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amitriptyline and alzheimers


Posted by tod

is there a contraindication in the use of amitriptyline in persons with alzheimer's disease?
 
Answers (3)
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No real contraindication, but generally there are newer meds that are better. It depends on what it is taken for. It is an old, old antidepressant, it is used for sleep, for chronic pain, and rarely for depression. It does have a lot of side effects. One big issue is that it has some anticholinergic activity as a side effect. This may tend to cause more cognitive slowing in someone with dementia, so it might not be the best med. It can also cause constipation and urinary retention. Not so much of a problem in younger people, but it may be a problem in elderly whom are more sensative to meds. 

Some elderly people have been on this med usually low dose for many years, for one reason or another.  Sometimes it is hard to get off the med, it is not addicting, but people can get a lot or rebound effects after years of use, like insomnia if the med is abruptly stopped.

So generally speaking it is a med I just would not use in someone with dementia. There are better safer meds out there, that can be used for all the possible things amitriptylene would be used for.

Amitriptyline appears it "may" be the best possible choice, for some.  I agree variable reactions to the drug, and some of its specific side effects, might  prove it is not a good choice for others, and you should discuss the risks carefully with your doctor. 

However, the ability of Amitriptyline to function as both an antidepressant and a sleep aid becomes very useful when the disease has progressed to the stage that makes uninterrupted sleep difficult.  Then, given it  is useful in addressing mutiple problems, the fact it is an "old" drug is, for some, among its most useful features, given that means it is available from WalMart as a prescription that costs only $4 to fill.

The unique fact that, alone among the antidepressants, the molecule also functions as a direct mimic of Nerve Growth Factor, also suggests it may provide a direct benefit in combatting the course of progression of the disease, through a neuroprotective effect that may help limit neuron cell death. 

See, for instance, the Wikipedia entry for the drug: 

 "Recently, amitriptyline has been demonstrated to act as an agonist of the TrkA and TrkB receptors. It promotes the heterodimerization of these proteins in the absence of NGF and has potent neurotrophic activity both in-vivo and in-vitro in mouse models."[19]

19.  ^ Jang; Liu, X.; Chan, C.; Weinshenker, D.; Hall, R.; Xiao, G.; Ye, K. (2009).

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2844702

Chemistry & biology 16 (6): 644–656. :.  


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