Drug Uses

Elavil is indicated for the relief of symptoms of depression. Endogenous depression is more likely to be alleviated than are other depressive states.

How Taken

Elavil comes as a tablet to take by mouth. It is usually taken one to four times a day and may be taken with or without food. Take Elavil exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Continue to take Elavil even if you feel well. Do not stop taking Elavil without talking to your doctor, especially if you have taken large doses for a long time. Your doctor probably will want to decrease your dose gradually. This drug must be taken regularly for a few weeks before its full effect is felt.

Warnings/Precautions

Before taking Elavil, tell your doctor if you have liver disease; kidney disease; asthma; thyroid disease; diabetes; stomach or intestinal problems; high blood pressure or heart disease; had a heart attack in the last 6 weeks; an enlarged prostate or difficulty urinating; or glaucoma. You may not be able to take Elavil, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above. Elavil may be harmful to an unborn baby. Do not take Elavil without first talking to your doctor if you are pregnant or could become pregnant during treatment. Elavil passes into breast milk and may affect a nursing baby. Do not take Elavil without first talking to your doctor if you are breast-feeding a baby. If you are over 60 years of age, you may be more likely to experience side effects such as drowsiness, dizziness, unsteadiness, feeling uncoordinated and low blood pressure. Your doctor may prescribe a lower dose of this medication.

Missed Dose

Take the missed dose as soon as you remember. If it is almost time for the next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take a double dose of this medication unless otherwise directed by your doctor.

Possible Side Effects

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Elavil. Older adults are especially liable to certain side effects of Elavil, including rapid heartbeat, constipation, dry mouth, blurred vision, sedation, and confusion, and are in greater danger of sustaining a fall. Side effects may include: Abnormal movements, anxiety, black tongue, blurred vision, breast development in males, breast enlargement, coma, confusion, constipation, delusions, diarrhea, difficult or frequent urination, difficulty in speech, dilation of pupils, disorientation, disturbed concentration, dizziness on getting up, dizziness or light-headedness, drowsiness, dry mouth, excessive or spontaneous flow of milk, excitement, fatigue, fluid retention, hair loss, hallucinations, headache, heart attack, hepatitis, high blood pressure, high fever, high or low blood sugar, hives, impotence, inability to sleep, increased or decreased sex drive, increased perspiration, increased pressure within the eye, inflammation of the mouth, intestinal obstruction, irregular heartbeat, lack or loss of coordination, loss of appetite, low blood pressure, nausea, nightmares, numbness, rapid and/or fast, fluttery heartbeat, rash, red or purple spots on skin, restlessness, ringing in the ears, seizures, sensitivity to light, stomach upset, strange taste, stroke, swelling due to fluid retention in the face and tongue, swelling of testicles, swollen glands, tingling and pins and needles in the arms and legs, tremors, vomiting, weakness, weight gain or loss, yellowed eyes and skin. Side effects due to rapid decrease or abrupt withdrawal from Elavil include: Headache, nausea, vague feeling of bodily discomfort Side effects due to gradual dosage reduction may include: Dream and sleep disturbances, irritability, and restlessness.

Storage

Store Elavil tablets in a well-closed container. Avoid storage at temperatures above 30°C (86°F). In addition, Elavil tablets 10 mg must be protected from light and stored in a well-closed, light-resistant container.

Overdose

Critical manifestations of overdose include: cardiac dysrhythmias, severe hypotension, convulsions, and CNS depression, including coma. Changes in the electrocardiogram, particularly in QRS axis or width, are clinically significant indictors of tricyclic antidepressant toxicity. Other signs of overdose may include: impaired myocardial contractility, confusion, disturbed concentration, transient visual hallucinations, and dilated pupils, disorders of ocular motility, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, and hyperpyrexia. Deaths may occur from over dosage with this class of drugs.

More Information

Use caution when driving, operating machinery, or performing other hazardous activities. Elavil may cause drowsiness or dizziness. If you experience drowsiness or dizziness, avoid these activities. Dizziness is likely to occur when you rise from a sitting or lying position. Rise slowly to prevent dizziness and a possible fall. Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while you are taking Elavil. Do not stop taking Elavil suddenly. This could cause symptoms such as nausea, headache, and malaise.

Disclaimer

This drug information is for your information purposes only, it is not intended that this information covers all uses, directions, drug interactions, precautions, or adverse effects of your medication. This is only general information, and should not be relied on for any purpose. It should not be construed as containing specific instructions for any particular patient. We disclaim all responsibility for the accuracy and reliability of this information, and/or any consequences arising from the use of this information, including damage or adverse consequences to persons or property, however such damages or consequences arise. No warranty, either expressed or implied, is made in regards to this information.

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A new neurobiological study has found that a synthetic form of THC, the active ingredient in cannabis, is an effective anti-depressant at low doses. However, at higher doses, the effect reverses itself and can actually worsen depression and other psychiatric conditions like psychosis.
It has been known for many years that depletion of the neurotransmitter serotonin in the brain leads to depression, so SSRI-class anti-depressants like Prozac and Celexa work by enhancing the available concentration of serotonin in the brain. However, this study offers the first evidence that cannabis can also increase serotonin, at least at lower doses.
Laboratory animals were injected with the synthetic cannabinoid WIN55,212-2 and then tested with the Forced Swim test -- a test to measure "depression" in animals; the researchers observed an antidepressant effect of cannabinoids paralleled by an increased activity in the neurons that produce serotonin. However, increasing the cannabinoid dose beyond a set point completely undid the benefits, said Dr. Gabriella Gobbi of McGill University.
"Low doses had a potent anti-depressant effect, but when we increased the dose, the serotonin in the rats' brains actually dropped below the level of those in the control group. So we actually demonstrated a double effect: At low doses it increases serotonin, but at higher doses the effect is devastating, completely reversed."
The anti-depressant and intoxicating effects of cannabis are due to its chemical similarity to natural substances in the brain known as "endo-cannabinoids," which are released under conditions of high stress or pain, explained Dr. Gobbi. They interact with the brain through structures called cannabinoid CB1 receptors. This study demonstrates for the first time that these receptors have a direct effect on the cells producing serotonin, which is a neurotransmitter that regulates the mood.
Dr. Gobbi and her colleagues were prompted to explore cannabis' potential as an anti-depressant through anecdotal clinical evidence, she said. "As a psychiatrist, I noticed that several of my patients suffering from depression used to smoke cannabis. And in the scientific literature, we had some evidence that people treated with cannabis for multiple sclerosis or AIDS showed a big improvement in mood disorders. But there were no laboratory studies demonstrating the anti-depressant mechanism of action of cannabis."
Because controlling the dosage of natural cannabis is difficult -- particularly when it is smoked in the form of marijuana joints -- there are perils associated with using it directly as an anti-depressant.
"Excessive cannabis use in people with depression poses high risk of psychosis," said Dr. Gobbi. Instead, she and her colleagues are focusing their research on a new class of drugs which enhance the effects of the brain's natural endo-cannabinoids.
"We know that it's entirely possible to produce drugs which will enhance endo-cannabinoids for the treatment of pain, depression and anxiety," she said.
The study, published in the October 24 issue of The Journal of Neuroscience, was led by Dr. Gabriella Gobbi of McGill University and Le Centre de Recherche Fernand Seguin of Hôpital Louis-H. Lafontaine, affiliated with l'Université de Montréal. First author is Dr. Gobbi's McGill PhD student Francis Bambico, along with Noam Katz and the late Dr. Guy Debonnel* of McGill's Department of Psychiatry.

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