Amitriptyline Overdose

Amitriptyline is an antidepressant drug, specifically a tricyclic antidepressant medication. It is one of the most widely used TCA drug. It is prescribed for treating depression. The efficacy of Amitriptyline is synonymous to the newer class of antidepressants such as SSRI or selective serotonin reuptake inhibitors. Specifically, Amitriptyline is prescribed for the following indications:

  • Depression
  • Anxiety disorders
  • Migraine prophylaxis
  • Attention Deficit Hyperactivity Disorder
  • Bipolar Disorder
  • Anorexia nervosa or bulimia nervosa
  • Post-herpetic neuralgia
  • Insomnia
  • Pain relief for ankylosing spondylitis
  • Prevention of biliary dyskinesia
  • Nocturnal enuresis in children
  • Post traumatic stress disorder (PTSD)

Other indications of Amitriptyline include:

  • Cyclic vomiting syndrome
  • Tinnitus
  • Carpal tunnel syndrome
  • Chronic cough
  • Fibromyalgia
  • Cystitis
  • Vulvodynia
  • Peripheral neuropathy that may be due to diabetes or Vitamin B overdose
  • Laryngeal sensory neuropathy
  • Painful paresthesia
  • Chronic fatigue syndrome
  • Multiple sclerosis
  • Functional dyspepsia

 The appropriate dosage of Amitriptyline for its depression indication is higher than in the management of pain. The usual dosage for pain treatment is 10 to 50 mg a day. According to studies, tricyclic antidepressants are not considered a first line of therapy for depression because of being high risk for overdose. Other antidepressant medications such as SNRIs and SSRIs are often used initially.


Amitriptyline is available in various brand names, but one of the most popular brands is Elavil. Amitriptyline overdose is related to increased ingestion of Amitriptyline by patients.

Overdose Amount of Amitriptyline

Ingestion of up to 750 mg of Amitriptyline by an adult results in Amitriptyline overdose.

Signs and Symptoms

The signs and symptoms of Amitriptyline overdose is mainly due to the anticholinergic effects of the drug at the different organs in the body as well as the brain. The heart may also suffer symptoms because of quinidine-like effects on the heart muscles. Signs and symptoms of Amitriptyline overdose include:

1. Altered metal Status

Drowsiness is a common symptom of Amitriptyline overdose. This results from the inhibition of the nerve impulse transmission in the central nervous system. Confusion may also be experienced. The presence of altered metal status may also lead to hallucinations by the patient.

2. Seizures

This happens because of the increase in the serotonin and norepinephrine levels at the nerve terminals thereby making the nerved impulse transmission less stable.

3. Heart blocks and arrhythmias

The effects of Amitriptyline overdose in the heart results from the impediment of the cardiac conduction system thereby inhibiting the action potentials from the cardiac pacemaker.

4. Widened QRS complex in ECG tracing

The widened QRS complex results from the reduction in the sodium influx in the myocardium. Widened QRS complex is usually seen in patients having Amitriptyline overdose or toxicity.

5. Hypo-tension

The alpha adrenergic receptors in the blood vessel walls are also blocked by Amitriptyline overdose thereby preventing vasoconstriction and leading to profound vasodilation because of the increased level of Amitriptyline in the blood.

6. Dry skin

This effect of Amitriptyline overdose results from the anticholinergic properties of Amitriptyline overdose.

7. Dilated pupils

This also results from the blockade of the alpha adrenergic receptors leading to dilation of the pupils. Dilated pupils are usually seen in patients with severe Amitriptyline overdose


8. Urinary retention

The anti-cholinergic properties of Amitriptyline overdose lead to the prevention of the acetylcholine to go to the neuromuscular junction for muscle contraction. As a result, the bladder loses its tone leading to urinary retention.

9. Slow respiration

The slowing of the respiration may be due to the CNS depression that results in depression of the respiratory center at the brain-stem  This may also result from the anticholinergic activity of Amitriptyline overdose leading to poor contraction of the respiratory muscles. The patient must be monitored for possible respiratory depression.

10. Hypothermia

Hypothermia is also a possible symptom of Amitriptyline overdose because of the loss of heat through vasodilatation.

