Breakthrough Symptoms on Amitriptyline

Hi! Hope this is the right category. Advice, please!
I’m worried I might be heading for a full-on relapse and not sure how to prevent it.

  • I was diagnosed in Feb 2021 and put on Amitriptyline.
  • Titrated myself up to 30mg, then down to 25mg about a year ago as my neurologist (had one appt for diagnosis with no follow-up needed) had told me to reduce usage when possible due to amitriptyline becoming less effective);
  • I’ve had a very stressful 12 months but things are resolving now (also been on long-term Fluoxetine 20mg - 40mg for the last 12 yrs);
  • I’ve been getting mild breakthrough symptoms in the last few weeks - whirly-headed when I wake up, daily ‘normal’ headaches (used to have these pre-amitriptyline), occasional neuralgia etc etc;
  • I’ve had 2 quite bad falls (nothing broken) in the last couple of weeks which is highly unusual for me and very possibly due to balance issues.
    So my questions are, please:
    Anything I can do to prevent a full-on relapse?
  • Lots of rest?? (not easy as I help support my 89yo mum and 24yo son who is on a long road to learning to live with severe ADHD and has just moved back in with us)
  • my sleep has been quite disturbed lately but I’m hoping to get a grip on that
  • I’m not sure whether I should increase my amitriptyline or
  • decrease it whilst symptoms still mild to give my brain a break from the ami in the hope that in a few weeks I can increase it again?
    Any advice would be very welcome, please!

Hi Bemahan, sorry to hear you’re struggling. For me, having falls would be a reason to seek professional help again. I say this from experience and hope it doesnt come across badly in any way! I had a relapse after having covid badly in September 21. By the January, I was having regular falls and ended up really hurting myself. I finally went to see my vestibular rehab specialist in March 22 (after someone on this site advised me to seek help) and she sent me straight to my consultant. He upped my Amitriptyline dosage and put me back on Betahistine as that was the combination that had gotten me through my initial vestibular attack. That, combined with regular rehab, as well as the usual lifestyle management (sleep, diet, supplements, walking etc) finally got me through the other side again. I’m not saying that what worked for me will work for you, and I’ve had short relapses that I’ve managed to get through by myself, but I do think that perhaps you should get some advice re the falls. Good luck, hoping you start to feel better soon. This can be rubbish!

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Hi! Thank you so much for taking the time to answer so fully. I’ll speak to my GP as I think she’ll have to re-refer me to Neurology

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Hope you get some answers soon. This condition really can be debilitating. Lots of luck!

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