An old antidepressant now used mostly at low doses for nerve pain, migraine prevention and sleep.
Explained by a GMC-registered GP, not a leaflet
Honest about what we can and cannot prescribe remotely
Side effects given the same weight as benefits
Your NHS records in the room, with your consent
Care led personally by Dr Khan
Attentive, unhurried care that listens properly
Five-star Google reviews from the people we have looked after
Registered with the Care Quality Commission
Amitriptyline is a tricyclic antidepressant, now used far more often at low doses for entirely different purposes.
It was developed in the 1950s and has largely been superseded as an antidepressant by SSRIs, which are safer in overdose and better tolerated. What kept it in use is that at doses a fraction of the antidepressant range it modulates how pain signals are processed in the spinal cord and brain.
Antidepressant doses are typically 75 to 150mg. Nerve pain and migraine prevention usually use 10 to 50mg — which is why finding "antidepressant" on the leaflet alarms people who were prescribed it for shingles pain.
Ordinary painkillers work poorly for nerve pain. That is not a failure of dose — the pain arises from the nerve itself rather than from tissue damage, and needs a drug that acts on nerve signalling.
Take it in the evening, two to three hours before bed rather than at bedtime. Taking it too late is the commonest reason people feel drowsy the next morning and abandon it.
Drowsiness and dry mouth are common in the first one to two weeks and usually settle. Knowing that in advance is what gets most people through to the point where it helps.
It is dangerous in overdose, considerably more so than SSRIs — relevant when there is any risk of self-harm.
In older adults it is used cautiously and at lower doses, because confusion, falls and urinary retention are all more likely.
No routine blood monitoring is needed at low dose. An ECG is considered at higher doses or where there is cardiac history.
Yes, at low dose for nerve pain, migraine prevention or associated sleep difficulty, where the picture is clear and the cause has been established.
What we would want first is a diagnosis rather than a symptom. Nerve pain has a cause, and prescribing for it without knowing the cause is treating the alarm rather than the fire.
We do not initiate amitriptyline at antidepressant doses remotely. That is a different medicine at a different dose with different risks, and it warrants face-to-face assessment.
Amitriptyline is a cheap generic, and low-dose treatment costs very little — often less than the England NHS prescription charge on a private prescription.
It comes as tablets and as an oral solution, which is useful for fine dose adjustment at the low end.
Stopping suddenly after regular use can cause headache, nausea, restlessness, sleep disturbance and vivid dreams. This is discontinuation, not addiction — but it is unpleasant and avoidable.
Reduce gradually over several weeks, more slowly if symptoms appear.
Give it four to six weeks at an adequate dose first. Most people who say it did not work stopped at 10mg after ten days.
Alternatives for nerve pain include duloxetine, and gabapentin or pregabalin — though we do not initiate gabapentinoids remotely, as they are controlled drugs with recognised misuse potential.
Nortriptyline is a related drug that is often less sedating and may suit people troubled mainly by drowsiness.
Because at low dose it changes how the nervous system processes pain signals, and that is a separate effect from its antidepressant action. A 10mg dose is nowhere near an antidepressant dose. It does not mean anyone thinks the pain is psychological.
Almost always because it is taken too late. Move it to two or three hours before bed. If that does not fix it, the dose is likely too high for you — lower doses often work just as well for pain.
Two to six weeks at an adequate dose. Sleep often improves within days, which is encouraging but is not the pain effect.
It can, and this is a genuine reason people stop. Worth raising rather than tolerating — alternatives exist.
Alcohol adds to the drowsiness considerably. Small amounts are usually manageable once established, but not while the dose is being increased, and not before driving.
No. It causes discontinuation symptoms if stopped suddenly, but it is not habit-forming and there is no craving or dose escalation.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 30, 2026
On this page
Ongoing
Time to be seen
Appointment length
Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
Cost
Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
Yes, your full record
Not routinely
Usually
Free
Same day
Often 10 to 15 minutes
Usually not
Sometimes charged
Varies by provider
Often a subscription
Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
Patient reviews