Dealing with depression is challenging, and the number of different types of antidepressants can make finding the right treatment overwhelming. If you have tried first-line antidepressant treatment and haven’t had success, you might be considering different antidepressant drugs to treat your depression symptoms.
Tofranil and amitriptyline are two tricyclic antidepressants that can be prescribed to treat depression symptoms when first-line depression treatments like SSRIs have failed. In this post, we’ll explore the many similarities and differences between these two different antidepressant treatments.
- How tricyclic antidepressants work
- What each medication treats
- What each medication costs
- Common doses and directions for each medication
- Side effects, drug warnings, and potential interactions for each medication
- Plus, we’ll address some frequently asked questions regarding each medication
If you have treatment-resistant depression or are looking to switch your current antidepressant medications, Klarity can help you take the right steps toward improving your mental health.
Klarity can connect you with a healthcare provider who will help you receive a depression diagnosis and treatment. To get started, take our brief self-assessment, and we’ll connect you with a provider in 48 hours or less.
|Drug Class||Tricyclic antidepressant||Tricyclic antidepressant|
|Brand / Generic Status||Generic (Brand name: Silenor)||Generic (Brand name: Elavil)|
|Form(s) of the Drug||Immediate-release tablets |
• Shapes indicate dosage
|• Immediate-release color-coded tablets
• Yellow, fruit-flavored liquid suspension
|Standard Dosage||Immediate-release tablets: |
• 10mg triangular tablet
• 25mg small round tablet
• 50mg large round tablet
|Immediate-release color-coded tablets
• 10mg per dose
|Conditions Treated||FDA-approved uses:|
• Major depressive disorder
• Nerve Pain
• Panic Disorder
• Irritable bowel syndrome (IBS)
• Enuresis in children
• Major depressive disorder
• Anxiety disorder
• Chronic fibromyalgia pain
• Nerve pain
• Sleep disorders
• Bladder pain
• Irritable bowel syndrome
|Cost||Generic form (imipramine): |
• $10 for a 30-day supply
• $430 for a 30-day supply
|Generic form (amitriptyline):
• $140 to $300 for a 30-day supply
• $4 for a 30-day supply with insurance or coupon card
|Side-Effects||Common side effects: |
• Mood/behavior changes
• Difficulty sleeping
• Agitation, hostility, and aggression
• Increased depression and suicidal thoughts
• Blurred vision
• Pain or difficulty urinating
• Difficulties with sex
• Nausea and vomiting
|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
|Warnings For Use||Drug interactions: |
• Blood pressure medication
• Valproic acid
• Thyroid supplements
• Many other antidepressants: SSRIs
• Type 1C antiarrhythmics
• MAO inhibitors
• Thyroid medication
• Alcohol, barbiturates and other CNS depressants
• Anticholinergic drugs
Amitriptyline and Tofranil Are the Same Class of Drugs (Tricyclic Antidepressants)
Tricyclic antidepressants are among the earliest antidepressants developed. They continue to be prescribed when more modern antidepressant drugs fail to work for patients with worsening depression or treatment-resistant depression.
This group of antidepressants increases levels of serotonin and other neurotransmitters in the brain; however, the mechanism for how they do this varies.Most antidepressants, including SSRIs, SNRIs, and tricyclics, work by increasing neurotransmitter levels and blocking the reabsorption of serotonin and norepinephrine, chemicals in the brain that regulate mood.
However, tricyclics cannot target neurotransmitters precisely, so they affect other receptors all over the body and can cause more side effects than SSRIs and SNRI antidepressants. Tricyclic antidepressants are nonselective and more modern antidepressant treatments are selective. (It’s in the name—SSRI stands for selective serotonin reuptake inhibitor)
Cyclic antidepressants are named after the number of rings in their chemical structure, so tricyclics are antidepressants with three (tri-) rings as opposed to tetracyclines with a four-ringed chemical structure.
Amitriptyline and Tofranil Are Both Used To Treat Major Depressive Disorder
Major depressive disorder is caused by a chemical imbalance in the brain, commonly a lack of serotonin and norepinephrine, which negatively impacts neuron communication. Neurotransmitters relay messages from one neuron to another, and when certain neurotransmitters are not able to do what they’re supposed to, it can affect how you feel and lead to depressive illness.
Serotonin and norepinephrine are neurotransmitters that significantly impact your mood, and if they cannot communicate properly, it can lead to much mental health and even physical concerns. When your brain has too much serotonin and norepinephrine, it can cause anxiety disorders, and when there is too little of these neurotransmitters, individuals can experience depression.