Long term effects of Amitriptyline Overdose

1. Respiratory depression

Respiratory depression is a possible long-term effect or complication of Amitriptyline overdose because of the depression of the CNS and the respiratory muscles.

2. Coma

Coma is the result of CNS depression that may further lead to the death of the patient suffering from Amitriptyline overdose

Causes and Risk factors

The main cause of Amitriptyline overdose is ingestion of large amounts of Amitriptyline. Overdose is mainly seen in pediatric clients as an accidental ingestion of Amitriptyline pills. Amitriptyline overdose may also be seen in depressed clients who are suicidal because TCAs commonly do not take effect immediately after initiation of the treatment. In this line, monitoring of depressed clients should be ensured in order to prevent Amitriptyline overdose.

Diagnosis of Amitriptyline Overdose

In order to identify TCA overdose diagnostic tests must be carried out; this includes an ECG. Electrocardiogram is necessary in order to monitor the cardiac functioning and identify arrhythmia, heart blocks and ECG changes such as a widened QRS complex. A blood test may also identify the actual TCA level in the blood.

Treatment of Amitriptyline Overdose

Treatment for Amitriptyline overdose include symptomatic relief as well as detoxifying the body from the high amounts of Amitriptyline in the blood. Possible treatments for Amitriptyline overdose include:

1. Administration of Activated Charcoal

Activated charcoal may be given by mouth in conscious clients and by naso-gastric tube in patients with altered metal status. Activated charcoal is given in order to absorb the Amitriptyline present in the stomach and prevent possible absorption in the intestines. A second dose of activated charcoal is sometimes necessary.

2. Sodium bicarbonate infusions

Sodium bicarbonate is given to treat possible acidosis because of Amitriptyline overdose. Patients with arrhythmias and QRS prolongation may also meed sodium bicarbonate.

3. Anticonvulsant medications

Intravenous diazepam may be given in order to control the seizures or convulsions. Phenytoin is not to be given even if it is an anticonvulsant drug because it may lead to further blocking of the sodium channels that may lead to more serious arrhythmias.

4. Oxygen therapy

Oxygen inhalation is necessary in order to prevent respiratory collapse and ease the breathing of the client.

5. Vasopressors

Vasopressor drugs such as Neo-synephrine may be used in order to normalize the blood pressure.

6. Physostigmine

The antidote for anticholinergic toxicity such as Amitriptyline overdose includes physostigmine. This is a cholinesterase inhibitor that increases the amount of acetylcholine in the neuromuscular junction. However, it should not be used in Amitriptyline toxicity because of possible seizures.

40 thoughts on “Amitriptyline Overdose

  • 11/06/2013 at 7:45 am
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    I overdosed on Amitriptyline 3 yrs ago. I was admitted to the hospital for 5 days and I have no memory of the stay or even a week later. I lost those 2 weeks completely. and my children think that since then my memory has really diminished. So we are wanting to know if long term memory problems can be caused from the overdose. Kristina

    Reply
    • 27/06/2013 at 9:42 am
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      I am wondering the same thing. My memory has diminished significantly, especially if im stressed. I lose things, large amounts of cash even. I have forgotten to pick my kids up, just headed straight home without them. Also, I kind of shut down after a high amount of stress like all emotions and thoughts leave me. If you know someone with an autism spectrum disorder, i feel like someone in the high functioning range. I want to get help, but im afraid of medication and what i might do with it, if it doest work.

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      • 22/07/2014 at 4:34 pm
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        Has anyone else suffered with long-term personality changes following amitriptyline? Again it’s been three years and I’m still not me…

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        • 30/01/2015 at 4:22 am
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          Hey, a week ago I OD on amitriptyline and have no memory of the entire day I did it and the following two days when I was in hospital. Due to having no memory, I’m not entirely certain as to why I did it. Has anyone else experienced memory loss?

          Reply
        • 29/02/2016 at 3:11 am
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          My daughter is also suffering from personality changes and short term memory problems since her overdose nearly two years ago. She has been unable to work because of that. Have you had any improvement? If so, how did you manage to improve?

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      • 29/02/2016 at 3:08 am
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        You are describing my daughter after an overdose nearly 2 years ago. She has not been able to work due to short term memory problems and a big change in her personality. Have you improved at all? If so, what helped you to do so?

