Is Amitriptyline (Elavil) Effective for Insomnia?

Low-dose amitriptyline (AM) is an off-label treatment in patients with insomnia. A recent randomized controlled trial demonstrated that AM is non-inferior to CBT-I in improving insomnia after 12 weeks. However, more patients showed clinically relevant improvements with CBT-I. Furthermore, AM was associated with more side effects than CBT-I and its benefits for sleep were temporary. Therefore, CBT-I should remain the first-line treatment given its broader benefits. If patients insist on medication, AM could be considered. However, patients should be well-informed about potential side effects of AM and the likely temporary effectiveness.