Lauri: Anticholinergic Effects of Amitriptyline?

[Lauri]

How long do the anticholinergic side effects of amitriptyline last once the drug has been washed out? Are some of these permanent? I am especially concerned about urinary retention and constipation, for which I am taking Flomax (off-label since I am a woman) and OTC meds. I am currently tapering from 7-8 years of 75-100mg of amitriptyline; the plan is: 100mg, 75mg, 50mg, 33.3mg, 25mg,15mg, 10mg, 5mg - reducing every fourteen days. The dose is currently 33.3mg and so far so good, no uncomfortable reactions except for extremely lucid dreams, but these are diminishing. I plan to take Flomax until I am completely off amitriptyline, unless the urinary retention is permanent. Lord, I hope not. Does anyone have experience with this? Many thanks.

[Altostrata]

Welcome, Lauri. I moved your first post here since it introduces your situation.

 

Have you noticed any change in the urinary retention issue since you've been reducing?

[Lauri]

No, but I probably won't see a difference until I quit taking Flomax. The retention was quite severe and it immediately alleviated the symptoms (three years ago). The symptoms did worsen when my amitriptyline dose was increased from 75mg to 100 mg last fall, so in hindsight, I guess the symptoms have abated since then. My primary concern was whether or not drug-induced urinary retention was permanent. Flomax is an alpha-blocker, and there is absolutely no good reason for me to be on it except for the retention. I didn't want to become discouraged if, once I am clean of the amitriptyline, I still have symptoms of retention for X number of weeks.

[Altostrata]

Being an alpha blocker, Flomax may be alleviating withdrawal symptoms.

 

If I were you, I'd take my time tapering off Flonase after the amitriptyline is done.

 

We don't have that many people here on tricyclics. Not sure if we can answer the question about long-lasting urinary retention. Livestrong has this info on long-term effects http://www.livestrong.com/article/257262-the-long-term-side-effects-of-amitriptyline/ -- but I don't know how reliable that info is, it's a secondary source, an interpretation of other sources.

 

Very good to hear your withdrawal symptoms are minimal.

 

Has your doctor been helpful with your tapering?

[Lauri]

Thank you for your questions and encouragement, and the link.

 

I never thought about tapering Flomax - great question for my urologist, who is also aware of the anticholinergic side effects of amitriptyline (amitriptyline is also prescribed for urinary incontinence - who knew)so he will be very supportive.

 

My doctor (GP), who I like very much, doesn't seem very knowledgable about anti-depressant withdrawal; and in fact supported my decision to quit cold turkey last summer. After three days of frightening nightmares and panic and no sleep, I assumed that I really did need to be on the drug. She increased the dose to 100mg. Same story as many of you, I think. I had been researching withdrawal for months before finally deciding to do it on my own in late 2011. My friends and family are aware and supportive, and are also on the lookout for unusual behavior. My greatest support, however, has been reading forums like these, and various books by Breggin, Greenberg, Kirsch, Icarus Project, etc. My doctor did agree to write a prescription for the drug in 25mg and 10mg dosages in order to make the taper easier, so she is aware that this is what I am doing. Frankly, I am probably a bit of a coward and don't want to convince her that I know what is best for me, although I have no doubt that she would also be supportive. I am prepared for the eventuality that the withdrawal symptoms may become distressing, and so I do feel that I could go see her at any time. I have been fortunate so far.

 

I am grateful for everyone on this forum. The information about tapering has been indispensable.

[alexjuice]

My doctor (GP), who I like very much, doesn't seem very knowledgable about anti-depressant withdrawal; and in fact supported my decision to quit cold turkey last summer.

 

Hi Lauri,

 

I've found that doctors who specialize in administering anti-depressants (psychiatrists) are not very knowledgable about withdrawal. There are a lot of reasons for this which we tend to discuss around here from now and again. This is just the reality of the today in this area, but it's beginning to change.

[Altostrata]

Lauri, is your GP the one who added Flomax to amitriptyline?

 

If so, she doesn't sound like she's very knowledgeable about antidepressants period. You should have been taken off amitriptyline, or at least reduced the dosage, when the urinary retention appeared. It's a pretty serious adverse effect.

 

Good to hear the Flomax has at least alleviated the adverse effect from the amitriptyline. But adding drugs to counter adverse effects of other drugs is a road to more adverse effects.

[Lauri]

But adding drugs to counter adverse effects of other drugs is a road to more adverse effects.

 

Quite right; I guess it just took me awhile to get that into my stubborn head. It's easy to normalize something that isn't immediately incapacitating.