Amitryptiline's effect on cognition.

[C-AA]

Hi, I was diagnosed with chronic Migraine/Tension-type headaches and put on the tricyclic antidepressant Amytriptiline as a means of prophylaxis at the age of 17. I started on an initial dose of 10mg and was told to increase by 10mg every week up to a maximum dose of 100mg until I experienced any pain relief or severe adverse effect, so I reached the 100mg daily dose whereby it was helping with sleep and reduction in headache frequency. During the follow-up appointment with my neurologist, I was told to decrease the dosage to 80mg for the next 3 months but out of concern I eventually decided to gradually lower the dose down to 50mg whilst still reaping the benefit. Overall I have been on Amitryptiline for over half a year and have dealt with the usual common side effects (dry mouth, weight gain, slight tremor, fatigue etc) without complication but recently I've been developing a growing concern of the psychoactive medication deteriorating my cognition (thinking skills) and subsequently lowering my mood. For the last couple of months, I have been going through episodes of 'brain fog' which last from a few days up to a couple of weeks, during these periods I have trouble processing information, decreased attention, confusion and generally feel dumber as if my mind has been dampened down (I can tell that I've lost intelligence I've had before as it seems like I need to put much more effort and time into solving mathematical problems/understanding my studies/learning). I also occasionally feel as if I am disconnected with reality or my actions and any thought process is achieved out of rational impulse; I feel completely out of control and heavily sense the decrease in mental state as clear/real as switching a light on and off, I lose my mental 'spark'. The first time this happened I felt like I had completely lost my mind and cried for days. When I finally got to talk to my neurologist about it she reassured me that the antidepressant had absolutely 'no' effect on my condition and said that it was merely my anxiety and not real, but after that appointment the episodes kept relapsing getting longer and worse (I am currently going through an episode right now) and I have never had issues with 'anxiety' or 'stress' in the past, in fact I would use any stress to enhance performance. So I decided to do some research on the topic and found that the antidepressant can impair cognition (including memory tasks), especially due to Amytriptiline's anticholinergic properties, as a long term side effect, proven by multiple scientific studies so I do not understand why my neurologist could confidently state that the medication was having no effect in that regard. It is very difficult for me to go through this whilst coping with stress as I undertake my final exams for University entrance (note the episodes of 'brain fog' don't only occur during times of elevated stress, however, any additional stress does exacerbate the situation which isn't so ideal).

I would love if anyone with sufficient knowledge in this subject area can supply me with any valuable insight or advice.

Am I taking the antidepressant at too low of a dose to experience an impaired mental state?

Could this solely be a form of anxiety?

Should I stop treatment?

Will the medication have any permanent effects on my 'thinking' capability?

Does anyone else experience this?

Thank you.

[babs1234]

I wouldn’t say I have knowledge on the the effects of the drug Amitriptalyne but I have experience. I was prescribed it a couple of years ago, straight onto 25mg a day. The side effects I can only describe as being like a zombie with dementia. Yes they helped the pain but only for 9 months when i then weaned myself off them. I think what your describing is most definitely caused by that damn drug

[C-AA in reply to babs1234]

Yes exactly, the term ‘zombified’ would describe it well.

[Cat00]

The trouble is migraine can have the same effect on cognition, and at your age it would be quite likely a time for the onset of those symptoms. I'm on a 100mg of Amitriptyline now, I've been on it 3 times and have had to stop twice for pregnancy for a couple of years at a time. The highest I've been on is 175mg.

50mg is a very low dose of Amitriptyline, when it is used as an antidepressant it is prescribed at 400-500 mg routinely.

You sound like a highly strung person and you are in a particularly stressful time in your life, so much starts changing at 17/18 years of age. You say you dealt with the "usual common side effects" but I would argue it is uncommon to have all those side effects, I certainly didn't have any of those. The predominant side effect of Amitriptyline is that it can make you extremely drowsy in the morning and so should be taken early in the evening so this wears off by morning, I take mine at 8.00 pm for this reason.

