Elavil (amitriptyline) alternatives: What can I take instead of amitriptyline?

Used to treat depression, this generic TCA doesn't work for everyone, but there are other options available

By Stephanie Melby, Pharm.D. | Sep. 11, 2024

Key takeaways

Amitriptyline is a prescription medication used to treat depression.
Other common off-label uses of amitriptyline include fibromyalgia, migraine prevention, and nerve pain.
Amitriptyline can cause dry mouth, dizziness, blurred vision, confusion, tiredness, and weight gain, which can be unwanted side effects and prompt the need for an alternative medication.
Alternative depression medications include selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants.

In this article:

Compare amitriptyline alternatives
Cymbalta
Prozac
Effexor
Remeron
Pamelor

In this article

Compare amitriptyline alternatives
Cymbalta
Prozac
Effexor
Remeron
Pamelor

Amitriptyline (formerly available under the brand name Elavil) is a generic prescription medication used to treat depression. Additionally, amitriptyline can treat a variety of off-label conditions (not approved by the FDA), including fibromyalgia (a chronic pain and fatigue disorder), migraine prevention, chronic headache prevention, and nerve pain. Amitriptyline is currently only available as an oral tablet. This medication belongs to a drug class called tricyclic antidepressants (also called TCAs). TCAs work by increasing the chemicals serotonin and norepinephrine in the body, which can regulate mood, attention, and pain. TCAs, like amitriptyline, can cause significant side effects because of how they work in the body on a variety of receptors.

While an effective treatment for some people, amitriptyline may not be the best and safest treatment for everyone, treating depression or another off-label medical condition. People with concerns of an increased risk of side effects may consider alternative medications. Common side effects of amitriptyline include constipation, dry mouth, dizziness, blurred vision, confusion, increased heart rate, tiredness, increased appetite, and weight gain. This medication may also worsen cardiovascular complications such as dangerous arrhythmias (irregular heartbeats). People with epilepsy may experience an increased risk of seizures, so amitriptyline should be used cautiously in those individuals. Additionally, TCAs like amitriptyline have a higher risk of overdose compared to other classes of antidepressants.

What can I take in place of amitriptyline?

There are other options available to treat depression and other off-label conditions that do not improve with amitriptyline. Depending on the condition being treated, these alternative medications can include other tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), atypical antidepressants, and monoamine oxidase inhibitors (MAOIs). For some off-label uses, cyclobenzaprine, Lyrica (pregabalin) or Savella (milnacipran) can be used. These options may suit certain individuals due to their different uses, side effect profiles, and dosages.

