my bladder lies to my brain. My bladder tells my brain I need to pee urgently. It's painful. It wakes me up. There's always some pee there but there's never enough to warrant the feeling of desperation! My bladder is lying!

They put me on Tamsulosin (1 capsule after the evening meal) and that has chased away the tension in the groin, but made no difference to the frequency of the urge to pee at night. Then after 12 months they added Betmiga (1 tablet after the evening meal) but that made no difference to the frequency of peeing, but it did rouse up an old indigestion problem, so I've stopped taking that.

After telling all this to a new doctor at my GP surgery last week, I said that I had basically reconciled myself to the fact that I have a dickey bladder and that it is not going to get any better but that I would like some sleeping tablets, just so that I could take the odd one now and then in order to get a good night's sleep - although I would be frightened of not waking up and possibly wetting the bed! She wasn't keen on giving me sleeping tablets but said she would give me something to make me feel drowsy and hopefully sleep better.

So now I have picked up a 28-day supply from the chemist and found that the drug which she has prescribed is "Amitriptyline". I read the leaflet and was surprised to see that its main use seems to be as an anti-depressant! Then I went online and found that amitriptyline is indeed mainly used to help people with depression. Does my doctor think I am depressed? Is that why she's prescribed amitriptyline? However, I found some web-pages which suggest it is prescribed for other conditions as well.

I was expecting to take only the odd tablet before bed in order to feel drowsy and sleep better, but now I find that amitriptyline is usually taken every night for depression, and that to be effective it needs to be taken daily. Should I just take it as agreed with the doctor, i.e. only now and then in order to sleep better?

I've found some web-pages where people say amitriptyline made their bladder problem worse, while others say it helped their bladder problems.

Any help would be appreciated.

[Happyrosie]

I haven’t got a real answer to your question except:I’m a woman, and for the last twenty years or so I’ve woken at least once in the night, often twice, wanting to wee. Cant get back to sleep until I’ve got up and done the biz. Whether much or little of it. I regard that as a normal pattern of being a bit older.

By your mid-sixties it’s normal to have a pattern of sleep that’s no nearly so restful as when you were younger. I’m thinking your doctor is giving you this medication because you come over as anxious,, or worried and that the amit. will help you with this.

You’ve not said anything about prostate investigations nor whether your wee has been tested for microscopic blood, bacteria etc etc. I expect that you have, and it’s all come up as normal.

I’m not a medical professional, just an interested amateur, but I think what the GP has prescribed fits in well with what you’ve written.

[Eddy001 in reply to Happyrosie]

Happyrosie, thanks for your thoughts. Yes, I have had lots of investigations done by the hospital. The only outstanding one (postponed by covid) is a "urodynamic test". However my GP agrees with me that its results are not likely to resolve the issue of urgent peeing several times per night, and the knock-on effect of sleep-disturbance causing crotchetiness and sometimes tearfulness. My GP wasn't happy about letting me take the occasional sleeping tablet, and so she prescribed "something to make you drowsy", which turned out to be amitriptyline. I didn't think to remind her that I already take something every night to make me drowsy, namely chlorphenamine, a hay-fever tablet which can be bought over the counter. If she prescribed amitriptyline because she thought I am depressed, she didn't say so.

[bantam12]

Amitriptyline is used for many reasons not just depression.

[Eddy001 in reply to bantam12]

Yes, I have noted that on the Internet. For example, the UK NHS website states that it is for "pain and migraine", although the leaflet in the packet of amitriptyline which I have been given refers mainly to depression.

[heatherevans28]

Amitryptaline is not used very often for depression anymore as it's not very effective in this regard. It has however been found to be effective for easing sleep issues, and relaxing bladder issues. It basically helps redirect nerve pathways. Lots of people use it to minimise frequency in the bladder, with success.

I personally don't find it helpful for this, but have taken it (or nortriptaline which is very similar) for years to help my sleep with chronic pain.

[Eddy001 in reply to heatherevans28]

Thanks, heatherevans28. The GP prescribed amitryptaline for me for sleep issues, or so she said, but if it "relaxes bladder issues" as you say, then I am encouraged to take it not just once in a while for a good night's sleep, but every night in order to see if it will stop my bladder "screaming" so frequently during sleep. I don't like taking drugs, and I keep them to a minimum, but if there's a chance amitryptaline will let me get a decent stretch of sleep each night then I am tempted to take it. I remain concerned though about its side-effects. Amitryptaline has been found to increase the risk of dementia. The NHS website reports a "study found that anticholinergic drugs were linked with about a 10% increase in the chances of dementia. However, not all anticholinergic drugs showed this effect. People who'd taken anticholinergic antidepressants, drugs for Parkinson's disease, and drugs used for urinary incontinence were more likely to have developed dementia". So this finding encourages me not to take amitryptaline. I am already concerned that my memory is not as good as it used to be. I had some baseline memory tests done by a psychologist a couple of years ago but I suspect the GP who I spoke to during the recent phone appointment wasn't aware of this. I doubt they read all the way through a patient's notes before an appointment.

nhs.uk/news/medication/some...