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  • 14/10/2013 at 8:32 pm
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    Thank you for sharing your experiences. They explained something to me.
    Years ago I OD’d on Amitriptyline, combined with Trilafon, Demerol, & alcohol. The Amitrip alone was probaby more than enough. I changed my mind a half hour later, made myself vomit, and lay down. Someone found me, I couldn’t be woken, spent 3 days in coma in ICU, I think another 8 in coronary care before checking out AMA (they were trying to force me to sign myself in to a psych hospital). Charcoal sucks.

    My brain wasn’t functioning properly for some period of time after. I sat and stared and did nothing for hours, maybe days, entirely unaware of the passage of time. Family, friends, neighbors, etc badgered me endlessly until I checked into a hospital weeks later. I attributed my mental status to major depression, but I believe you are correct, it was an after-effect of the drugs (or coma). During a psych eval 6 months later, my Stanford-Binet IQ was well over 145, so I don’t think it did any permanent damage. Unsure if there was any lasting cardiac damage. I was diagnosed with long QT syndrome some time after, but it could have existed all along.

    The experience revealed that if you are self-destructive, do not take chances with mixing chemicals if uncertain or seeking assistance in getting help, because your freedom will be taken away leaving you with very expensive hospital bills as providers take the most secure, expensive approach to avoid a repeat performance. Fair-weather friends will RUN away and family members will walk on eggshells for years, but with bottled rage festering from emotional upset, stress, cost, abandonment, manipulation, etc. 20 yrs later, docs will be sketchy about giving you pain killers or muscle relaxants no matter how badly needed due to that history. In some states, 30 yrs later you could still be unable to purchase a rifle for hunting. There is NO shame in admitting you need help and asking for it. In fact, one should be proud of accepting responsibility and asking for help instead of giving up or acting out to get it. If life is truly that unbearable and you can’t perceive any solutions or methods to ease your pain, focus on getting through the next minute, hour, night, etc., if it doesn’t improve you can always give up tomorrow, or the day after, or the day after. Depression REALLY reduces the ability to handle stress and problem solve DRAMATICALLY. Sometimes it only takes a small improvement in mood for you to see options you couldn’t before. It’s quite common that sudden strong suicidal ideation is an indication that the depression is weakening and a person who’d felt immobilized finally felt able to do SOMETHING, even though it wasn’t something productive. Just a little more time often allows solutions to develop and percolate in your brain until you feel capable to recognize and pursue them. Because, REALLY, charcoal and catheters and intubation and locked doors and restraints and being trapped with deeply crazy strangers while at the mercy of often kinda bizarre mental health professions is pretty much the definition of sucking balls.

    Reply
    • 13/09/2014 at 4:40 am
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      Persephone
      That made the most sense in all i’ve read tonight. Thank you. Am im process of planning suicide and this may make a difference to me. Thank you. x

      Reply
  • 16/04/2014 at 12:00 pm
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    My 20 year old daughter hazel has taken 40 strips of 50mg amitriptyline and is laying in hospital right now and this is the third day of her not waking up please tell me how much you took when u overdosed

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    • 26/02/2015 at 11:47 am
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      I overdosed on endep and was in a coma for 3 days. Had I not collapsed on the kitchen floor I believe I would have not survived. When I recovered I was taken to a private psychiatric hospit where I was so sick in the stomach I had to learn how to eat again by myself. It is a dangerous drug. Be very careful with it.

      Reply
      • 20/07/2015 at 1:24 am
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        hi how many did u take + did u take them all at onnce hope im not being rude i suffer very bad deppression

        Reply
  • 15/07/2014 at 12:23 pm
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    Reply
  • 09/10/2014 at 4:31 am
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    Ive just taken 1g (1000mgs) of the stuff, im 56kgs and normally 20mgs knocks me out, is the amount ive just taken , a dangourous amount ??

