January 26, 2023

Many patients are prescribed both SSRI medications and tricyclics / TCAs at the same time. Commonly, tricyclics are used in non-psychiatric / low doses (“low dose TCAs”) to alleviate neuropathic and functional concerns including functional dyspepsia, IBS, migraines, diabetic neuropathy, and other complaints.

Hey guys welcome back to my youtube channel this is daniel rossell here i’m bringing you this video today uh from not my usual location i’m bringing it to you from rural usa i’m out here in connecticut for another week visiting in-laws and really enjoying a little bit of break from the traffic and incessant honking and noise and chaos in jerusalem it’s good to be

Uh good to be somewhere else for a little while um i’m making this video this is putting about putting it up on my youtube channel but it’s very different from most of my content i did previously try to set up a different youtube channel just for talking about mental health stuff and then i realized that if anyone actually comments on those videos i’m never going

To see the comments because i never log into like anything except this youtube channel so i figured whatever my main youtube channel is already such a random array of topics and information i’ll just uh just go on contributing to the chaos so what i want to talk about today is my one month update uh taking lexapro and amitriptyline together now the reason i make

This video you know from any mental health video i posted today is the intention my intention in recording it has been to help people because i know that when i was thinking about starting amitriptyline after already taking lexapro i was extremely nervous about the idea of going on a cocktail of antidepressants i was reading so much stuff about serotonin syndrome

I was super super worried about it to be honest and so far i have not had any problems and i’ve heard from both my doctor my family doctor and the gastro who added the amitriptyline the tons of people are on this combination basically if your doctor says it’s safe my advice and this is not medical advice my advice would be listen to your doctor it probably is safe

They’re not interested in losing their medical license by prescribing reckless drug combinations so this prevented me this fear of of taking these two different um types of antidepressants really kept me from even trying amitriptyline for a year and then i made a few unsuccessful attempts to get on amitriptyline and now i’m finally on it so um that’s why i made

This video after one month because i’ve got to the two week point on amitriptyline a few times and i found the fatigue like just too much and i mentioned in the first video when i talked about starting these drugs it’s only because of drug a lexapro that my anxiety is a lot lower and i was able to get into that mind space of saying you know what this fatigue i’m

Feeling from starting drug b i mean trip to lynn is kind of scary but it’s probably going to pass and i don’t think i could have gotten on drug b without drug a so let me talk about um i’m just assuming that folks anyone who’s stumbled onto this video hasn’t done so because they follow me on youtube you’ve just typed in lexapro amitriptyline into youtube and you

Found this video so i’m just going to give you a very very quick um run through of why i personally am prescribed these two drugs so drug a the lexapro is um for as probably i think a lot of people take it anxiety and depression it’s something i’ve been struggling with depression particularly for a long long time i think probably most of my life but it was only

After having my gallbladder surgery three years ago that i got into a point of feeling like i was stuck down some kind of a in a bad place essentially and that’s gonna segue nicely into why i’m taking drug b so drug b is for all those problems from gallbladder surgery so i know a lot of most people have their gallbladders removed um and they are totally a-okay

And that is fantastic you know i’m not trying to scare anyone away from having it but there is a substantial uh percentage of patients who go on wake up from surgery to have these new issues and that was my case i’ve had what’s called functional dyspepsia and it doesn’t sound like such a bad thing it sounds like burping if you just take away the functional word

And just focus on this pepsi alright it means like burping and bloating and all this but it has kind of really really impacted my quality of life and got to the point where you know i was kind of any anything would cause it for me like water i would drink water and my stomach would just like have a life of its own it would just like blow it out like that and you

Know it got to the point where i was scared to drink water i was scared to eat because all the foods and by the way i wasn’t i never have suffered from um an eating disorder to the to the extent that i never like stopped eating i ate anyway because i love foods but it was an incredible dinner and that was kind of after two years of well maybe a year and a half of

Um having no relief and i was like my gastro telling me this will get better and then nothing getting better i was like okay i’m firstly i need to try to figure something out b i’m now really really depressed and i need to work on the depression so that was actually what got me in the door of a psychiatrist’s office and why i started taking lexapro was i was just

At this such a down point of feeling overwhelmed by just my body it was like a different i like woke up from the surgery with a different digestive system that just didn’t know how to process foods um i went to psychiatrists and i’m just going to say this not to diss this particular psychiatrist but just to warn people the psychiatrist i went to sorry i went to

A gastro first the gastro prescribes amitriptyline i never took it didn’t start the meds then went to psychiatrists i was like well i’m super depressed and the psychiatrist was extremely anti-taking amitriptyline even though the amitriptyline was prescribed for a non-psychiatric issue and i’m just saying this again to warn people you may run into this psychiatrist

Thinking because it’s a psych-med tricyclic antidepressant it’s only since about 2013 to what i found out what i’ve figured out on google earth to the best of my knowledge that low-dose tricyclics have become a big thing in gastroenterology they’re used for treating functional gi problems like functional dyspepsia and also ibs so maybe my psychiatrist didn’t know

That but he told me you know what forget amitriptyline this is an old drug we don’t use it anymore shred your gastros prescription i’m going to start you out on lexapro lexapro is going to solve all your problems it’s going to solve your it’s going to take take away the anxiety depression in your stomach will be perfect i waited for four months on the laxapro worked