Tricyclic antidepressants like amitriptyline and Tofranil treat major depressive disorder by preventing the reabsorption, or reuptake, of serotonin and norepinephrine, so there is enough present in the brain to facilitate regular communication between neurons. By restoring levels of these neurotransmitters, patients who take amitriptyline and Tofranil can see an improvement in their depression symptoms.
What Else Does Amitriptyline Treat?
Amitriptyline can treat various other conditions, and although these uses are off-label, a medical professional may prescribe it to treat the symptoms of conditions such as anxiety or migraines. Consult with a professional about amitriptyline’s other uses.
Off-label Uses for Amitriptyline
- Irritable bowel syndrome (IBS)
- Diabetic neuropathy
- Postherpetic neuralgia or post-shingles skin pain
- Post-traumatic stress disorder (PTSD)
- Sialorrhea or excessive saliva flow
- Interstitial cystitis or bladder pain syndrome
What Else Does Tofranil Treat?
Tofranil can treat many of the same off-label conditions that amitriptyline treats; however, there are a few additional conditions that physicians will prescribe Tofranil as treatment.
Off-label Uses for Tofranil
- Nerve Pain
- Panic Disorder
- Irritable bowel syndrome (IBS)
- Enuresis in children
Doses, Dosage Form, and Side Effects of Tofranil
Common Tofranil Doses and Forms
Tofranil comes in tablet form, in 10 mg, 25 mg, and 50 mg doses. Dosage begins low, usually around 50-75 mg/day, and increases to as much as 150 mg/day. A dosage higher than 200 mg/day for outpatients is not recommended.
Common Tofranil Side Effects
Tofranil has some similar side effects as other tricyclics, in addition to others. Common side effects of Tofranil can include:
- Mood/behavior changes
- Difficulty sleeping
- Agitation, hostility, and aggression
- Increased depression and suicidal thoughts
- Blurred vision
- Pain or difficulty urinating
- Difficulties with sex
- Nausea and vomiting
Common Tofranil Drug Interactions
Taking Tofranil with MAO inhibitors (an antidepressant) can have serious and sometimes fatal results, and when taken with SSRIs or SNRIs the chances of serotonin syndrome increase. Tofranil may interact with certain medications for high blood pressure, anticholinergics, digoxin, disopyramide, valproic acid, and thyroid supplements.
Speak with a professional about any medication you are taking before starting Tofranil, and do not start any new medicines without consulting a medical provider.
How Much Does Tofranil Cost?
For a 30-day supply of 25 mg tablets, Tofranil costs around $430. For the generic version, which is called imipramine, patients pay around $10 for the same supply.
Doses, Dosage Form, and Side Effects of Amitriptyline
Common Amitriptyline Doses and Forms
Amitriptyline comes in tablet form and is available in multiple sizes. Depending on the patient, a doctor may prescribe the following sizes: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, or 150 mg.
When medical professionals prescribe amitriptyline, they will likely start at a smaller dose, around 25-50 mg once a day, and are recommended to be taken before bed. The doses will increase every 5-7 days until a final dose is reached, usually around 100-200 mg daily.
Common Amitriptyline Side Effects
Several side effects are possible when patients take amitriptyline. Most common include:
- Dry mouth
- Physical weakness
- Excessive sweating
- Blurred vision
- Changes in weight
- Changes in appetite
- Urinary retention
Common Amitriptyline Drug Interactions
Patients taking Amitriptyline should avoid certain drugs while on the medication, including blood thinners, MAO inhibitors, medications that make you drowsy, and any other substances that increase serotonin levels.
How Much Does Amitriptyline Cost?
For a 28-day supply of amitriptyline under a generic brand, patients without insurance can expect to pay about $13, and those with insurance can expect a price of around $5.
Licensed providers on Klarity provide personalized mental health treatment. Find a provider that matches your needs and preferences.
Do I Need A Prescription for Amitriptyline or Tofranil?
Yes, you will need a prescription from a qualified medical provider to take both amitriptyline and Tofranil. A medical provider can help determine which antidepressant is the best option for you. Klarity can connect you with a mental health professional who can diagnose and prescribe antidepressant treatment.
Other Tricyclic Side Effects
Antidepressants that alter neurotransmitters can seriously affect a patient’s mind and body, so it is crucial to understand the side effects of taking any tricyclic antidepressant.
