I am 11 weeks post‑reduction of amitriptyline from 10 mg to 7.5 mg and still have tachycardia, gastrointestinal upset and insomnia; a brief increase back to 10 mg caused tachycardia, shakiness, nausea and intrusive thoughts. Should I try a modest increase to 8 mg or 8.5 mg, or remain at 7.5 mg?

Management of Prolonged Amitriptyline Withdrawal at 11 Weeks Post-Reduction

Primary Recommendation: Stabilize at 7.5 mg Before Any Further Adjustments

Stay at 7.5 mg for at least 4–6 more weeks before attempting any dose increase. Your recent trial of returning to 10 mg triggered new symptoms (racing heart, shakiness, nausea, intrusive thoughts) after only 6 days, indicating your nervous system is still recalibrating and cannot tolerate upward movement yet. 1, 2, 3

Understanding Your Current Situation

Why Symptoms Persist at 11 Weeks

• Antidepressant discontinuation syndrome typically resolves within 1–2 weeks for most patients, but a subset experience protracted withdrawal lasting weeks to months, particularly with tricyclic antidepressants like amitriptyline. 2, 3
• Your improvement in burning feet, nausea, and anxiety demonstrates that your nervous system is healing—just more slowly than average. 1, 4
• The persistence of tachycardia, GI upset, and insomnia at 11 weeks suggests you are in the minority who require extended stabilization time at each dose level. 3, 4

Why the 10 mg Trial Failed

• Reinstatement of the original dose does not always suppress withdrawal symptoms when the nervous system has already begun adapting to the lower dose. 1, 3
• Your body had spent 11 weeks adjusting to 7.5 mg; jumping back to 10 mg likely triggered a paradoxical destabilization rather than symptom relief. 3, 4
• The new symptoms (shakiness, intrusive thoughts) after 6 days at 10 mg represent acute medication intolerance, not withdrawal resolution. 5

Specific Action Plan

Immediate Management (Next 4–6 Weeks)

• Remain at 7.5 mg daily without any dose changes. 3, 4
• Do not attempt 8 mg or 8.5 mg yet—your recent failed trial at 10 mg indicates you need more time to stabilize before any upward titration. 1, 3
• Most discontinuation symptoms are self-limiting and will continue to improve with time at a stable dose. 2, 3

Monitoring During Stabilization

• Track your three remaining symptoms weekly: racing heart (resting heart rate), GI upset (frequency/severity), and insomnia (hours of sleep per night). 3
• Expect gradual improvement over 4–6 weeks, similar to the pattern you experienced with burning feet, nausea, and anxiety. 2, 4
• If symptoms worsen significantly or new symptoms emerge, contact your prescriber immediately—this may indicate a need for symptomatic treatment rather than dose adjustment. 3

When to Consider a Modest Increase (8 mg or 8.5 mg)

Only attempt a small increase if ALL of the following criteria are met:

1. You have remained stable at 7.5 mg for at least 4–6 additional weeks (total 15–17 weeks post-reduction). 3, 4
2. Your three remaining symptoms (tachycardia, GI upset, insomnia) have plateaued or worsened despite 4–6 weeks of stability. 3
3. You have no new symptoms and the symptoms from the 10 mg trial (shakiness, intrusive thoughts) have fully resolved. 1, 3

If you meet these criteria, increase to 8 mg (not 8.5 mg) using the following protocol:

• Split your 7.5 mg dose and add a small fragment to reach approximately 8 mg daily. 3, 4
• Maintain 8 mg for a minimum of 4–6 weeks before evaluating response. 3, 4
• If 8 mg triggers new symptoms within the first week, immediately return to 7.5 mg. 1, 3

Symptomatic Management While Stabilizing

For Racing Heart (Tachycardia)

• Rule out other causes: Check thyroid function (TSH), electrolytes, and caffeine intake. 5
• Avoid stimulants, excessive caffeine, and decongestants. 5
• If tachycardia is severe (resting heart rate >100 bpm) or associated with chest pain/dizziness, seek immediate medical evaluation. 5

For GI Upset

• Eat small, frequent meals and avoid trigger foods (spicy, fatty, acidic). 3
• Consider short-term use of antacids or H2 blockers if needed. 3
• Maintain hydration and avoid NSAIDs, which can worsen GI symptoms. 3

For Insomnia

• Low-dose amitriptyline (10–20 mg) is actually used off-label for insomnia, so your current 7.5 mg dose is subtherapeutic for sleep. 6
• Implement sleep hygiene: consistent bedtime, dark/cool room, no screens 1 hour before bed. 6
• Consider short-term use of melatonin 3–5 mg at bedtime or a brief course of a non-benzodiazepine sleep aid if insomnia is severe. 6
• Do not increase amitriptyline solely for insomnia while you are still experiencing withdrawal symptoms. 3, 4

Critical Pitfalls to Avoid

• Do not make frequent dose changes (more often than every 4–6 weeks)—this prevents your nervous system from stabilizing and prolongs withdrawal. 3, 4
• Do not assume you need to return to 10 mg just because withdrawal is prolonged—many patients successfully discontinue after extended stabilization at lower doses. 1, 4
• Do not misinterpret withdrawal symptoms as a need for higher doses—your improvement in three symptoms proves you are healing at 7.5 mg. 2, 3
• Do not abruptly stop amitriptyline if symptoms worsen—gradual tapering is essential for tricyclic antidepressants. 1, 3, 4

When to Seek Immediate Medical Attention

• Chest pain, severe palpitations, or syncope (fainting). 5
• Suicidal thoughts or severe mood changes. 5
• Severe confusion, hallucinations, or signs of serotonin syndrome (if taking other serotonergic medications). 5
• Inability to eat/drink due to severe nausea or vomiting. 3

Long-Term Perspective

• Protracted withdrawal from tricyclic antidepressants can take 3–6 months or longer in a minority of patients, but symptoms do eventually resolve with patience and dose stability. 1, 4
• Your gradual improvement in three symptoms (burning feet, nausea, anxiety) is strong evidence that your remaining symptoms will also improve with time. 2, 3
• Very conservative tapering schedules (holding at each dose for 6–12 weeks) are sometimes necessary for individuals with prolonged withdrawal. 1, 4