Brain fog and tiredness are a huge part of migraine. Of course you can take yourself off amitriptyline all together and see if the fog continues but I would expect all migraine prophylaxis to have these symptoms listed in the side effects somewhere. All migraine meds effect the brain obviously, so you'll have to discuss with a doctor what your options are. Migraine is a strange condition which contain many subtle effects as well as the obvious ones and they can really start to get going at your age and be very difficult to pin down. They change continually. Amitriptyline is an old drug by NHS standards so they like it because they have a lot of data on it but there are other options but it is important for you to be aware you may not rid yourself of these symptoms that are bothering you.

[elryoe in reply to Cat00]

Very good post. I started having migraines 2008 and have one about every 7 days. I have taken Amitriptyline,Tramadol,Gabapentin,Ketorolac and Sumatripyline (think that's the spelling),but I also have afib and really can't take any Tripylines meds as they make me feel as if I am having a heart attack. The meds did make me sleep better. I also had a May 14th,2019 occipital nerve block injection, and no migraines for 3 weeks...But...they are back!

Looking into CBD products now. Anybody have experience with this?

[elryoe in reply to elryoe]

The meds I am referring to are Triptans in relation to afib.

[Cat00 in reply to elryoe]

My understanding with cbd oils etc is that they may dull the intensity but not the frequency. Also there is a lot debate over whether you would have to have an oil with an active component of THC for it to work and then obviously you may have to experience the recreational side of the drug which you may not want, also they are harder to source.

[babs1234 in reply to elryoe]

Are the last st of drugs you’ve mentioned taken on separate occasions. Did any work better than the other and are the side effects on any better than the he others.?

[elryoe in reply to babs1234]

I am 74 and started getting migraines at age 64. Get migraines on average of 4 a month that last around 6 hours each time. I know that is less than others, but that pain is still there.

Yes, took them on separate occasions and none of them eased or stopped the pain, Reading articles on CBD and the amount of THC in CBD products is 3%,which claims to not make one feel any high. Gonna try it.

[babs1234 in reply to elryoe]

Let me know how you get on with it. I’m using the Gammacore and so far good 😊 I have Hemicrania Continua which is almost daily

[babs1234 in reply to elryoe]

How did you cope with side effects of these drugs?

[Kariss in reply to elryoe]

Hi elryoe,

I’ve been taking cbd oil for several months and find it quite good. I’m using it for general pain caused by rheumatoid arthritis and fibromyalgia. I also suffer headaches and migraines regularly. There are no addictive side effects as the molecule that gives the well known ‘high’ has been filtered out from the plant during processing leaving only the beneficial cannabinoids and terpenes. I find it doesn’t really help my pain but has improved both my mood and my IBS symptoms so I feel better in control of myself. I researched the cbd thoroughly before deciding to try it. If you do give it a go, buy from a reputable uk seller (assuming you’re in the uk!) and start at the lowest dose to see how it works for you. It isn’t cheap and the bargain offers are usually not strong enough to be effective so you want to get good value for what you buy. Look online for the best reputable uk sellers. I chose Hempura because they make it easy to understand what you are buying and how to use it. Good luck, I hope you find some relief!

[elryoe in reply to Kariss]

CBD didn't work today! Back to the drawing board.

[C-AA in reply to Cat00]

Hi thanks for the response,

I understand that things like lack of sleep and migraines can cause a person to feel such ‘brain fog’ because I know how that feels as I’ve experienced it and I can confidently say it is nothing compared to the cognitive impairment I’ve been continuously experiencing whilst on Amitriptyline; it is one thing to feel a little tired or mentally exhausted due to pain and unable to think clearly and another to feel completely mentally dead. I do not feel as if any headache ,fatigue or other system is diminishing my cognition but that my actual thinking ability is diminishing in itself. I understand that 50mg is a low dose but as you said, the fact that I’m experiencing so many side effects listed proves to me that the medication is having a significant effect on me and my nervous system and therefore I wouldn’t consider 100~50mg a low dose, surely the drug would have a scaled effect, if at 400mg it causes cognitive impairment it would be expected to cause a lesser but evident impairment at a lower dose.