Compare amitriptyline alternatives
Drug name	Uses	Dosage	Savings options
Amitriptyline	Major depressive disorder (unipolar) Fibromyalgia Chronic headache prevention (tension-type) Interstitial cystitis (bladder pain syndrome) Irritable bowel syndrome-associated pain Migraine prevention Myofascial pain syndrome Nonradicular neck pain Neuropathic pain, chronic (including diabetic neuropathy) Postherpetic neuralgia	Take 50 to 150 mg by mouth per day	Amitriptyline coupons
Celexa (citalopram)	Major depressive disorder (unipolar) Generalized anxiety disorder Panic disorder Post-traumatic stress disorder (PTSD) Binge eating disorder Obsessive-compulsive disorder (OCD) Vasomotor symptoms associated with menopause	Take 10 to 40 mg by mouth once daily	Celexa coupons
Cyclobenzaprine	Muscle spasm Fibromyalgia	Take 5 to 30 mg by mouth per day	Cyclobenzaprine coupons
Cymbalta (duloxetine)	Generalized anxiety disorder Major depressive disorder (unipolar) Chronic musculoskeletal pain Fibromyalgia Neuropathic pain associated with diabetes mellitus Migraine prevention	Take 60 to 120 mg by mouth once daily	Cymbalta coupons
Effexor (venlafaxine)	Generalized anxiety disorder Major depressive disorder (unipolar) Panic disorder Social anxiety disorder Migraine prevention Neuropathic pain associated with diabetes mellitus Obsessive-compulsive disorder (OCD) Post-traumatic stress disorder Premenstrual dysphoric disorder Vasomotor symptoms associated with menopause	Take 37.5 mg to 225 mg by mouth once daily	Effexor coupons
Lyrica (pregabalin)	Fibromyalgia Neuropathic pain associated with diabetic peripheral neuropathy and spinal cord injury Postherpetic neuralgia Focal onset seizures Generalized anxiety disorders Restless leg syndrome	Take 75 to 600 mg by mouth in divided doses per day	Lyrica coupons
Pamelor (nortriptyline)	Major depressive disorder (unipolar) Chronic headache prevention (tension-type) Irritable bowel syndrome-associated pain Migraine prevention Nonradicular neck pain Neuropathic pain, including diabetic neuropathy Postherpetic neuralgia	Take 25 to 150 mg by mouth once daily or in divided doses	Pamelor coupons
Prozac (fluoxetine)	Major depressive disorder (unipolar) Panic disorder Bipolar disorder Obsessive-compulsive disorder (OCD) Bulimia nervosa Premenstrual dysphoric disorder Generalized anxiety disorder Post-traumatic stress disorder (PTSD) Social anxiety disorder Fibromyalgia	Take 10 to 60 mg by mouth once daily	Prozac coupons
Remeron (mirtazapine)	Major depressive disorder (unipolar) Chronic headache prevention (tension-type) Panic disorder	Take 15 to 45 mg by mouth once daily at bedtime	Remeron coupons
Savella (milnacipran)	Fibromyalgia Major depressive disorder	Take 50 to 100 mg by mouth twice daily	Savella coupons
Wellbutrin (bupropion)	Major depressive disorder (unipolar) Seasonal affective disorder Smoking cessation Bipolar disorder	Take 100 to 450 mg by mouth per day in divided doses for 12-hour formulations and once daily for 24-hour formulations	Wellbutrin coupons
Zoloft (sertraline)	Major depressive disorder (unipolar) Panic disorder Obsessive-compulsive disorder (OCD) Post-traumatic stress disorder (PTSD) Social anxiety disorder Premenstrual dysphoric disorder Generalized anxiety disorder	Take 25 to 200 mg by mouth once daily	Zoloft coupons

Other alternatives to amitriptyline

Other alternatives for treating depression include other TCAs, SSRIs, SNRIs, atypical antidepressants, and MAOIs.

Other Tricyclic Antidepressants (TCAs):

Doxepin
Imipramine
Norpramin (desipramine)

Other Selective Serotonin Reuptake Inhibitors (SSRIs):

Fluvoxamine
Lexapro (escitalopram)
Paxil (paroxetine)

Other Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs):

Fetzima (levomilnacipran)
Pristiq (desvenlafaxine)

Atypical Antidepressants:

Trazodone
Trintellix (vortioxetine)
Viibryd (vilazodone)

Monoamine Oxidase Inhibitors (MAOIs):

Emsam (selegiline)
Marplan (isocarboxazid)
Nardil (phenelzine)
Parnate (tranylcypromine)

Top 5 amitriptyline alternatives

The following are some of the most common alternatives to amitriptyline.

1. Cymbalta (duloxetine)

Cymbalta is a brand-name medication available as a generic called duloxetine. Cymbalta is an SNRI. Like amitriptyline, this alternative can be used to treat depression, fibromyalgia, nerve pain, and migraines (prevention). Additionally, duloxetine can be used for anxiety disorder and chronic musculoskeletal pain. The recommendations for the treatment of depression typically prefer an SSRI or SNRI, such as duloxetine, because TCAs have significantly more side effects.

Furthermore, duloxetine is effective for treating fibromyalgia and is recommended in guidelines. Duloxetine is typically taken once daily; common side effects include nausea, drowsiness, fatigue, dry mouth, and headache. Cymbalta (duloxetine) may be a suitable alternative for those who have not experienced improved symptoms with amitriptyline for depression, fibromyalgia, or migraine prevention.

2. Prozac (fluoxetine)

Prozac is a brand-name medication that is also conveniently available as a generic medication called fluoxetine. Prozac is another common type of antidepressant that is an SSRI. Prozac can also treat depression and fibromyalgia. This medication can treat several other medical conditions, including bipolar disorder, bulimia nervosa, obsessive-compulsive disorder, and panic disorder. As mentioned, the recommendations for the treatment of depression typically prefer an SSRI or SNRI, such as fluoxetine. Fluoxetine is also effective for treating fibromyalgia. This medication is conveniently taken once per day, and common side effects include nausea, diarrhea, drowsiness, headache, trouble sleeping, dry mouth, and sexual dysfunction. Prozac may be a well-suited alternative for those who cannot tolerate side effects associated with amitriptyline.