In rare cases, tricyclic antidepressants like amitriptyline and Tofranil can cause increased suicidal thoughts in children, teens, and young adults. Discuss this risk with your medical provider before taking either.
If you are experiencing suicidal thoughts, immediately reach out to the Suicide Prevention Lifeline by calling 988.
What is Serotonin Syndrome?
Serotonin syndrome is another possible severe side effect when taking an antidepressant that elevates serotonin levels. When these medications cause too much serotonin to build up in the brain, it can cause serotonin syndrome. Serotonin syndrome causes shivering and diarrhea, and in more severe cases, seizures, muscle rigidity, fever, and death.
When patients begin taking or increasing the dosage of an antidepressant that increases serotonin levels, such as SSRIs, SNRIs, and tricyclics, they will need to monitor for signs of serotonin syndrome. These symptoms will usually show up within the first few hours.
Pregnancy and Breastfeeding on Tricyclics
Although some tricyclics can pass through the breast milk at low levels, studies have shown that it is harmless, and none has been reported concerning Tofranil or amitriptyline. Women who are pregnant or breastfeeding are generally considered safe to take tricyclics, but they should be used with caution, as they can potentially cause low birth weight, preterm birth, respiratory distress, or withdrawal syndrome after birth.
Increased Bleeding Risk With Tricyclics
There is no evidence to suggest that when taken alone, tricyclics increase bleeding. However, when taken with blood thinners, tricyclics can increase the effect of blood thinners.
Tofranil and Amitriptyline Frequently Asked Questions
Below are frequently asked questions about Tofranil and amitriptyline:
What is Tofranil?
Tofranil is a brand name for the drug imipramine, which is a tricyclic antidepressant with additional off-label uses.
What is Amitriptyline?
amitriptyline is a tricyclic antidepressant used to treat depression and other conditions, including nerve pain and migraines.
Are Tofranil, Amitriptyline, and other Tricyclics the same drug?
Although Tofranil, amitriptyline, and other tricyclic antidepressants are similar, they are not the same drug. Tofranil and amitriptyline have similar side effects, as well as off-label uses; however, there are differences in both as well.
Why is Tofranil an off-label treatment for anxiety?
Tofranil is a tricyclic antidepressant with off-label use for treating anxiety because it elevates levels of serotonin and norepinephrine, which help the brain and body function normally.
What’s better for anxiety? Tofranil or Amitriptyline?
Tofranil and amitriptyline can be prescribed to treat anxiety; however, in general, neither are as effective as medication that is designed to treat anxiety.
What’s better for depression? Tofranil or Amitriptyline?
The effectiveness of Tofranil and amitriptyline depends on the individual and their medical history, which a healthcare provider would evaluate to determine which medication to try.
Can I drive on antidepressants like Tofranil or Amitriptyline?
You can drive on antidepressants such as Tofranil and amitriptyline. However, they can cause drowsiness and other side effects that could impair driving ability. Before operating any heavy machinery, it is important to understand how the medication affects you.
Can I drink alcohol on Tofranil or Amitriptyline?
Alcohol can increase the severity of certain side effects, including worsening depression and anxiety. Therefore, it is not recommended that patients combine alcohol and tricyclic antidepressants.
Does it matter what time of day I take Tofranil or Amitriptyline?
Many clinicians will recommend patients take Tofranil or amitriptyline in the evening before bed to avoid side effects such as drowsiness impacting their day.
Find the Right Medication to Treat Your Depression On Klarity
If first-line antidepressants failed to treat your depression, then you may want to consider treatment with amitriptyline or Tofranil. When you book an appointment on Klarity, you can speak to a medical provider who can diagnose and treat depression. Receive professional care with no insurance needed, no subscription, and no hidden fees. We offer access to depression treatment that is convenient and accessible to everyone. Schedule an appointment today through our online contact portal and be seen by a medical provider within 48 hours.
“Amitriptyline HCL – Uses, Side Effects, and More.” WebMD. https://www.webmd.com/drugs/2/drug-8611/amitriptyline-oral/details
“Compare Elavil vs. Tofranil.” Iodine. https://www.iodine.com/compare/elavil-vs-tofranil
“Tofranil.” Medical News. https://www.news-medical.net/drugs/Tofranil.aspx
“Tricyclic antidepressants and tetracyclic antidepressants.” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/antidepressants/art-20046983