Switching from Amitriptyline to Escitalopram (or any other SSRI)

[KrustyTheKat]

I’ve been on Amitriptyline for a few years at 25mg. I’ve recently decreased dose to 20mg and I really want to switch to an SSRI (escitalopram in particular).

Just wanted to know if anyone has made the switch and if you needed to come off the first med completely then wait and start the second med after a wait period or were you able to just do a direct switch?

I’m see my GP next week but just wanted some advice now.

I switched from amytriptyline to duloxetine, I did a direct switch.

No issues.

@Octavia64 That’s good to hear. Can I ask what dose Amitriptyline you were on when you switched? Thanks

I was on 50mg.

Hope you don't mind if I follow this OP. I have been on a low dose of tricyclic clomipramine for a number of years but after a relapse a couple of months ago I increased my dose to 75mg.
Unfortunately I haven't been able to sleep at all on this dose (not sure why - the insomnia wore off quite quickly when I took this dose before.)
Anyway have been told to reduce again to 50mg but if can't resolve may need to switch.
Is there a reason why you would like to come off the amitriptyline?

How have you found duloxetine @Octavia64

@kizziee Hi, I want to come off the Amitriptyline as it’s causing more harm than good. I find it just “dries me out”, I have constipation, dry eyes, dry mouth (causing dental problems), some urine retention and elevated heart rate, it’s not actually helping my anxiety/IBS so there’s no point.

I’m hoping to just do a straight switch to an SSRI.

Fo you know what meds you might switch to?

@KrustyTheKat that makes complete sense. The tricyclics do have significant side effects. Worth it if they are helping - but as you say, if not working for you then really not pleasant.
I don't know if I'll be switching yet (ideally I won't because I'm very sensitive to medications and changes) but I know it's a possibility. Escitalopram and sertraline have both been mentioned.

Ps. @KrustyTheKat 25mg amitriptyline is quite a low dose so you may be getting all side effects without any benefits (although problem as you probably know is that if you increase dose you're likely to get more side effects too.)

@kizziee Yes I’m sensitive to medications too which is why I didn’t want to increase the Amitriptyline dose if I’m getting all these symptoms from just 25mg.

Thats also why I’m hoping for a straight swap so I can (hopefully) lessen the side effects of completely coming off Amitriptyline and then starting a new AD (I know start ups can be rough)

I know this isn't an answer to your question, but is there a reason you're looking to go onto Escitalopram specifically? I ask because I was on Escitalopram for four months before switching to Sertraline (currently not taking any SSRIs any longer). Curious to know what your doctor or nurse has told you about the benefits of going on Escitalopram vs other SSRIs.

@filingmonotype I was taking citalopram years ago which really helped my mood and anxiety but then I came off of it.

When I tried to go back on it a few years ago the initial side effects were so horrendous I stopped. A GP (not my usual one) advised I try Amitriptyline.

My usual GP has since advised trying Escitalopram as he said it’s like Citalopram but a better version which may have less side effects and is very good for anxiety.

Did you find Escitalopram unhelpful? I know quite a few people who are on Sertraline and are doing well but they’ve all said the initial side effects are really bad and I just can’t deal with that.

@KrustyTheKat Escitalopram did not work for me. I found it difficult to cope with the side-effects: nausea, sexual dysfunction, inability to focus on anything such as work-related tasks or reading a book, and I felt that at any point in the day I would fall asleep. It did work very well for managing my anxiety and depression (to a point), and I slept incredibly well when I took it. But my inability to focus on important tasks at work and being unable to enjoy a book in my spare time were the two main factors in deciding to go on Sertraline instead. I had far fewer side-effects while taking Sertraline, although the nausea and sexual dysfunction were still problems. I eventually tapered off it because I didn’t feel like myself anymore, and wanted to try other routines to manage my depression and anxiety. One very positive outcome of going on SSRIs for me was that they did give me the boost I needed to start doing things like maintain a gym routine, which I’ve found difficult to do in the past.

@filingmonotype did the nausea last for the whole of the 4 months (and also the time you were on sertraline.)
Do you mind sharing what doses you took?

@kizziee the nausea was persistent the whole time I took Escitalopram. It was one of the reasons I stopped taking it, because I really hate feeling nauseous. I started on a 10mg/day dosage for the first eight weeks. I then spoke with my GP to explain that I wasn't really feeling any different. They increased my dosage to 20mg/day and then it started to lower my anxiety and depressive moods, but then also I began feeling incredibly tired all the time.

When I changed to Sertraline the nausea went away after a few weeks. I was on 50mg/day for the Sertraline during the four months I took it before I started tapering off.

Thank you @filingmonotype

Ps @filingmonotype it's good to see that even if they didn't help overall the medication helped you towards other ways to manage your depression.

UPDATE:
I spoke with my GP and he has suggested I drop to 10 mg Amitriptyline and start 2.5mg escitalopram for 1-2 weeks. Then 5mg Amitriptyline and 5mg escitalopram for 1-2 weeks then no Amitriptyline and 10mg escitalopram. All of these timelines can be extended if I suffer withdrawal side effects.

That's good that you have a timeline but also that the Dr is being flexible so that you can respond to how you feel.
Hope it all goes well.

You won't get withdrawal, not at that dose. I think cross-tapering like that, you'll be fine.

I did the opposite and switched from an SSRI onto Amitriptyline. No problem at all. Though I think coming off the Amitriptyline might be more of a problem as I've had it a long time at a high dosage but I'll cross that bridge when I need to.

@kizziee I will start my new meds tomorrow so fingers crossed I’m ok. Have you actually reduced your medication yet? If you have how do you feel?

@Heartsnrainbows Thanks for the encouraging words, I’m hopeful things shouldn’t be too bad at those low doses, but even if they are I have to persevere with it.

Good luck @KrustyTheKat I’m on sertraline and trying to wean myself off as there’s a link between taking ssris and bone fractures and I don’t want to risk it with a family history or oesteoperosis. My dr just told me to wean off sertraline and use beta blockers as and when I need for panic attacks. It’s interesting that there are so many approaches. He said that any non ssri AD had such shitty side effects they’re not worth it.

@Onekidnoclue Thanks. How are you getting on weaning off? Will you replace it with something else?

Best of luck @KrustyTheKat
(I have started a reduction to see if that helps the sleep.)

The worst you'll likely get is a few days of headache and foggy brain. Good luck!

I’m hoping not to replace the sertraline with anything except beta blockers or Valium for anxiety. All the ssris and snris have the same links to bone issues and the older style ADs scare me with the potential side effects