Amitriptyline (Elavil) a Tricyclic Antidepressant (TCA) used in the Treatment of Major Depression

Sun, 17 Aug 2025 21:00:55 +0000

Dr. Pagnani of Rittenhouse Psychiatric Associates discusses Amitriptyline (Elavil) a tricyclic antidepressant (TCA) that has been used in psychiatry to treat depression since about 1960. Tricyclic antidepressants are not as commonly used as some other antidepressant medications (like SSRIs and SNRIs) as they tend to carry increased risks for side effects (including, but not limited to, cardiac arrhythmias, increased intra-ocular pressure, dry mouth, constipation, urinary retention, sedation, orthostatic hypotension, tachycardia and others). Amitriptyline is also FDA approved for use in neuropathic pain, post-herpetic neuralgia, fibromyalgia and migraine headache prophylaxis. If an individual develops suicidal thoughts while taking an antidepressant (or at any time, whether they take a medication or not) they need to seek immediate medical attention. TCAs, like amitriptyline or Elavil) can be extremely effective (with all of this being said) and for some individuals who do not respond to other treatment modalities, they can be an important next step for the treatment of their depression.

Dr. Pagnani is the founder and medical director of Rittenhouse Psychiatric Associates, an Instructor at The Johns Hopkins Hospital for the Department of Psychiatry, he supervises psychiatric residents at Jefferson Hospital, he serves on the Young Professional Board of Uplift, the Center for Grieving Children and he maintains a private practice of Psychiatry in Philadelphia where he sees patients for one-time psychiatric evaluations and second opinions. He is a licensed physician and surgeon in NJ, PA, NY, MD, DE, FL and CA and can provide consultations to individuals via HIPAA compliant Telehealth visits living in these locations.

Rittenhouse Psychiatric Associates is a private practice of psychiatry consisting of about 25 psychiatrists, psychiatric nurse practitioners and psychotherapists with physical locations in Philadelphia and Paoli, PA and serving all of PA, NJ, NY and FL virtually via HIPAA compliant tele-psychiatry. Individuals seeking not only evaluations but long-term psychiatric care, can contact Rittenhouse Psychiatric Associates directly.

These videos aim to increase awareness and discussion of mental health topics and to encourage struggling individuals to schedule an appointment directly with a mental health provider. Mental health needs to be normalized, and simply speaking about mental health topics openly, is an important first step.

Dr. Pagnani and Rittenhouse Psychiatric Associates are NOT advocating for or against the use of any mentioned psychiatric medications for any specific individual. Additionally, any side effects mentioned are not a complete list of potential side effects or contraindications to taking any mentioned medications, and all risks and benefits of a medication should be discussed with an individual’s provider at an appointment, before starting, stopping or making changes to a medication regimen.

This video is INFORMATIVE ONLY - NOT MEDICAL ADVICE.

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