[Hidden]

Have you been tested for other illnesses? Diabetes.MS.Parkinsons.Fibromyalgia and many more inc spine issues? So many things effect the bladder it isn't it's own thing it's part of a whole system and on the end of the line so anything like in a river that gets thrown in finds it's way out into the sea/mouth of the river(Bladder)

I do work with local hospital on Incontinence and breaking down the Stigma and it's one of the things i brought up to make/ask a check sheet so when go to events you can ask people or show them things that cause issues!

Yet so many inc Quacks have no idea that they say have Diabetes can cause bladder problems in many ways as it effects kidneys also plus another is fluid in tissues like legs then when in bed it drains back and often fluids will irritate bladder.

Lots of things you drink/eat can irritate also Caffeine/Processed foods/Spicey foods and much more.

Even many Specialists are ignorant to there own Chosen Field of work!.

Been to many yet was local nurse that runs group that said Ha if have Fibromyalgia will get these issues i have many that have same.

Bladder problems are often the first indicator of other problems so keep on top of it as it's pretty sensitive to changes within the body.

Also lock your post as many won't respond if unlocked as anyone can read outside forum.

Select community only when posting.

[Eddy001 in reply to Hidden]

oscarbravo, thanks for trying to help. I have always been in excellent health and still am, apart from the urinary frequency and IBS. Both the IBS and the bladder issue have been fully investigated (except for one test in the case of the bladder which will be done once covid is over but which the consultant has said is not likely to alter his view that there is simply a signalling problem between my bladder and brain).

I have always had a weaker bladder than most people, ever since I was a child. I remember when I was about 7 years old being forced to hold my urine because there was no toilet nearby. I can still recall the pain. Maybe that experience caused damage. Ever since then I have been aware that in social situations I am the one who needs to rush to the loo before anybody else.

I don't drink coffee anymore, because of the bladder, and I only drink one small glass of wine with dinner. I have noticed, however, that if I have a pint of beer in the evening I may then get a good five or six hours of solid sleep, despite the large amount of liquid involved in a pint of beer! It's all very strange. The body works in peculiar ways. For example, sometimes I resolve on having an evening meal which has very little fluid in it, a largely dry meal, in the hope that that will cut out the need to pee during the night: but, no, it doesn't follow!

Re. locking my post, I considered whether to let it be seen publicly or not before I posted it. I decided it must be public because I would not have found this group if some other people had not considerately let their posts be seen by everybody. I am not concerned who sees my posts. I hope my post may draw others to this forum, so we can help each other. Also, I am quite certain that I cannot be identified by my online name. I think that anybody who is fearful of their posts being public ought to think about changing their online name.

[Happyrosie]

Before you take a prescribed tablet together with something over-the-counter, it might be best to check with your pharmacist whether they are safe together.

[Eddy001 in reply to Happyrosie]

Thanks for being so caring, Happyrosie. But don't worry, I wouldn't take two different tablets to induce drowsiness at the same time . Anyway, as mentioned to heatherevans, above, I've decided to stick with the chlorphenamine and not to take the amitryptaline. It's not worth the risk. An 11% increased risk of dementia is not worth taking.

[Ronnieboy]

I wake up every night after about 4 hours wanting to go usually it's a fair amount there,sometimes I drink nothing at night but it makes no difference,sometimes I can't get back to sleep for hours,I've got the conclusion it's because I'm getting older,I'm 69,maybe we think we are more tired than we are,I haven't had a good night's sleep since I was about 60.sometimes I feel like a pee during the day and there's not much there,I've just accepted it and don't worry about it,and it eases a bit.best of luck to you.

[Eddy001]

Ronnieboy , your situation sounds similar to mine. I've discussed mine with two male friends of about the same age and they experience nothing of the same symptoms. They sleep right through the night in a state of bliss. They really don't know how lucky they are!

The consultants who have investigated my situation say that my bladder control has simply gone haywire. I first got really irked by this situation about 10 years ago, aged 56. I got depressed at that time because the frequent wake-ups, depriving me of sleep, caused tearfulness during the day. I did quite a lot of research at that time and made things better for myself by the following method. I used it successfully for quite a few years but over the last couple of years I have slipped out of using it. I think the best course for me is to now force myself back into it!

I bought an tablet with an amoled screen (a screen that shows true jet-black, with no light passing through the black), installed the "Moonreader Pro" app on it, the tweaked Moonreader's settings so that the screen would be jet-black and the text would be green. Moonreader also enables you to alter the brightness/dimness of the text while reading, so I keep the text as dim as possible but still readable. I then side-loaded epub books onto the tablet. Then whenever I woke up for a pee and wasn't able to get back to sleep, I would sit up a bit in bed, reach for the tablet, switch it on, go straight into Moonreader, and read. With the above settings the amoled screen emits almost no light, so I quickly got lost in the plot while not having my wakefulness activated further by light. After a while I found myself getting sleepy. I know for a fact that reading in such conditions somehow usually makes me get sleepy quite quickly, and if it doesn't I am happily engaged in the reading.

