Brand change amitriptyline

[Sunnydeligh]

Amitriptyline I keep having bouts of anxiety with each brand change anyone else have this ?

[Hidden]

Hi, I was until recently taking amitriptyline, (AMT) but for chronic nerve pain. I have recently read that it has been proven (I'm not sure what the proof was) that AMT is successful at treating depression. Myself, I think it worthwhile challenging this "proof". In 1969 I had a course of AMT. When I told my GP it wasn't working, he doubled the dose. Then doubled it again, things got vague, he may have doubled it again. Rather than help my depression, especially by not dealing with the things that were causing it, the side effects made it worse by disabling me from dealing with them.

I have had some short term courses of treatment for anxiety and depression since 2008. The treatment of choice by the GPs I've seen has been SSRIs. I found these very effective in lifting me enough to be able to deal with the issues on a longer term basis. When expressing surprise at being prescribed AMT for nerve pain, my GP said, "It's well known that AMT doesn't work for depression.

Bearing that in mind, it's probably true that different "brands" (i.e. which company makes them), of a drug, do affect you differently. This is because they are prepared differently and if you read the ingredients, you'll see it's not just the active ingredient (AMT) but a variety of other things, that may vary between manufacturers. These could affect absorption rates, sensitivities etc.

Why are you getting different brands? If you live in the UK this is probably because of a recent initiative by the NHS to stop the prescribing of what THEY call "Branded" drugs, that is drugs manufactured by a particular company, that is the company that developed the drug had a patent on it. There will will only be ONE such brand. These drugs are expensive. Once the patent has expired other companies can "copy" the drug. The copies are called "Generic". "Branded" drugs are still significantly more expensive than the same "Generic" drug. It may vary across the UK but generally doctors are being instructed to stop prescribing Branded drugs where a Generic version is available.

NEXT - you take your NHS prescription to a pharmacy. It is NOT for a particular brand. The pharmacy can give you the drug sourced from any manufacturer they like. They purchase their drugs on a bulk basis and consider wholesale costs and availability when buying them. In other words, they shop around. So what they buy and stock will vary, hence the AMT you get may vary in manufacturer, (which you see as "brand"). You can ask the pharmacy, as I recently did, to "try" and give you the same brand every time, but they will say they can only try. It's not down to the individual pharmacy

I imagine if you live somewhere like the USA, you can insist on having the same "brand" every time. You're paying for it!

In the UK, you can also insist on having the same brand every time. There is a drawback. You will have to ask for a PRIVATE prescription. Luckily you will not have to pay for the prescription form, (there is normally charge for this). HOWEVER, you will have to pay the pharmacy IN FULL for the drug. (Even if you're normally exempt from prescription charges). In the case of some drugs this could be very expensive, e.g. a drug I was recently prescribed costs about £50 a month. I'm not sure how much AMT costs.

Overall though, rather than question why you get different brands of AMT, firstly I would question why your'e getting it all. After all, even if the recent report shows it IS effective, there was no comparison with SSRIs which have been known to be effective for years. Secondly, I wonder if you're relying on drugs alone to deal with your anxiety and depression. There is now evidence that non-pharmaceutical therapies can be just as effective. One such therapy, I can recommend from persona experience is Mindfulness Cognitive Behaviour Therapy.

Hope this helps

Good luck

[Sunnydeligh in reply to Hidden]

Hi thank you for ur response I’m actually taking it for vulvodynia which is suspected to be A nerve pain issue I spoke to my dr yesterday he said he had put a request for a certain brand that doesn’t set my anxiety of and I have to effectively try fish around for that brand from pharmacy to pharmacy which will suck but i won’t have to pay any extra I have low folic level that can cause excessive fatigue and anxiety so I suspect that doesn’t help either I also been dizzy which isn’t helping my anxiety but I did have inflammation of ear which can cause that just bad timing all round I guess x

[Hidden in reply to Sunnydeligh]

Hi good to hear you can get the brand that suits you, but, yes, it sucks that you'll have to shop around, I wonder if you could get it straight from the manufacturer. I was up until recently on amitriptyline for nerve pain. In my case a compressed nerve in my spine. A couple of weeks ago the pain got a hell of a lot worse and my doc changed it to Gabapentin, which I consequently guess is more effective for nerve pain. That might be an alternative for you, but then it might be out of the frying pan into the fire. Since, I guess, you don't suffer from RLS it doesn't really matter,

I'm sure your ear infection and hence dizziness will soon clear up and that will be one less thing to be anxious about. Sorry to say, there will be other things.

