Amitriptyline versus placebo for major depressive disorder

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Evidence from review shows amitriptyline is an effective treatment for major depressive disorder which is associated with a number of adverse effects.

Amitriptyline is a tricyclic antidepressant that was synthesised in 1960, introduced as early as 1961 in the USA, and still regularly used. This review assesses the effects of amitriptyline compared to placebo or no treatment for major depressive disorder in adults. It includes 39 trials with a total of 3509 participants and confirms amitriptyline efficacy compared to placebo or no treatment. This finding is important, because the efficacy of antidepressants has recently been questioned. However, the review also demonstrated that amitriptyline produces a number of side effects such as vision problems, constipation and sedation. It is a limitation of this review that many studies have been poorly reported, which might have led to bias. As data on death were not reported, this review could not clarify whether amitriptyline increases mortality by its side effects or reduces it by preventing suicides. However, due to its relatively well‐documented efficacy together with its low cost (amitriptyline is available as a generic drug, and inexpensive in at least some countries) amitriptyline should not be forgotten as a treatment option, especially for those patients who have not responded to safer drugs.

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