    Reply
    • 22/11/2014 at 4:14 am
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      that would be enough to kill you for sure.
      i take 20mg each night and it has hardly any affect on me. so if i were to OD as a way out id need at lease 2 -3grams im am about 76kg

      Reply
    • 25/11/2014 at 11:49 pm
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      Hey Danielle I took 3000 mg. And was in a coma on a ventilator in Icu for a wk. I have had memory issues as well as some altered personality traits. Damn gta go contact me dave katzenbach on fb if u wna tlk

      Reply
  • 31/12/2014 at 12:10 am
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    I overdosed on amitriptyline in late 2005, was comatose in ICU for at least a week, maybe more. My memory was severely compromised — I mean, my memory of anything is greatly diminished, both before and after the overdose. I lost a lot of memories, which is sad, and also reduced my capacity to form new memories. Additionally I have had cardiac consequences, with a tendency towards bradycardia (reduced heart rate).

    Reply
  • 07/03/2015 at 2:17 pm
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    Anyone know why I have permanent heart problems after accidental amitriptyline OD? I get high heart rates and skipping for years. I take atenolol to control it. Cardiologists say there’s nothing wrong. It makes no sense. I have all these heart problems after the OD for years happening every day. I felt my heart beat weaken after the OD in my throat and it’s been wanting to pound for exercise ever since.

    Reply
  • 07/03/2015 at 7:28 pm
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    Does anyone know why I have permanent heart problems after an accidental OD on amitriptyline? My heart has been skipping and going at a high rate since the overdose. It’s been over 6 years since the OD. I use beta blockers to control it. The cardiologists say there’s nothing wrong with my heart even though I have all these crazy issues with it since then. It skips and races like crazy even on beta blockers if I don’t exercise everyday.

    Why are mods deleting my posts?

    Reply
  • 22/09/2015 at 12:42 am
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    How much amitryptalin will it take to kill me??? I have three full bottles 90 tabs of 10 mg??

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  • 15/10/2015 at 4:06 am
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    How was the ED staff aware that you had ODed on amitriptyline? Did you tell them? Or have a history?

    Reply
  • 30/11/2015 at 5:26 am
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    Iv just taken 96 @25 MG I HOPE NOT TO BE HERE TOMORROW MORNING will this do?? Please advise asap… Lol.

    Reply
  • 13/03/2016 at 2:52 pm
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    My issue is taken to ER for taking 20/ 50mg pills. Amitriptyline and alcohol was 81. Few months later found out that they followed no protocol. No securing airway, aspirated and was decerebrate posturing and they did nothing. I’ve had abnormal I eeg and MRI because I knew something was wrong bc I don’t remember anything and daily activities are hell. I was a nurse and I stayed unconscious for over 2 days. Is there not a standard of care for treatment and is it possible to go after hospital for not doing anything. I will never be able to work as a nurse or anything else. My son had died and I made a mistake but I deserved help.so are they liable for not giving standard care? I was there within an hour. I was posturing and husband asked why? Told normal it was normal.they took any chance of living normal life. Never did a level.I understand that I did it but they have a duty to act.They failed to and I hold them responsible for that. I want to look at negligence because they failed to act. Any thoughts?

    Reply
  • 20/03/2016 at 12:02 pm
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    Kristi

    Yes they are liable. They do have a duty of care. It is their job.

    You were not well and needed care, they should have delivered it to you.

    I urge you to fight and seek justice. They owe you compensation.

    Reply
  • 22/03/2016 at 4:47 am
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    Just over 12 months ago I overdosed on amitriptylene, was in coma for a week, then hallucinating and a non retentive memory for another week. The third week was in a recovery ward for stroke victims relearning how to walk. Since then have been medicated with Sertraline which has been effective but still experimenting with the dosage. Currently taking 100mg per day. Find I a suffering from lack of energy and initiative and have some short term memory problems. Most of the time I feel dazed and have impaired balance which has resulted in some dangerous falls.
    Is this all due to the overdose, or is there an Sertraline component ?
    Is this going to be for ever ?

    Reply
    • 06/05/2016 at 7:41 am
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      what did you experience physically as the meds began to work? everyone says something very different. some painful some peaceful.

      Reply
  • 30/03/2016 at 10:52 am
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    I overdosed on Celexa and amitriptyline over 7 years ago. I was on life support for 4 days. My heart rate has been high ever since. Any one else experience this?

