Q: I have been taking amitriptyline before bed for at least 20 years.  I have fibromyalgia, and it helps me sleep.

I’ve tried to get off it twice, but the insomnia was unbearable.  Most doctors don’t seem to know how to help lessen the symptoms resulting from discontinuing this drug.  Cutting the dosage in half did no good at all.

My short-term memory is awful.  I think it’s the drug, and I’ve lost my self-confidence.  What can I do to lessen symptoms of withdrawal?  Is there a safe substitute for amitriptyline?  I would appreciate any help I can get.

A: Amitriptyline (Elavil) was first marketed in the United States in 1961.  The food and Drug Administration has approved this drug only for treating symptoms of depression. Nevertheless, many health professionals prescribe it off label to treat insomnia, nerve pain, migraines and fibromyalgia.  Nearly 10 million prescriptions are dispensed annually.

Amitriptyline is a strong anticholinergic medication.  That means it interferes with a crucial brain chemical called acetylcholine. A new study of more than 300,000 people found that those who take anticholine drugs like amitriptyline are more likely to develop dementia (BMJ, April 25, 2018).

• copyright The Seattle Times