Amytriptyline (Elavil)

ELAVIL AMITRIPTYLINEAmytriptyline or Elavil  is…

A commonly used tricyclic ‘antidepressant’ that blocks serotonin and norepinephrine uptake leaving more of those neurotransmitters available for use in the central nervous system. (Serotonin is often referred to as the ‘good feeling’ chemical).

Like several other ‘antidepressants’ Elavil used to treat many symptoms other than depression including insomnia, migraine, PTSD, a number of ‘central sensitivity syndromes’ (fibromyalgia, irritable bowel syndrome, interstitial cytisus, vulvodynia), peripheral neuropathy, multiple sclerosis. It has been on the market since 1983.

Amytrityline May Be Beneficial In Chronic Fatigue Syndrome (ME/CFS) Because…

It can increase the levels of neurotransmitters (serotonin, dopamine) that may be low in some patients. It may also increase patient’s pain thresholds by increasing central nervous system norepinephrine levels. It is often used to assist with sleep.

Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia Studies

A 2012 fibromyalgia study had mixed results.  Amytriptyline reduced symptom and anxiety scores and increased blood flows but failed to effect autonomic activity and reactivity. A 2011 Cochrane report found that amytriptyline was superior to duloxetine and milnacipran in reducing pain, sleep disturbances and fatigue in FM but they noted that the study quality was low.  A 2011 review of drugs for fibromyalgia  found that amytriptyline had similar effects on pain and fatigue as duloxetine, milnacipran, and pregabalin.

Chronic Fatigue Syndrome (ME/CFS) Doctors Report

Dr. Lapp noted that antidepressants, including Elavil, were useful in improving sleep, energy levels and cognition and in reducing pain in many of his patients.  Dr. Lapp stated that while Elavil does induce sleep it can reduce the amount of deep sleep one enters into, possibly impairing its long term effectiveness.


as with many medications of this type ME/CFS patients often respond well to much lower doses than are traditionally used. Dr. Lapp recommends starting at 1/3 to 1/2 (or even lower) the recommended dose. The IACFS/ME Treatment Primer  recommends the dose be taken 5 hours before bedtime.

Sleep treatments for ME/CFS from Phoenix RisingThe Sleep Series on Phoenix Rising


Pain Med. 2012 Jan;13(1):131-6. doi: 10.1111/j.1526-4637.2011.01286.x. Epub 2011 Dec 5. Effect of low-dose amitriptyline on autonomic functions and peripheral blood flow infibromyalgia: a pilot study.Kulshreshtha PGupta RYadav RKBijlani RLDeepak KK.

Drug Class Review: Drugs for Fibromyalgia: Final Original Report [Internet]. Editors Smith BPeterson KFu RMcDonagh MThakurta SDrug Class Reviews.

Rheumatology (Oxford). 2011 Mar;50(3):532-43. Epub 2010 Nov 14.Comparative efficacy and acceptability of amitriptyline, duloxetine and milnacipran infibromyalgia syndrome: a systematic review with meta-analysis. Häuser WPetzke FÜçeyler NSommer C.





Charles Lapp. 2001. Using antidepressants to treat chronic fatigue syndrome.

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