    Reply
  • 13/04/2016 at 3:24 pm
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    I believe I overdosed on when I was 13-14 yr old took 13 100mg tabs I now at 36yrs cannot have children ,heart palpitations @19yrs and horror short term memory since. Morning after taking I hard exreme difficulty walking staying awake and troubles breathing and eating for four dys. I never told anyone I o.d. and told everyone o had flu bug
    Nobody

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    • 21/05/2016 at 9:32 pm
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      Heather why can’t you have kids? What did the od do?

      Reply
  • 19/04/2016 at 6:25 pm
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    I think I may have overdosed two nights ago on amitriptyline. I was drinking heavily, and have been taking it for migraines once a night. I suffer from depression and anxiety, untreated, and I feel like the amitriptyline made it more severe. I had and argument with my S/O that got worse than ever… And I decided to end my life. I took all remaining pills in the bottle and ended up feeling really distorted and high. My tongue was numb, my face turned blue-ish, I was super slowed down physically and speech… I don’t remember anything other than that until waking up very disoriented in the morning to an extremely concerned boyfriend who kept coming back from work to check on me. He said I was unresponsive, cold, shivering, and that I had… Released my bowels… he was so close to calling an ambulance, but didn’t want me to be put on suicide watch. This isn’t the person who I am. When I woke up again, I vomited, and my legs went numb. I honestly thought I was dying. I was terrified – even though I’d done it to myself. Since then, I’ve just not felt the same. I’m super inattentive, relaxed, and I can barely feel my pulse. I just feel off. Do I need to visit the hospital? Can there be damage that I’m not seeing? Can I die this late after taking so much? There were about 60-70 pills remaining of the lowest dose.

    Reply
  • 28/04/2016 at 6:09 am
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    I overdosed in 2002 at the age of 35. I took enough to die, layed down and entered a coma that lasted ?? The time is a black hole and was never discussed, so I really don’t know how long I was there in the hospital. The only memories I have of my recovery are a faint recollection of a charcoal taste, and being chastised by a nurse as I hallucinated/tried to escape from a non-existent monster and fell from bed. I also slightly recall denying to a hospital person that I tried to kill myself. But of course I did. I also remember a neighbor visiting me–she was the only person other than my husband who knew where I was. (He didn’t tell my family.) This woman shot herself in the head and died four years later. I have great guilt that she looked at my suicide attempt and saw it as an escape + that she used a more catastrophic means. Her family was devastated.

    I have no long-term health affects now that I know of. But the emotional damage that I did to my children is lifelong. I thought at the time that I was leaving for their benefit, but that was depression and mental abuse talking. The man that drove me to that brink has since destroyed another woman. I and my children are so much better off without HIM. I am here. You stay here too. Life gets better even tho it doesn’t look like it tonight. I swear.

    Reply
  • 06/05/2016 at 7:37 am
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    what I would like to know if you have clear memory of it. is what were you feeling waiting for the meds to start. not what you were thinking about but what physical sensations were you experiencing? some claim amitriptyline is painful others say of course not. I would appreciate your views.

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    • 20/05/2016 at 10:07 am
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      I had about 10 minutes I think or less and started a voice recording. Woke up 4 days later in ICU. My spouse noticed all the lights off and we were separated and I was telling my kids I love them and that’s all I remember. He busted the bedroom door down and called 911. He never let me hear the recording. I was laying down on the bed fell with recorder in hand. Again….I regret the foolishness as now I’m suffering from memory and balance issues.

      Reply
  • 16/05/2016 at 1:10 pm
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    I just want to say this much to all you guys and girls out there…. I have read these posts and it is shocking. 5 Years ago my brother died of an overdose of tablets which I wont name for your sake. Today my sister lies in a coma for taking an overdose of tablets which I also wont name!!!

    Do you have any idea how selfish your act is?? Do you know what you do to the people who actually care, the unnecessary suffering and pain caused by the loss of a child, sister, brother etc. The guilt that racks the family when you die, because almost always, somebody will blame themselves… SERIOUSLY….go an see a friggin psychologist or somebody who can teach you the value of life.

    You have a purpose on this earth and clearly you are to arrogant and naïve to understand the true meaning of life. I feel sad and pitty for you.

