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Depression
18 min read
Written by Klarity Editorial Team
Published: Nov 16, 2022
Medically Reviewed by Dr. Zoe Russell
Though amoxapine and amitriptyline have similar effects on the body and brain, one may work better for you depending on your depression symptoms, body chemistry, and contraindicated medications or conditions. The comparison guide below can help you have a more informed discussion with your healthcare provider when deciding if you should start antidepressants.
If you are interested in treating your depression with medication, schedule an appointment on Klarity today. We’ll match you with a healthcare provider who can evaluate your symptoms through online depression treatment to determine if Amoxapine, Amitriptyline, or another form of antidepressant is right for you.
Amitriptyline | Amoxapine | |
Drug Class | Tricyclic antidepressant | Tricyclic antidepressant |
Brand / Generic Status | Generic (Brand name: Elavil) | Generic (Brand name: Asendin) |
Form(s) of the Drug | • Tablets • Yellow, fruit-flavored liquid suspension | Immediate-release color-coded tablets |
Standard Dosage | Tablets: • 10mg • 25mg • 50mg • 75mg • 100mg • 150mg Liquid suspension: • 10mg per dose | Immediate-release color-coded tablets: • 25mg: white • 50mg: orange • 100mg: blue • 150mg: light orange |
Conditions Treated | FDA-approved uses: • Major depressive disorder • Anxiety disorder • OCD Off-label uses: • Chronic fibromyalgia pain • Nerve pain • Sleep disorders • Bladder pain • Irritable bowel syndrome | FDA-approved: • Depression with psychotic features • Nerve pain Off-label: • Difficulty sleeping |
Cost | Generic form (amitriptyline): • $140 to $300 for a 30-day supply • $4 for a 30-day supply with insurance or coupon card | Generic (amoxapine): • $20 to $36 for a 30-day supply Brand name: • Brand name formula not available for Rx |
Side-Effects | Common side effects: • Drowsiness, blurred vision • Dry mouth, constipation • Weight gain • Difficulty urinating • Persistent heartburn • Easy bruising or bleeding • Black stools • Vomit that looks like coffee grounds • Muscle spasms, shaking • Severe abdominal pain • Decreased libido • Enlarged or painful breasts • Severe dizziness, fainting, seizures, confusion • Eye pain, redness or swelling, vision changes • Sweating | Common side effects: • Sedation or drowsiness • Dry mouth • Constipation, nausea • Fatigue or weakness • Blurred vision • Anxiety or restlessness • Insomnia or difficulty sleeping • Confusion or altered consciousness • Palpitations or changes in EKG patterns • Tremors • Increased appetite causing changes in weight over time Serious side effects • Signs of Neuroleptic • Malignant Syndrome (NMS) • Serotonin syndrome • Increased suicidal thoughts or self-harm behaviors |
Warnings For Use | Drug interactions: • Quinidine • Cimetidine • Many other antidepressants: SSRIs • Type 1C antiarrhythmics • MAO inhibitors • Thyroid medication • Alcohol, barbiturates and other CNS depressants • Anticholinergic drugs | Drug interactions • Other anticholinergic medications • Blood pressure medication • Alcohol and barbiturates • MAOIs • SSRIs • Thyroid supplements |
Tricyclic antidepressants (TCAs) are among the earliest antidepressants developed. Though many physicians opt for more modern antidepressants with fewer side effects, like SSRIs or SNRIs, tricyclic medications are sometimes prescribed if other formulas prove ineffective.
Tricyclic medications are named for their chemical structure, which contains three rings. Both of these medications are tricyclic-class antidepressants that work by preventing norepinephrine and serotonin reuptake in the brain. This makes both of these neurotransmitters more available in the body and evens out chemical imbalances that cause major depression.
Amoxapine and amitriptyline may be among the most commonly prescribed tricyclic antidepressants. However, critical differences may make one a better choice for you.
According to MayoClinic, major depressive disorder—also called clinical depression—is a pervasive feeling of sadness, numbness, or loss of interest in daily life. You may have difficulty caring for yourself or maintaining relationships, trouble sleeping, little to no appetite, or even angry outbursts fueled by frustration and fatigue.
While depression often results from external events, tricyclic antidepressants like Amitriptyline and amoxapine are most often prescribed to treat endogenous, or internalized, depression. This kind of depression happens when the brain doesn’t produce enough serotonin and norepinephrine.
Tricyclic medications are among the most effective at increasing these neurotransmitters in the brain and alleviating the symptoms of major depression.
Amitriptyline, or its brand name Elavil, is also prescribed to treat insomnia and nerve pain. It’s usually prescribed in much lower doses to treat these conditions, between 10mg and 25mg. However, those taking it for insomnia may experience daytime drowsiness.
Healthcare providers sometimes prescribe medications off-label to treat conditions outside the FDA-approved use. This is a common practice, especially if other medications don’t work or are contraindicated for certain individuals.
Amitriptyline can be prescribed off-label to treat:
Amoxapine—brand-name Asendin—is only FDA-approved to treat clinical or major depression. All other uses are off-label.
Medical professionals may prescribe amoxapine off-label to treat:
Amoxapine is the generic name for Adensin, a tricyclic antidepressant frequently prescribed to treat depression caused by an internal chemical imbalance. Because of its high likelihood of side effects and contraindications, it’s often used as a last resort for those resistant to other types of antidepressants.
