We rank amitriptyline B tier for sleep, and it is the tricyclic to pick there because you want a tertiary one. It earns its place when there is another indication and it is safe for that patient (no cardiac problem or constipation); we also think it is first line for fibromyalgia pain.
When we reach for it
A tricyclic is worth it when there is another indication and it is safe for that particular patient (for example, for cardiac reasons, or no constipation): it will help the sleep and you can treat the primary disorder too.
“If you have another indication for them and it's safe to use in that particular patient for cardiac reasons or they don't have constipation, for example, they'll help the sleep and you'll be able to treat the primary disorder”
44:08Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026
Choosing a tricyclic
We think amitriptyline is first line for fibromyalgia pain. Of the tricyclics on our board, we almost wish we had put just amitriptyline, because you really want a tertiary tricyclic.
“I think it's first line for fibromyalgia pain. Now, we have other TCAs on there. I almost wish we just put amitriptyline because you're really going to want a tertiary TCA”
45:01Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026
From these episodes
- Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026 · 2 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.