Additionally, I have done my research and even on the NHS website does not say that a dose higher than 150mg is used to treat depression, usually it is between the range of 50-150mg for depression and 25-75mg for chronic pain.

[Cat00 in reply to C-AA]

It sounds like you have already made up your mind. Unfortunately the effects of drugs are not always linear all these interactions are more complex than that but you sound like you have already decided so what more is there to say.

As it happens I was with a doctor this morning discussing Amitriptyline and she had just prescribed someone a dose of 250mg so the NHS guidelines aren't the only source of data out there. The NHS website is only a starting point and is hardly definitive.

[C-AA in reply to Cat00]

Yes but I would love to be wrong. I need any evidence or scientific test carried out that will prove that Amitriptyline does not impair cognition as all I have now going against my raw feeling and all public information on the drug, is my neurologist’s word.

Unfortunately I do not get to see her until August and the GP does not help in this situation as I’m advised to leave it to the specialist.

Is there a possibility that a doctor would hide the full truth from a patient in an attempt to rid any worry on my side and thus ensure treatment is carried out successfully?

Here are a few sources on this topic:

Again, would love to hear your feedback.

“The findings of this study are consistent

with the hypothesis that after one month of treatment with amitriptyline, depressed patients can show a deterioration of memory function, despite alleviation of depression. The decline in memory performance associated with amitriptyline ap- parently reflects the relatively high anticholinergic action of the drug, rather than a deficiency in its antidepressant action.“

link.springer.com/content/p...

“Only amitriptyline impaired performance on tests of memory, producing a significant decrement, relative to placebo, after 4 weeks of treatment.“

ncbi.nlm.nih.gov/pubmed/152...

[Cat00 in reply to C-AA]

I don't think a doctor would hide this sort of information from you to make you less anxious, they do hide stuff from patients with dementia when it is deemed to be more damaging for them, like the fact they even have dementia and whether their family members are still alive etc. Amitriptyline is such a common drug most doctors probably have a lot of experience with it.

I would say the link you posted to the study is not particularly useful, scientifically speaking at least, although is interesting. They only studied 35 people with only 10 of them being on Amitriptyline, with such a tiny sample size it can't hope to give you any useful data its far far too small. Also they were only on the drug for a month, with most side effects occurring in the first 6 weeks this means they don't even know if things settled down and their memory returned as can happen. You have to be on these things for a while to really have a true idea of how useful they are going to be to you.

Experience the only real marker, and even then just because a drug didn't work on you in one decade does not mean it won't work on you in another, the variables are massive.

I've been on at least 13 drugs for migraines, plus GON injections and Botox. Over the years various doctors would disagree with the previous doctors approach and put me on all the same meds again but at different doses or combinations. If Amitriptyline isn't for you there are many alternatives, none of them work well on me but are fabulous for other people but then mine are very intrenched.

[C-AA in reply to Cat00]

Hey there I’ve lowered my dose and my brain fog has subsided but I’ve also begin to notice that my resting heart rate has increased from around 70bpm to over 100bpm during the course of amitriptyline treatment. Is this to be expected?

Anything to be concerned about?

[C-AA in reply to C-AA]

I’ve seen it go up to 130bpm now during exercise so it’s slightly worrying.

[Cat00 in reply to C-AA]

Yes Amitriptyline can raise or lower your heart rate. It is something I have been bothered about for years, I hate the fact that I do a lot of cardio fitness, at least 6 hours a week and yet my sedentary husband has a much lower resting heart rate than me. My neurologist ordered me a heart monitor test where you wear a monitor for a couple of days just to check everything was ok because my heart takes a long time to come down after exercise ( I think anyway ). I wore it a month ago but they still haven't "analysed the data yet" so I don't know how it went, although I'm slightly assuming its not terrible or they would have contacted me. But I don't know if it always effects the heart or just can effect it?

