I did a short Twitter thread on my experience of amitriptyline for Long COVID, which is reproduced below. TL;DR it didn’t work for me and possibly made things worse by masking PEM/PESE, which led to crashes.

https://twitter.com/lessorfewer/status/1777673506081087804:

https://twitter.com/lessorfewer/status/1777673506081087804

I tried 10mg but stopped after a week. Even that dose was sedating me + made me bad at pacing: it muted some neurocognitive sx but masked PESE so I was overdoing it. AWFUL brain crash for weeks (right-side ice pick headache + eye/vision problems) within a week of stopping.

10mg gave me good sleep for a few days but then worsened. Just tried 5mg for 6 days. Again, good sleep for a few days but then worsened. No sedation and again muted some neurocognitive sx but again felt I was overdoing it and masking PESE (could still feel it "underneath").

It worked against anxiety, which was nice, but it didn't stop some sx, like tinnitus. On 10mg I also felt a bit weirdly detached, which I didn't like. I was supposed to go up to 25mg but really didn't want to increase that much after taking 10mg.

I also have reservations about anticholinergic effects on cardio-autonomic symptoms, gut, and other drug interactions. I haven't yet tried LDN but read that it blocks the effect of AMT: https://www.ajmc.com/view/ten-drug-combinations-that-show-the-risks-of-psychiatric-polypharmacy-

I saw one paper on AMT for LC headache (https://link.springer.com/article/10.1007/s00415-022-11225-5) but because I felt it was masking PESE and allowing me to overdo it, I'm not sure it's suitable for all kinds of LC headache. My headaches are now mainly with histamine (I think!) and overexertion

I saw a few papers about AMT and mast cells:

Also read that AMT shouldn't be used if there is a history of arrhythmias (https://ncbi.nlm.nih.gov/books/NBK537225/), which I have since getting Long COVID.

References 2022-07-12 Amitriptyline for post-COVID headache: effectiveness, tolerability, and response predictors https://link.springer.com/article/10.1007/s00415-022-11225-5

1982-05-20 Differential release of serotonin and histamine from mast cells https://www.nature.com/articles/297229a0

1986-04 Non-differential inhibition of histamine and serotonin release from mast cells by amitryiptyline https://link.springer.com/article/10.1007/BF01987991

2011-06 Amitriptyline and Prochlorperazine Inhibit Proinflammatory Mediator Release From Human Mast Cells: Possible Relevance to Chronic Fatigue Syndrome https://journals.lww.com/psychopharmacology/citation/2011/06000/amitriptyline_and_prochlorperazine_inhibit.27.aspx