Amitriptyline (Elavil) versus ...

Based on "Essential Psychopharmacology"
written by Stephen M. Stahl, MD, PhD

Amitriptyline vs Desipramine (Norpramin)

Postherpetic neuralgia
Desipramine appears to produce the greater reduction in pain intensity. Clinically meaningful pain relief (moderate or better) is significantly more likely with desipramine than with amitriptyline 7.

Amitriptyline vs Capsaicin

Painful diabetic neuropathy
Topical capsaicin and oral amitriptyline produce equal and significant improvements in pain. However, topically applied capsaicin is considerably safer alternative to amitriptyline for relief of diabetic neuropathy pain and, unlike amitriptyline, does not cause systemic side effects 8.

Amitriptyline vs Trazodone

Major depressive disorder
Amitriptyline and trazodone are both effective but not statistically different from each other in terms of antidepressant action 2.

Neurotic depression
Amitriptyline is less effective than trazodone in the treatment of neurotic depression 18. Significant improvement may be noted with trazodone within the first 7 days of treatment.

Side effects
Amitriptyline produces significantly higher weight gains than Trazodone 1.
Amitriptyline has the effects on the electrocardiograph and on systolic time intervals consistent with its proven anticholinergic and quinidine-like properties. Trazodone, in contrast, has no quinidine-like effects and minor effects on systolic time intervals 3.
Both produce impairments on memory tasks. However, the effect of amitriptyline is significantly greater and may reflect its anticholinergic action over and above global sedative effects 16.
The study demonstrated that information processing, attention, and visual-motor skills are more adversely affected by amitriptyline 17.

Amitriptyline vs Divalproate

Migraine prophylaxis
Divalproate ER is more effective during first 3 months than amitriptyline in migraine33. However after 6 months, both are equally effective in migraine prophylaxis.

Side effects
Hair fall, menstrual irregularity, polycystic ovary, and weight gain occur more frequently with Divalproate ER33.


Further reading
  • 1. Hecht Orzack M, Cole JO, Friedman L, Bird M, McEachern J. Weight changes in antidepressants: a comparison of amitriptyline and trazodone. Neuropsychobiology. 1986;15 Suppl 1:28-30. PubMed
  • 2. Kerr TA, McClelland HA, Stephens DA, Ankier SI. A comparative clinical and predictive study. Acta Psychiatr Scand. 1984 Dec;70(6):573-7. PubMed
  • 3. van de Merwe TJ, Silverstone T, Ankier SI, Warrington SJ, Turner P. A double-blind non-crossover placebo-controlled study between group comparison of trazodone and amitriptyline on cardiovascular function in major depressive disorder. Psychopathology. 1984;17 Suppl 2:64-76. PubMed
  • 7. Rowbotham MC, Reisner LA, Davies PS, Fields HL. Treatment response in antidepressant-nai"ve postherpetic neuralgia patients: double-blind, randomized trial. J Pain. 2005 Nov;6(11):741-6. PubMed
  • 8. Biesbroeck R, Bril V, Hollander P, Kabadi U, Schwartz S, Singh SP, Ward WK, Bernstein JE. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Adv Ther. 1995 Mar-Apr;12(2):111-20. PubMed
  • 16. Sakulsripong M, Curran HV, Lader M. Does tolerance develop to the sedative and amnesic effects of antidepressants? A comparison of amitriptyline, trazodone and placebo. Eur J Clin Pharmacol. 1991;40(1):43-8.
  • 17. Burns M, Moskowitz H, Jaffe J. A comparison of the effects of trazodone and amitriptyline on skills performance by geriatric subjects. J Clin Psychiatry. 1986 May;47(5):252-4. PubMed
  • 18. Goldberg HL, Finnerty RJ. Trazodone in the treatment of neurotic depression. J Clin Psychiatry. 1980 Dec;41(12 Pt 1):430-4. PubMed
  • 33. Kalita J, Bhoi SK, Misra UK. Amitriptyline vs divalproate in migraine prophylaxis: a randomized controlled trial. Acta Neurol Scand. 2013 Jul;128(1):65-72.

Published: March 31, 2008
Last reviewed: May 14, 2017


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