So I think I need to exercise a little bit more self-discipline and start reading in bed again. I got through a huge number of great novels by this method! What I've been doing for the past couple of years since falling out of the habit is just lying there, hoping that sleep will return, and of course getting a bit angry when it doesn't! When I've had a pee I'm still a bit sleepy so it takes a bit of determination to decide, "Right, I'm going to sit up, reach for the tablet, put on my reading glasses, and do some reading!"

Maybe this will work for you too.

[jl2879 in reply to Eddy001]

Thanks for sharing. I’ve just had two scans (kidney and bladder) and a bladder X-ray today, as I almost permanently need to urinate. It is also quite painful and I can’t remember the last time I didn’t get up through the night 3-4 times. I use podcasts to get back to sleep. I’m 54, female and have had two children. I’m not too concerned as I know there was no blood in my initial urine samples. I’ve also been prescribed Amitryptiline a few years back for anxiety/insomnia. Didn’t do a thing for me. I’ve struggled with anxiety/insomnia for decades and have been lucky enough to find a GP who will prescribe Zopiclone ad-hoc when needed. They HATE prescribing these ‘Z’ drugs. I’m sensible and know taking them every night is not the answer as they are addictive and eventually stop working. Cymbalta (Duloxetine) worked well for my overactive bladder (prescribed for anxiety primarily and to help with chronic back pain); it does work, but is not pleasant to get on or off for some people. I’ve been driven to suicidal thoughts due to insomnia in the past, and it drives me mad that GP’s have access to these drugs but will not prescribe them. Good luck.

[Eddy8765 in reply to jl2879]

Thanks for your reply, "jl2879". (I'm Eddy001 but I forgot how I joined so I have had to re-join with a new Eddy name!)

Thanks for mentioning Cymbalta. I'm due a covid-era phone-call from the consultant in the urology department of my local hospital come this July, and I expect he may prescribe some new drug. I'm not excited. If there is a wonder drug they would have given it to me already.

Have you heard about the following website? I've joined. It could hold promise. When you join you have to answer lots of questions about your condition, so that you are adding to the group's database of knowledge. Who knows what it might throw up?

stuffthatworks.health/overa...

I've more or less given up alcohol in order to have less liquid inside me and because they say that alcohol irritates the bladder, however here's a strange thing. Every once in a while, maybe once a month, I will have a pint of lager about 4pm to 6pm, followed by dinner at 7pm with a small glass of water, and that night I may sleep right through, without a single rising for a pee! However, if I drink a pint of lager the next afternoon, then I will be up three or four times during the night that follows! Weird! But this has happened to me now about five times! It does seem to suggest that alcohol, or perhaps lager, has a particular effect on the bladder. Certain alcohols do have different effects. Ouzo always gives me terribly vivid dreams and sometimes nightmares, while Fernet Branca (like ouzo it's good for indigestion) doesn't affect my brain at all.

[jl2879]

Thanks for the information re stuffthatworks - sound interesting. Apologies for the late reply - I have a lot going on in my life and often miss the email notifications etc.. for HeathUnlocked. I totally understand your concerns regarding Amitriplyline and dementia and funnily enough I've again been prescribed it for my bladder this week and am now debating whether I should take it for the reason you have highlighted to me - I was unaware of the link so will do some research, particularly as my father is 80 yrs old and is in advanced stages of Parkinsons and Lewy body dementia. It's a wicked disease but he's literally taken no medication most of his life, nor are there any family genetics or obvious causes, just s**t luck! I've taken many medications for insomnia over the years - often being tried on various antidprepressants some of which have 'multiple uses' , often not associated with depression, but helping with other neurologcal pains (I've yet to find one I could ever recommend that helps with insomnia - podcasts did that for me in the end - and I was in a terrible state of mental health with lack of sleep for decades). Re alcohol, I too have almost given up with it as clearly it's a diuretic to start with, however I love a glass of wine and the social element that goes with it and I feel utterly miserable having to limit or stop this part of my life. I've tried having a very watered down versions of the drinks I enjoy - but I'm literally living on the toilet; however it's the same with water. Maybe I don't eat enough..... big meals have never been my thing.

[Eddy001]

At only 54 you seem to be in a bad way, "jl2879". I don't know what else to say. Except try to make sure you get hold of the very best medical help you possibly can. I understand your situation though mine is nowhere near as bad.

[fourbanks]

hi, eddy my dr put me on prochlorperazine maleate which is also for depression. i have had a bladder problem for years with recurring kidney stones. i do also have amitriptyline but overall prochlorperazine maleate i find better as its anti-sickness properties are good and helps you relax better

[Eddy8765 in reply to fourbanks]

"fourbanks", thanks for mentioning prochlorperazine. The following authoritative UK website advises that is good for chasing away feelings of sickness, and also anxiety.

nhs.uk/medicines/prochlorpe...