Diabetic patients
having diabetic neuritis can experience severe lightning pains and
severe paraesthesias, which could be severe enough not only to disrupt
normal daytime activities, but also to disturb the sleep. Although
many new therapies have come in the past few years including carbamazepine
and recently gabapentin, most of them do not work inspite of a very
good control of diabetes.
Amitriptyline is a very good drug. I have been using this drug to
treat endogenous depression for the last 30-40 years and am still
continuing to do so, because unlike other modern drugs, it does not
cause dependence (unlike alprazolam etc).
It is worth noting that after this drug is given in doses of 25-75
mg, it takes 3-6 weeks for the patient’s depression to improve.
But as far as administration of the drug to treat diabetic neuritis
is concerned, it is very interesting to note the following few facts.
The drug does not work in all patients, and in such cases the patient
can be switched to gabapentin.
All family physicians must note that in those patients, where amitriptyline
works, it works like magic, which can be compared to the response
of an antibiotic given to a serious patient of fatal pneumonia.
The moment amitriptyline is started in a dose of 25-75 mg at bed time
(I use 75 mg and advise the patient to stay at home for three days
because the drug may cause drowsiness and excessive sleepiness) the
patient’s symptoms disappear within 48-72 hours dramatically.
After the patient’s symptoms disappear, the patient can be put
on a maintenance dose (the same dose to which the patient responded,
for a period of few months, if not more). And why should the doctor
hesitate to continue this drug, when in cases of primary endogenous
depression, we prescribe this drug continuously for one year or more,
and in certain cases for years together.
Thus my advice to family physicians is to tell the patient to stay
at home for three days. If the patient shows some improvement, the
drug may be continued for five days, before saying that the therapeutic
test is negative. The family physician should try this drug before
deciding to prescribe other drugs like gabapentin or carbamazepine,
which have to be continued for months together. These drugs have many
other side effects, which amitriptyline does not have.
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital,
Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital,
Mumbai 400 008.