3. Effexor (venlafaxine)

Effexor is another brand name of an SNRI antidepressant that is also available as a generic called venlafaxine. Venlafaxine can treat depression and be used for migraine prevention, just like amitriptyline. Venlafaxine can also be used for several other conditions, including generalized anxiety disorder, panic disorder, nerve pain associated with diabetes, obsessive-compulsive disorder, and symptoms of menopause. Like other SNRIs and SSRIs, venlafaxine is an SNRI that is included as a preferred option in the recommendations for the treatment of depression. The American Headache Society states venlafaxine is a reasonable treatment option for migraine prevention. Depending on the formulation, this medication can be taken once per day or two to three times per day. Common adverse effects include nausea, increased sweating, diarrhea, dizziness, drowsiness, trouble sleeping, and dry mouth. Venlafaxine may be an appropriate alternative for those who are treating depression or trying to prevent migraines.

4. Remeron (mirtazapine)

Remeron is a brand-name medication that is available as a generic drug called mirtazapine. Mirtazapine is considered an atypical antidepressant and works differently from other antidepressant drugs to treat depression. Mirtazapine is used to treat depression and prevent chronic headaches like amitriptyline. It can also be used for panic disorder. While mirtazapine used for preventing chronic headaches does not have as much clinical data available as some other medications, mirtazapine may help lower the number of headaches and has fewer side effects than amitriptyline. Mirtazapine is an effective treatment for depression and can be taken once per day, usually at bedtime. Common side effects include drowsiness, constipation, increased appetite, dry mouth, and weight gain. Mirtazapine may be a reasonable alternative for those who have not experienced improved symptoms of depression or chronic headaches with amitriptyline.

5. Pamelor (nortriptyline)

Pamelor is a brand name TCA, like amitriptyline, also available as a generic medication called nortriptyline. Nortriptyline can be used for depression and several other conditions, including migraine prevention, chronic headache prevention, and nerve pain. The American Headache Society recommends both amitriptyline and nortriptyline as TCA treatment options for migraine prevention. Nortriptyline has similar side effects as amitriptyline, including nausea, drowsiness, dry mouth, dizziness, blurred vision, confusion, and constipation. Nortriptyline is available as an oral capsule and an oral liquid for those who have difficulty swallowing tablets and capsules.

Natural alternatives to amitriptyline

Alternative remedies for amitriptyline used for depression include lifestyle changes and therapy that can improve mood and overall well-being. Some treatments include cognitive behavioral therapy and regular exercise.

Depression guidelines emphasize the importance of therapy in addition to drug treatment. The American Psychological Association states cognitive behavioral therapy (CBT) is a form of psychological treatment that leads to significant improvement in functioning and quality of life in several mental health conditions. This type of therapy can help identify thinking patterns that cause distress to manage overwhelming emotions and unhelpful behaviors.

Exercise activities such as yoga, tai chi, aerobics, and resistance training can improve depression symptoms. A recent clinical study evaluated the effect exercise has on depression symptoms and found that walking, jogging, yoga, and strength training moderately reduced depression, particularly when the activity was higher in intensity.

Exercise is also an alternative remedy used for fibromyalgia and is often considered the most effective treatment. Activities that can be helpful include yoga, tai chi, or other low-impact aerobic exercises. Additionally, acupuncture, chiropractic therapy, and massage may help ease fibromyalgia symptoms.

How to switch to an amitriptyline alternative

1. Discuss all health conditions with a healthcare provider

Before switching from amitriptyline to an alternative, a healthcare provider must know all medical history and conditions. Some alternatives should be used with caution or avoided with certain medical conditions.

2. Do not suddenly stop taking amitriptyline without medical advice

Only stop taking amitriptyline if the healthcare provider has been consulted and given instructions to stop the medication. People who stop amitriptyline suddenly may notice an increase in symptoms and experience adverse effects such as dizziness, headache, feeling restless, and flu-like symptoms. Make a plan with the healthcare provider to either slowly discontinue the medication or lower the dose gradually to discontinuation.

3. Discuss all prescription and over-the-counter medications with a healthcare provider

Before switching from amitriptyline to an alternative, a healthcare provider must review a complete medication list, including prescription drugs, OTC (over-the-counter) medications, and supplements. Certain alternatives have dangerous drug interactions that must be avoided.