    A nun once told me that God knows each and every persons strength, and he will never burden you with something you cant handle. FIND YOUR PURPOSE AND IF SOMETHING IS CAUSING YOU TO FEEL THAT YOU DONT BELONG IN THE LAND OF THE LIVING…THEN CAST IT OUT OF YOUR LIFE AND MOVE ON. But don’t for a second end the one precious life you have been given because you feel that it is too much. You and You alone can change your life and nobody can do that for you. If you want to commit suicide it is because you are to lazy to find another way to deal with your anguish.

    CONCERNED

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  • 20/05/2016 at 10:01 am
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    Wow…reading these are alarming yet I will share. I flipped…and I mean just lost it and flipped over in 2009 and took a LOT of amitrip along with some Lorcet and clonazepam. All I know is I was in a coma for 3-4 days and don’t remember anything & when I did wake up I still don’t remember hardly anything then went straight to a psych ward from ICU. Stayed there for a week and then home. I am now suffering from some serious memory issues of short term. Like immediately short term. My long term memory is still good but I’m really stressing over this short term thing. I went for a complete psych evaluation last year due to worries about it and he said I failed thr stoop test. I asked my hisband what the Dr said the long term affect would be and he said brain damage. I feel like I have some of that going on. I am not sure but I’m worried about my future.
    Letting you all know….its been 7 years this past April and I regret it every day. Now I have two grandchildren and life is amazing but I didn’t see it then.
    I hope you all really think about the future …..and your family. It’s not,worth it.

    Reply
  • 28/05/2016 at 3:31 pm
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    I want to end it all I have 75 x 25mg Amitryptiline will that kill me??

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    • 31/05/2016 at 3:27 am
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      Please dont do that too yourself my mother just done this 3 days ago and has no memory no balance and speech problem …no clue whats going on at the moment ..we are heart broken and in hopes she comes back too her self when the meds are out of her system….listen when life gets hard it doesnt stay that way forever…things will always get better i promise! At this time it might feel like its the best thing too do but it really isnt….your not feeling like yourself if you wanna do this please go talk too someone and get urself some help..pick urself up u got this! All i know is that the guilt i have right now is unreal that i didnt know my mother wanted too end her life and how sad she was too try…She really thought everyone hated her and its because she has a illness …She is well loved by everyone …Just like YOU are.. if you feel like the worlds against you your not alone …your life will get easier please think about you and ur family and go talk too someone …things will work them selfs out they always do ? just letting u know i care

      Reply
  • 14/06/2016 at 3:03 am
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    i feel i have nothing left to live for. I have only 480mg of Amitriptyline and was hoping it would send me to eternal sleep so I cn get out of the living hell that is my life. My female partner accuses me constantly of belittling her. She is paranoid. I never know what sort of mood she is going to be in when she wakes up. I can’t leave because I have no income. She has driven away all my friends so I have nobody to turn to. If only these pills were enough, I would email someone and tell them to tell the truth about her when I’m finally at rest.
    Maybe I just throw myself under a train

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  • 20/07/2016 at 12:26 pm
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    im a 14yo girl with anxiety and depression and long term health issues that doctors haven’t formally diagnosed yet. i am so upset right now and i feel like this is my only escape. i have no where else to go. the other night i was about to take 22x 25mg Amitriptyline pills when i was stopped by my boyfriend/bestfriend. i want to try again but i don’t want to hurt him. I’m told i still have so much to live for but this is my 3rd year of depression and I’m so over it. my life is pretty much made of doctors appointments for chronic headaches and unusual MRI results. I’m so down right now – i need a second to breathe. it feels like someone is screaming at me 24/7 and that the whole world is against me. my head is always hurting and i feel like my family is going to be even more fucked up if i do it which is making my situation even more stressful. i have supportive and loving friends but my grades in school are dropping and I’m failing at almost everything i do. my boyfriend told my mum about the other night so she took me to the doctors. my K10 test was 43/50. now i have 4 different organisations and doctors being contacted about me. having to explain all this to people is getting frustrating, exhausting and making me feel worse and more motivated to overdose. I’m such a mess right now and it doesn’t help that my dad goes away for 3-4 months at a time for a year each time. i know i need help but things just get messy and frustrating when i talk to people about it. i don’t know what to do anymore. do i end it or stay here in this dark hell hole.

    Reply

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