[kqr]

"Best" is a complicated concept. Yes, amitriptyline has the greatest efficacy, i.e. response rate in a clinical setting. It may still have poor effectiveness (how well it works in the real world) because it belongs to a class of medications which, if you use them, you have to exclude many types of common foods from your diet. It also has less safety margins in terms of overdosing than many modern alternatives.

And then there's also the odd fact that earlier trials of antidepressants show better effect than recent ones -- even for the same treatment and all else held equal. We don't know why.

[alex_hitchins]

What foods should I avoid? I'm been taking Amitriptaline for 8 years now for pain management and wasn't given any advise on substances to avoid.

Although I'm on another Anti-Depressant, I certainly notices a positive effect from Amitriptaline that outweigh the bad effects.

[mnw21cam]

Basically, the foods you need to avoid are any that might cause constipation, because Amitriptyline kind of does that for you already. The parent post was possibly confusing Amitriptyline with a different drug.

It is very weird to be mixing two different antidepressants. Depending on what your other antidepressant is, it could be dangerous. Were your two medications prescribed by the same doctor, and if not, have the two doctors talked to each other? A very simplistic view is that some antidepressants cause the body to make more serotonin, and others prevent the body from destroying serotonin as quickly. Doing one is fine, but doing both at the same time can lead to serotonin syndrome.

Amitriptyline does have higher risk from overdose than SSRIs, but has much gentler withdrawal symptoms.

[markroseman]

Being on more than one antidepressant is not unusual, and can even sometimes be optimal. Even ones acting on the same neurotransmitter often target different receptors and hence different symptoms. More often it's because doctors are better at adding drugs rather than taking away ones prescribed by other doctors "just in case."

Serotonin syndrome can be an issue with all kinds of things (most people aren't warned about being on a SSRI and having cough syrup for example), but is not very common in practice, and because it coincides with a change/increase in medication, often sorted out quickly, even if it's characterized as a "side effect" or "tolerability" problem and not actually recognized for what it is.

[alex_hitchins]

Thank you for your concern. Yes, both medicines were prescribed by the same doctor, and there are others in the mix as well that mean Serotonin Syndrome is something I'm very aware of (Tramadol, Immigran). It's been a fixed dosage for a long time and I'm regularly seen by my GP, have LFT's twice a year etc. Just to note, the Amitriptaline isn't perscibed in my case for depression, it's taken in a smaller dose for it's neurapathic pain properties.

I find the ZoMorph blocked me up quite a bit, Fibrogel works well in this case.

[markroseman]

Amitriptyline is a tricyclic; it's MAOI's that require a special (low-tyramine) diet.

[kqr]

I stand corrected. I was indeed thinking of the wrong class.