Amoxapine is available as tablets color-coded according to dosage, as follows:
Dosage usually begins at 25mg. If the patient tolerates the medication well, the dosage is gradually increased to between 200 and 300mg. Some individuals may need up to 400mg, but no prescription should be higher than this.
The most common side effects of amoxapine include:
Amoxapine can interact adversely with many drugs and supplements, including:
Since amoxapine is a generic medication, it’s available at lower prices. Depending on your insurance coverage and available discounts, a one-month supply may cost between $71 and $20.
Amitriptyline is the generic name for Elavil, which is also a tricyclic antidepressant. It has many of the same effects and uses as amoxapine, though it has more bothersome side effects than amoxapine. It can also be used to treat nerve pain and insomnia.
Amitriptyline comes in tablets that are color-coded to indicate the dosage, as follows:
Patients typically start with a dose of 20 to 50mg per day—to be taken at bedtime—and gradually increase their dosage to between 150 and 300mg per day. The dosage should not exceed 300mg.
Side effects result from your body acclimating to a new medication. Many are temporary and diminish or disappear entirely after a few weeks. However, if your side effects become debilitating, contact your healthcare provider immediately.
The most common side effects of amitriptyline include:
Drug interactions occur when one medication interacts adversely with other medications or supplements you’re already taking. Amitriptyline may increase the effects of your other medications or vice versa, placing your health at risk.
Amitriptyline is contraindicated for combination with many drugs and supplements, including:
Because it’s the generic version of Elavil, amitriptyline is relatively inexpensive. Depending on your insurance coverage and available discounts, a 30-day supply may cost between $25 and $4.
Yes, all tricyclic drugs used to treat major depression are controlled substances and require a prescription to take them. Individuals taking this class of antidepressants are also usually closely monitored by their healthcare providers to ensure they’re tolerating the medication well and are not experiencing cognitive side effects like suicidal ideation.
Though every tricyclic drug is a little different, they all have similar effects on the brain and share specific side effects. Some of these side effects include:
These drugs may also lead to more significant concerns, such as those described below.
Serotonin is a neurotransmitter that regulates everything from mood and sleep cycles to wound healing and bone health. Having the right amount is crucial to optimum health. However, antidepressants can sometimes increase serotonin in the brain to dangerous levels, resulting in serotonin syndrome.
Common symptoms include anxiety, nausea, tremors, irregular heartbeat, or seizures. Left untreated, it can be fatal. If you experience any of these symptoms, contact your healthcare provider immediately.
Tricyclics may harm your baby if you’re pregnant or breastfeeding while taking these medications. Neonatal infants exposed to these drugs in the womb may be born with a dependency on them, which places their health at risk. These medications are also metabolized into breast milk and may have unknown effects on breastfeeding infants and children.
While tricyclics may not be indicated for bleeding risk when taken alone, they can interact with other medications and increase the likelihood of excessive bleeding. This is especially true if you take blood pressure medications or other antidepressants.
If you have major depression and believe that antidepressants could help, find a provider on Klarity today for simple and affordable online depression treatment. In just 48 hours, you’ll be speaking with a medical professional virtually to discuss your symptoms and determine if medications like Amoxapine, Amitriptyline are right for you.
Though all tricyclic medications are in the same class of drugs and work similarly in the body, they’re not all the same drug. Each formula is a little different to help ensure there are safe options for as many people as possible.
Amoxapine has proven effective in alleviating anxiety disorder, but it hasn’t yet undergone the rigorous testing needed to be FDA-approved for that use.
Both medications can alleviate the symptoms of anxiety. However, amoxapine is prescribed more often because it’s less likely to cause daytime drowsiness than amitriptyline.
Which medication is right for you depends on several factors, including other medications or conditions you may have. Your healthcare provider can review your medical history with you and help you decide which medication to try.
You should avoid driving or operating other heavy machinery until you know how these medications will affect you. They may cause daytime sleepiness, which causes an impaired ability to concentrate.
No. Drinking on TCAs is much different than other antidepressants, so be sure to speak with your medical provider about alcohol usage when you’re taking these medications.. Alcohol increases the effects of these drugs and may make it hazardous to drive or cause a fatal chemical reaction in the brain.
Since both medications may cause mild to moderate drowsiness, it’s best to take them at night, an hour or so before you intend to go to bed.
Sources:
“Amoxapine.” Rx List.
https://www.rxlist.com/amoxapine-drug.htm#description
John P. Cunha. “Elavil.” Rx List.
https://www.rxlist.com/elavil-drug.htm#description
Sanjai Sinha. “Amitriptyline.” Drugs.com.
https://www.drugs.com/amitriptyline.html#side-effects
“Asendin (Oral).” Drugs.com.
https://www.drugs.com/cons/asendin.html
“Compare Amoxapine vs. Elavil.” Iodine.
https://www.iodine.com/compare/amoxapine-vs-elavil
Mayo Clinic Staff. “Tricyclic Antidepressants and Tetracyclic Antidepressants.” Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983
Craig Sawchuk. “Depression (Major Depressive Disorder).” Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
“Serotonin Syndrome.” Cleveland Clinic.
https://my.clevelandclinic.org/health/diseases/17687-serotonin-syndrome
Seth Gordon. “Amitriptyline: Off-Label Uses For Certain Types Of Pain.” RO Health Guide.
https://ro.co/health-guide/amitriptyline-for-pain/#wait-what-is-off-label-is-that-dangerous
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