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Depression

17 min read

Trimipramine vs Amitriptyline

Written by Klarity Editorial Team

Published: Oct 11, 2022

Medically Reviewed by Dr. Zoe Russell

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When you are living with depression, it’s important that you find a treatment that’s going to give you relief from your symptoms. But with all of the antidepressant medications available, it can be difficult to understand which one will be right for you. 

This article explains the similarities and differences between the two tricyclic antidepressants, trimipramine and amitriptyline, so you can be more informed when pursuing the best depression treatment for your needs. 

Licensed providers on Klarity provide personalized treatment. Find a provider that matches your needs and preferences.

If you have depression and want to learn more about your treatment options and whether trimipramine or amitriptyline would be right for you, Klarity can help. We’ll connect you with a licensed healthcare provider in your state for affordable, fast, and simple online depression treatment

Find a provider through Klarity today and within 48 hours, you could begin your journey toward relieving your depression symptoms. 

This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the Suicide Prevention Lifeline immediately at 988.

AmitriptylineTrimipramine
Drug ClassTricyclic antidepressantTricyclic antidepressant

Brand / Generic StatusGeneric (Brand name: Elavil)Generic (Brand name: Surmontil)
Form(s) of the Drug• Tablets
• Yellow, fruit-flavored liquid suspension
• Immediate-release capsules
Standard DosageTablets:
• 10mg
• 25mg
• 50mg
• 75mg
• 100mg
• 150mg

Liquid suspension:
• 10mg per dose
Immediate-release capsules:
• 25 mg
• 50 mg
• 100 mg
Conditions TreatedFDA-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 uses:
• Major depressive disorder

Off-label uses:
• Difficulty sleeping
CostGeneric form (amitriptyline):
• $140 to $300 for a 30-day supply
• $4 for a 30-day supply with insurance or coupon card
Generic (trimipramine):
• $30 to $78 for a 30-day supply

Brand name:
• $160 to $171 for a 30-day supply
Side-EffectsCommon 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:
• Drowsiness, fatigue
• Nausea, vomiting, abdominal cramping, or constipation
• Dry mouth
• Changes in blood pressure
• Blurred vision
• Changes of sensation, such as feeling “pins and needles” in your extremities
• Loss of appetite
• Decreased sex drive
• Headache
• Skin rash

Serious side effects:
• Suicidal thoughts or self-harm behaviors
• Serotonin syndrome
• Signs of heart attack
• Signs of stroke
Warnings For UseDrug interactions:
• Quinidine
• Cimetidine
• Many other antidepressants: SSRIs
• Type 1C antiarrhythmics
• MAO inhibitors
• Thyroid medication
• Alcohol, barbiturates and other CNS depressants
• Anticholinergic drugs
Drug interactions:
• Anticholinergic medications
• MAOIs
• Certain medications for high blood pressure
• Drugs that may increase the level of the medication
• Protease inhibitors
• Drugs that affect heart rhythm
• Motion sickness medication
• SSRIs
• MDMA
• St. John’s wort
• Thyroid medications

Amitriptyline and Trimipramine Are the Same Class of Drugs (Tricyclics)

Tricyclic antidepressants are commonly used today when other forms of antidepressants, like SSRIs and SNRIs, fail to work. All tricyclics work by increasing the levels of serotonin and other neurotransmitters in the brain and blocking the reabsorption of chemicals that regulate mood. However, the mechanism for how different tricyclics work varies with each one. 

Amitriptyline, trimipramine, and other tricyclics cannot target specific neurotransmitters as precisely as other antidepressants that work similarly, so they have the potential to cause more side effects. Tricyclics are among the earliest antidepressants to be developed; however, their effectiveness varies from person to person. 

What Are Tricyclics?

Tricyclics are one of the earliest antidepressants developed and are still used today to treat major depressive disorder and other conditions. Tricyclics are one of several kinds of antidepressants that fall under the category of “cyclic” antidepressants. 

There are many different types of tricyclics, including the following:

  • Amoxapine
  • Trimipramine
  • Vivactil
  • Norpramin
  • Pamelor
  • Amitriptyline

Amitriptyline and Trimipramine Are Both Used To Treat Major Depressive Disorder

Amitriptyline and trimipramine are both tricyclic antidepressants, meaning that they work by increasing neurotransmitter levels in the brain. Certain neurotransmitters like serotonin and norepinephrine help regulate our mood by communicating with other parts of the brain to stimulate or calm us. When the brain lacks the proper amount of these neurotransmitters, it can result in major depressive disorder. 

In some cases, the brain reabsorbs neurotransmitters like serotonin before they are able to send a signal, resulting in low levels in the brain. Antidepressants like amitriptyline and trimipramine prevent this reabsorption, allowing the brain chemicals to function at normal levels and therefore stabilize your mood. 