I hope you don;t mind me saying this, it does sound to me that you easily get anxious about things and I'm not saying that's bad or wrong, but it's not helpful. You still might consider my suggestion about mindfulness as an effective means, and enjoyable means, of managing anxiety.

Good luck

[nightdancer]

FYI, Amitriptyline is a tricyclic antidepressant which will make RLS worse in 99.9% of people who take them, also the SSRI's. Any reputable web site, including the RLS-UK Foundation web site, Johns Hopkins in the US, the US RLS Foundation, etc, will all have the same info. There ARE some anti-d's that will not make it worse for most people, but those 2 classes of meds are first and foremost on the Drugs to Avoid list. I, personally, was given it for prevention migraines, pre-RLS diagnosis, and I was ready to jump out of the highest window. I know people who had to be talked down off a bridge, and many other people, too. Not exactly sure what you mean when you say "anxiety". The only anxiety it usually gives us is worse RLS, and THAT will make you very anxious. having said that, ONCE in a while we find a person who does not have that problem, but it is pretty universal.

[Hidden in reply to nightdancer]

Thanks for this, I didn't realise until today that AMT makes RLS worse, you''re the second person that's told me. I don''t know if Sunnydelight actually has RLS, not mentioned. There are other reasons than RLS for suffering anxiety. Any way, I had an SSRI for about 8 weeks in 2015 and I think I gained more from it than any effect on my RLS. Anxiety was the greater problem at the time. But I hope to avoid it in future, it was a last resort.

Incidentally anxiety in my case is a mental health issue and is worse when provoked by events (e.g. marriage breakdown). It's characterised by apprehensiveness, "dark", sometimes obsessive thoughts, insomnia, fearfulness, lack of concentration poor memory, clumsiness, a feeling that things are out of control, that even the simplest tasks are complicated, a feeling that I constantly need to be doing something, things take forever. Palpitations, chest pains, trembling, rapid heart rate, panic attacks etc. This to be differentiated from the agitation, worry or restlessness that my RLS may sometimes cause me. I believe that under the ICD-10 anxiety and depression are interrelated and the standard treatment is more or less the same.

A GP once insisted I have a course of Mirtazapine a TETRA cyclic antidepressant. I don't remember if it had any effect on my RLS. It also did absolutely nothing for any anxiety I might have had at the time. At the time I was struggling with my (ex) wife's unreasonable behaviour which included blaming me solely for all our problems, insisting I was suffering from a mental illness, cancelling my appointment with my usual doctor and insisting on an earlier appointment she'd made with a D***head of a doctor who colluded with her. RLS was not an issue!!! It seems to me there's no realistic pharmaceutical alternative to tricyclics or SSRIs for anxiety/depression, especially if you have RLS.

The information about RLS, AMT and SSRIs just emphasises the importance of non pharmaceutical therapies for anxiety and depression. Accepting of course, that although they may not make RLS worse, they won't help the RLS. Sunnydelight even f you're suffering from "anxiety" as an independent mental health issue rather than as a result of RLS, it appears that your best bet is to get off the AMT!

Considering I've had RLS for over 30 years and was a health professional, I seem to be relatively ignorant about it! In my defence I can only say that I have been more concerned about the effect of other heath issues on my quality of life, cancer being one. Still, only been on this site a day and already learning much.

Thanks again Nightdancer

[Pippins2 in reply to Hidden]

There are 2 antidepressants which dont worsen RLS .They are Wellbutrin (not available in the UK for depression , only available as Zyban to help smokers stop ) and Trazadone Some can take Mirtazapine x

[nightdancer in reply to Hidden]

I have taken Mirtazapine for 8 years now, does not bother my RLS, it is for my PTSD. will not go into those details, BUT, it is a fairly safe one. I am functioning much better WiTH it than without, and no more panic attacks, which are completely separate from my RLS. As usual it is all trial and error. Trazadone, as Pippin mentioned, is a safe one, and works much better most of the time than Wellbutrin. But, what works for one does not work for the next person, one of the "rules" for RLS. Knowledge is power!