My way up to 20 milligrams which is the maximum dosage and it didn’t i wouldn’t say nothing for my stomach it just didn’t do a lot for my stomach it took away some of the nausea that this kind of weird uh nausea i’ve been having since the surgery which if you’ve had your gallbladder out you might know what i’m talking about it’s a weird kind of nausea that really

Lingers it’s not bad enough that you throw up but it just kind of sits there um so it did actually help with that but i was still like bloating after literally everything so this particular doctor basically refused to uh prescribe me tripling or work with my gastro so i went back to my family doctor and i said look i’m suffering to an insane extent i don’t

Want to stop the lexapro because living with less anxiety and depression has been amazing and they know that both anxiety and depression are major contributory things to stomach problems but it’s not it hasn’t solved the problem i need to take something else or something in addition so he said just take amitriptyline so my the difference between the psych and

My family doctor is my family doctor and i don’t mean this in an ageist way he’s a younger guy maybe in his i think 40s 30s and he he was very well versed on the use of low-dose tricyclics um i told him look if you need me to see a psychiatrist to approve this combination do that he said no it’s totally fine um in the end i actually did because i was too anxious

And the psychiatrist also said it’s fine so here’s what i’m taking currently i’m taking 20 milligrams of ciprelax sorry alexa pro in the morning for anxiety depression that’s my mental health medication and since the last month i’ve also been taking 20 milligrams or two of these little pills per day of amitriptyline and i take the amitriptyline at nighttime because

Anyone who takes this drug knows it is a sedating kind of drug the effect kind of goes away over time but definitely for the hour or two after you take it it puts you into this kind of slightly sleepy state it’s actually kind of a pleasant state like when you’re you know tired from the day and ready to go to bed and amitriptyline’s commonly prescribed off label

For sleep disorders so um how’s it been has this helped with my stomach things i think it’s helping a little my doctor told me you need to give this three months like a solid three months of uh of time before saying you want to come off it you want to try something else so that’s my intention um i’m definitely something i’ve been struggling with and sorry for all

These gross details part of my dyspepsia has been this feeling that i can’t burp it’s bizarre it’s like the air comes up and gets stuck somewhere around here in my throat and that reflex to like get the air out doesn’t happen and i get all bloated i’ve also since a gallbladder surgery and my doctor says maybe it’s some like vagus nerve damage and he’s not a like

Naturopath he’s a like gastroenterologist at a teaching hospital so i don’t think he’s a quack in any way um i’ve also i’ve also started having these weird burps like sometimes i’ll drink soda and a burp will just come out and i’m like what so my system’s gone a bit wacky but that hasn’t been happening as much with the amitriptyline in terms of the combo side

Effects while you know amitriptyline is there is a reason why psychiatry moved from these types of drugs these tricyclics to these types of drugs these ssris and that’s because the tricyclics tend to have much more side effects so you have fatigue you can have urinary retention something i just read is sun exposure i did not read the whole patient i’ve never you

May notice i have a vague beet red color going on so that’s either from not putting on a high enough factor or the amitriptyline i live in israel so i never get i rarely get like kind of reddish like this so i’m thinking maybe i need to take more care with sun exposure because of the amitriptyline basically there’s been no interactions um i don’t feel like

There’s anything weird going on since i’ve started this combination and it’s definitely helped so i’ve read on a facebook group for amy tripling people taking amateur trips and some people take 20 amitriptyline and even 35 of uh sorry 20 milligrams of lexapro and 35 of amitriptyline so the impression i’ve got is that there is wiggle room in terms of um you

Know the level you get to before stuff like serotonin syndrome becomes a real concern but that the good news is that that’s something that doctors know how to manage and um you know i don’t i don’t think i need to repeat the disclaimer because there’s no way you can get these medications without going to a doctor and they’ll be able to weigh up the possibility

I was told by three doctors and again there’s my anxiety saying maybe this guy is is risky maybe this guy’s risky i get a third opinion fourth opinion three different doctors told me that um lots of like he has lost my family doctor for one told me he’s lots of his patients are taking exactly what i’m taking the lacto-pro for you know something like depression

And amitriptyline for the low-dose amitriptyline for the lots of uses people make of that that tends to be a lot of pain disorders people with migraines fibromyal fibromyalgia diabetic pain these older antidepressants seem to have different properties that they’re still using and i think that’s actually great because in one sense drug drugs have evolved in the

Other sense they’re not saying and these older drugs are much cheaper they’re all generics now so i actually think it’s amazing that medicine is continuing to make use of these older medications and sometimes co-prescribing them along with the newer ones for mental health problems that don’t have as many side effects so yeah i’ve been really happy so far i’m kind

Of bummed as usual that i let my anxiety delay this process by two years but i thought i’d put this up on youtube just in case anyone is um on these two meds or worried about taking ace a ssri and a tricyclic and by the way there’s a few acids aries of course and there’s a few tricyclics and ssris you also have prozac zoloft paxil and then i mean in the tricycle

Class you have nortriptyline immune i don’t know there’s a bunch of other more ones i’m leaving out so i hope this video was useful if you are in that place of worrying about these combos and stuff like that um and yeah thanks for watching and um i might post maybe after uh six months on these two drugs or a year i’ll do another review if i’m still taking them

Thanks for watching and have a very good day

Transcribed from video
Lexapro (escitalopram) and Elavil (amitriptyline): 4 weeks' update By Daniel Rosehill