What Else Does Amitriptyline Treat?

Along with depression, healthcare providers prescribe amitriptyline to treat various conditions, from anxiety to irritable bowel syndrome. This use of amitriptyline is off-label and should always be discussed with a medical provider. 

Off-label Uses for Amitriptyline

  • Anxiety
  • Irritable bowel syndrome (IBS)
  • Insomnia
  • Diabetic neuropathy
  • Fibromyalgia
  • Migraines
  • 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 Trimipramine Treat?

Trimipramine is especially effective in treating depression, especially in cases where a sedative effect is helpful. In addition to depression, trimipramine has off-label uses for treating other conditions. Medical professionals may prescribe trimipramine to treat anxiety. However, these uses are not always FDA-approved, and you should speak with your provider before using trimipramine to treat other conditions.

Off-label Uses for Trimipramine

  • Anxiety 
  • Insomnia
  • Psychotic symptoms

Doses, Dosage Form, and Side Effects of Trimipramine

Common Trimipramine Doses and Forms

Trimipramine comes in 25 mg, 50 mg, and 100 mg capsules. Most patients will start between 50-75 mg a day and gradually increase dosage as needed. It is not advised that adolescents exceed 100 mg a day, but in some cases, adults may increase to up to 300 mg a day. 

Common Trimipramine Side Effects

As with other kinds of tricyclics, trimipramine has many possible side effects. The most common side effects include the following:

  • Nausea, vomiting, diarrhea, and stomach pain
  • Weakness and tiredness
  • Anxiety
  • Confusion
  • Dizziness
  • Headaches
  • Nightmares
  • Change in appetite or weight 
  • Constipation
  • Difficulty or frequent urination
  • Changes in sex drive and ability 
  • Pain, burning, or tingling in the hands or feet

More serious side effects can also occur in patients taking trimipramine. If you experience any of these symptoms, contact a medical professional immediately: 

  • Jaw, neck, and back muscle spasms
  • Fever and sore throat
  • Slow and difficult speech
  • Difficulty breathing or swallowing
  • Yellowing of the eyes or skin
  • Seizures
  • Hallucinations
  • Chest pain or irregular heartbeat.

Common Trimipramine Drug Interactions

If you are currently taking any medication, you should discuss possible interactions these could have with trimipramine. Some drugs that may interact with trimipramine include:

  • Anticholinergics
  • Clonidine
  • Some drugs for high blood pressure
  • Drugs that affect liver enzymes
  • Protease inhibitors
  • Drugs that affect heart rhythm
  • Drugs for motions sickness
  • Thyroid medication. 

In some cases, taking MAO inhibitors with trimipramine can cause serious and sometimes life-threatening drug interactions. You should discuss when to start or stop taking any medications with a medical professional.  

How Much Does Trimipramine Cost?

Prices will vary depending on a patient’s insurance plan. However, for a 30-day supply of 50 mg oral capsules, the price is around $308. 

Doses, Dosage Form, and Side Effects of Amitriptyline

Common Amitriptyline Doses and Forms

Amitriptyline comes in tablet form, and depending on the patient, a healthcare provider may prescribe the following sizes: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, or 150 mg. Usually, medical providers will begin with a smaller dose, then work the dose up every 5-7 days until a final dose is reached. 

Common Amitriptyline Side Effects

Several side effects are possible when patients take amitriptyline and most commonly include: 

  • Nausea
  • Headaches
  • Vomiting
  • Dry mouth
  • Drowsiness
  • Physical weakness
  • Confusion
  • Nightmares
  • Unsteadiness
  • Excessive sweating
  • Confusion
  • Blurred vision
  • Changes in weight
  • Changes in appetite 
  • Constipation
  • Urinary retention  

Common Amitriptyline Drug Interactions

Amitriptyline can have interactions with some drugs that can be serious and even fatal. You should discuss any additional medications with a medical professional. Some common drugs that can have interactions with amitriptyline include blood thinners, MAO inhibitors, medications that make you drowsy, and any other substances that increase serotonin levels. 

How Much Does Amitriptyline Cost?

Under a generic brand, a 28-day supply of amitriptyline will cost about $13 for patients without insurance and around $5 with insurance. 

Do I Need A Prescription for Amitriptyline or Trimipramine?

Yes, you need a healthcare provider to prescribe you both amitriptyline and trimipramine, so you should speak to a medical professional if you think either of these is right for you. Klarity can help connect you with an experienced professional who can prescribe you amitriptyline or trimipramine in as little as 48 hours, if applicable. 

Other Tricyclic Side Effects

It is important to understand the possible side effects of any antidepressant before taking it. Antidepressants like tricyclics work by altering neurotransmitters in the brain, which can have serious effects on the mind and body. In some rare cases, tricyclic antidepressants have been known to cause suicidal thoughts in teens, children, and young adults. 

