Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
1 drug selected — Amitriptyline(click to collapse)
1/4 selected
Amitriptyline
Elavil
Tricyclic Antidepressant
FDA-approved indications
- Depression
Off-label uses
- Neuropathic pain
- Migraine prophylaxis
- Tension headache prophylaxis
Half-life10 to 50 hours
Decision GuideWhen to pick each / when to consider an alternative
Amitriptyline
Consider when
- Treatment-resistant or severe depression — highest-ranked antidepressant for efficacy in Cipriani 2018 NMA (OR 2.13)
- Chronic pain comorbidity (neuropathic pain, migraine, fibromyalgia) — broadest off-label pain evidence base among TCAs
- Insomnia-predominant depression — most sedating TCA; potent H1 antagonism useful when sedation is therapeutic
- Depression with concurrent migraine prophylaxis needed — Class II AAN/AHS guideline evidence for migraine prevention
- +1 more
Consider an alternative when
- Elderly or fall-risk patient — worst anticholinergic burden among TCAs; orthostatic hypotension +++; Beers Criteria 'avoid'
- Cardiac disease or conduction abnormality — contraindicated post-MI; class-defining cardiotoxicity (heart block, QRS widening in overdose)
- Weight gain is unacceptable — class-top weight gain +1.60 kg (Pillinger 2025); 46% gained ≥2 kg vs 19% placebo
- Overdose risk with active suicidal ideation — TCA class lethal in overdose; narrow therapeutic index
- +1 more
| Axis | Amitriptyline TCA |
|---|---|
| Boxed Warnings | |
Suicidality (boxed warning) | |
Neuroleptic malignant syndrome (NMS) | |
| CNS | |
Sedation / somnolence | |
Activation / insomnia | |
Emotional blunting | |
Tardive dyskinesia | |
Seizure risk | |
| Metabolic | |
Weight gain | |
| Autonomic | |
Anticholinergic burden | |
Orthostatic hypotension | |
| Cardiac | |
QTc prolongation | |
Cardiac conduction / AV block | |
| Hepatic | |
Liver enzymes / hepatotoxicity | |
| Electrolytes | |
Hyponatremia / SIADH | |
| Dermatologic | |
Photosensitivity / skin pigmentation | |
| Sexual | |
Sexual dysfunction | |
| Discontinuation | |
Withdrawal / discontinuation | |
| Interactions | |
Serotonin syndrome risk | |
CYP interactions / DDI profile | |
| Safety | |
Overdose toxicity | |
| Pregnancy | |
Lactation / breastfeeding safety | |
| Drug-specific / distinctive axes | |
Hematologic / bone marrow suppression (distinctive label feature) only in Amitriptyline | |