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.

@KrustyTheKat how is it going ?

@kizziee Hi, it’s going surprisingly well so far.

I’ve managed to get down to 5mg Amitriptyline and 5mg Escitalopram. I’ve had one episode of feeling a bit nauseous and my anxiety spiked but that’s it. I’m just hoping it doesn’t get any worse as time goes on.
How is your reduction going?

That's good to hear @KrustyTheKat

I reduced to 60mg which helped the sleep but unfortunately anxiety and depression have really increased. Very difficult to function.

Just waiting to hear if Dr advises increasing back to 75mg or looking to switch to something else. (I've been on this medication a long time on lower doses until the relapse so very nervous of a switch.)

@kizziee It’s so hard finding the right medication at the right dose. Really hope you get a resolution soon 🙏🏼

UPDATE:
Thought I’d update this thread. I’m now taking 5mg Amitriptyline and 5mg Escitalopram and I feel awful!

I’ve developed horrible heartburn, nausea and stomach cramps. I spoke to my GP and he thinks it might be the Escitalopram and has prescribed me Lansoprazole.

Im reluctant to take it as the side effects can be nausea and diarrhoea! My stomach is so sensitive I’m scared this will happen to me. I tried Gaviscon tablets which taste horrible and made me feel really sick but I could only stomach one and your meant to take 2-4, so it didn’t do much.

Im so fed up with it all. I have no idea what medication is causing these symptoms and I’m not sure whether it will subside after a while or not.

Any advise anyone?

Oh no. What a nightmare. How long after starting the escitalopram did you get symptoms?
would you consider citalopram? Or sertraline?
they’re both ssris. Escitalopram is an SNRI. so it blocks reuptake of both seratonin and nor adrenaline.
aside from the bone issue (which is rare and a particular concern given my awful bone density) I’ve thought sertraline was magic and would really recommend esp for anxiety.
hope you find a fix.

@Onekidnoclue Thanks for your reply.
As I understand it Escitalopram is a SSRI?

The symptoms have been going be for about 2 weeks, I know it’s not long but it’s a daily occurrence so I’m just feeling really fed up with it! I think I did the whole reduction and cross-tapering process too quickly.

I’ve been on Citalopram in the past for a few years and it worked really well until it stopped being effective.

I’m really scared to try Sertraline as I know quite a few people who have tried it and had horrible digestive issues, which is my big fear!

I take both

@KrustyTheKat really sorry you are having these issues. Do you think there might be a bit of withdrawal going on too (which will hopefully ease.) I know what you mean re it being really difficult to know what is causing what. I hope it all settles really soon.

Ps have you tried gaviscon liquid instead of tablets ?

@PrincessHoneysuckle Do you mind sharing what dose you’re on for both? My GP said I can take both but they need to be at a very low dose

@kizziee Yes I think there is withdrawal going on but who really knows?

Looking at other forums people withdrawing from Amitriptyline seem to have a lot of nausea and heartburn as a symptom.

I’m definitely going to buy some liquid Gaviscon.

Having both is interesting. Surely as they’re both ssris they work the same way? I don’t understand the benefits. Might be me being thick though, happens a lot!

You’re right. Escitalopram is an ssri. I was thinking of venoflaxine which is a snri. Friend went onto it after citalopram didn’t work any more. She has severe ibs and has been fine but clearly a sample of one.
ive Found the coming off sertraline awful and stopped after tapping to 50. Was considering going back up but I’ve found out I’ve go hypo thyroid and turns out sertraline stops the replacement thyroxine being absorbed so I do really need to come off it but can’t face it. God this is a pain in the arse!!!

This link is helpful for an overview of switching between different antidepressants.
https://cks.nice.org.uk/topics/depression/prescribing-information/switching-antidepressants/#from-a-tca

A low dose of amitriptyline is probably having a very mild sedative effect and not doing much else tbh. Antidepressant doses need to be much higher.

If I was weaning off amitriptyline and got to 25mg I'd try alternate days for a week or two before stopping or if that caused any issues go down to 2x 10mg and reduce more slowly from there.

Once you are on such a low dose of amitriptyline you can start escitalopram and stop the amitriptyline over the following week.

@AltitudeCheck Thanks for the info.

I think I tapered off too quickly and I was even thinking of going back to maybe 10mg amitriptyline and see if I feel better before tapering down really slowly.