[Jazmynk97]

I’ve taken this medication for years starting at the age of 17 im turning 21 and just recently came off of it due to my migraines always returning and the need to increase in dosage and now I have a nasty case of dry eye that has made my life a literal hell on top of my migraines. I feel all the same strange cognitive symptoms you describe not sure if doctors would “hide” it or if they genuinely don’t know seems like migraine is a trial and error type thing for doctors I’m losing hope in treatment with medications & I hope my cognitive functions will return back to normal (been off for 3 months).

[C-AA in reply to Jazmynk97]

I would turn to the more natural approaches to treatment such as Acupuncture, Massage, Exercise, Meditation etc as they really do help to cope with headaches, and completely avoid any psychoactive drug especially anticholinergic antidepressants such as Amytriptyline in the future and likewise hope my cognition is normalised soon.

Any permenant effect due to being on the drug for several months would be absolutely detrimental to my mental health as I really did admire my brightness in the past and it would be a shame to lose out on any future aspiration.

I don't like how my neuroligist did not mention this risk at all before as I would have never taken the drug if I knew this was the case.

[Cat00]

I thought you might like to know I saw my Neurologist this morning and I asked her in more detail about Amitriptyline and the effects on cognition. She said there has been a recognisable link with effects on cognition ( well memory specifically ) and Amitriptyline. But she said there is an observable link with all anticholinergics and that out of all of them Amitriptyline has the lowest observable effect. She said this is noticed more in people taking 150mg and above. There is a link between anticholinergics and dementia later in life. I asked her if I should be on it, I am a bad insomniac, she said that because my sleep is so bad without it, the negative effects of poor sleep outweigh the negative effects of the anticholinergics on my brain essentially. If you google Amitriptyline or anticholinergics and link with dementia there is masses on the internet, print it out and take it to your GP then maybe you can have a more constructive conversation with.

[C-AA in reply to Cat00]

Thanks for letting me know,

It seems then from her proffesional point of view that what I researched and concluded is true and so although it may be considered as the safest anticholinergic drug it still does have some sort of impairment on cogntion meaning that what my neurologist told me wasn't the full truth which is sad because I would never have considered taking the drug if I knew this to be the case.

There are also of course so many other attributes of cognition (other than memory) that don't seem to have been measured and this entire sense of the unknown when it comes to antidepressants so the neuroligist saying 'no effect' would be far off from the truth. Until now I thought you could fully trust in the NHS but from now I'll be doing my own research before making any decision.

Dementia is really the least of my concern as I'm only 18, more concered about the raw cogntive impairment due to being on the drug and that doesn't seem to have been looked into much.

I even doubt I truly have migraine as I experience no aura, no audio or visual sensitivity, only chronic headache type pain/pressure all over the top of my head (not one sided) which is usually strongest in the morning upon waking. I guess whether I have been misdiagnosed or not wouldn't matter much now. I also understand that it's an extremely broad spectrum.

Thanks for the help, good luck with the rest of your splendid 'migraine' journey.

[Cat00]

The NHS is generally awful in my experience, unless you are actually dying, my husband had cancer at the age of 30 and they were amazing.

Only 45% of migraineurs have aura, and audio and visual sensitivity varies tremendously with each migraine. The one sided things is bollocks too. I don't think I've met anyone who has these "classic" symptoms, but this is a forum for people for whom migraine has become a major problem. I think people who have occasional manageable migraines wouldn't bother being on a migraine forum!

I did think as a rule they didn't put you on prophylaxis until you were suffering quite a few headache/ migraines a month though, I presume each doctor has their own threshold for prescribing prophylaxis.