If you or someone you love is experiencing suicidal thoughts, call 988 immediately to speak with the Suicide Prevention Lifeline. 

What is Serotonin Syndrome?

Tricyclic antidepressants work by increasing serotonin in the brain, which in rare instances, can cause a condition called serotonin syndrome. When tricyclics are taken with other drugs that increase serotonin, like SSRIs and SNRIs, too much serotonin can build up in the brain. Symptoms can include shivering, diarrhea, seizures, muscle rigidity, fever, and death. 

Pregnancy and Breastfeeding on Tricyclics

Women who are breastfeeding or pregnant are generally considered safe to take tricyclics at the same time. In some cases, small amounts of the drug can pass through the breast milk. However, studies have shown that these are low, harmless levels. 

Increased Bleeding Risk With Tricyclics

When tricyclics are taken at the same time as blood thinners, there can be an increase in the effects of the blood thinners. However, when taken alone, tricyclics are not likely to increase bleeding in general. 

Find the Right Medication to Treat Your Depression With Help From Klarity

Trimipramine and amitriptyline are often prescribed to patients whose depression is resistant to other forms of medication. However, due to their high side effect profiles, you should always consult with a medical professional before starting either one. 

If you need a reliable, affordable way to treat your depression with the help of a psychiatric expert, Klarity can help. We’ll connect you with a licensed healthcare provider for simple and effective online depression treatment. 

Your provider can evaluate your symptoms and determine if trimipramine, amitriptyline, or another form of antidepressant is right for you. If applicable, they’ll send a prescription directly to your local pharmacy so you can finally get the relief you deserve. 

Schedule your first appointment on Klarity today and be seen by a healthcare provider in as little as 48 hours. 

Trimipramine and Amitriptyline Frequently Asked Questions

Are Trimipramine, Amitriptyline, and other Tricyclics the same drug?

All tricyclics, including trimipramine and amitriptyline, act in a similar way. However, there are slight differences in the effect that they have on certain neurotransmitters. Different tricyclics may vary in the length of time they remain in the body, how they are metabolized, their interactions with other medications, and their side effects. 

Why is Trimipramine an off-label treatment for anxiety?

Tricyclics like Trimpipramine can be used to treat anxiety because they elevate serotonin and norepinephrine levels to help the brain function regularly.

What’s better for anxiety? Trimipramine or Amitriptyline?

Trimipramine and amitriptyline can be used to treat anxiety, but they are not as effective in general as medication designed to treat anxiety. The effectiveness of any tricyclic antidepressant for treating anxiety will depend on the patient’s personal reaction to the drug. Klarity can put you in contact with a medical provider who can discuss which medication may work best for you. 

What’s better for depression? Trimipramine or Amitriptyline?

Trimipramine and amitriptyline will have varying degrees of effectiveness from patient to patient. A healthcare provider can evaluate a patient’s medical history to determine which medication would be the best to try. 

Can I drive on antidepressants like Trimipramine or Amitriptyline?

Trimipramine has been known to have sedative side effects, so it is always important to understand how the medication works in your body before driving or operating heavy machinery. 

Tricyclic antidepressants such as trimipramine and amitriptyline have been known to cause drowsiness and other side effects that can affect driving ability. However, patients taking them can drive if these symptoms are not an issue.  

Can I drink alcohol on Trimipramine or Amitriptyline?

It is not recommended that patients drink alcohol while taking trimipramine or amitriptyline. Alcohol can increase the severity of side effects and worsen patients’ depression or anxiety. 

Does it matter what time of day I take Trimipramine or Amitriptyline?

Trimipramine and amitriptyline can be taken at any time of the day, but medical providers typically recommend taking them before bed to avoid any drowsiness impacting your daily routine. 

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All professional services are provided by independent private practices via the Klarity technology platform. Klarity Health, Inc. does not provide any medical services.
Fax:
(855) 975-3008

PO Box 5098 Redwood City, CA 94063

100 Broadway Street, Redwood City CA, 94063

logo
All professional services are provided by independent private practices via the Klarity technology platform. Klarity Health, Inc. does not provide any medical services.
If you’re having an emergency or in emotional distress, here are some resources for immediate help: Emergency: Call 911. National Suicide Prevention Hotline: Call 988. Crisis Text Line: Text Home to 741-741
Fax:
(855) 975-3008

PO Box 5098 Redwood City, CA 94063

100 Broadway Street, Redwood City CA, 94063

If you’re having an emergency or in emotional distress, here are some resources for immediate help: Emergency: Call 911. National Suicide Prevention Hotline: Call 988. Crisis Text Line: Text Home to 741-741
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