So, here’s a good game. Given the choice, what drug would you like to add to the nation’s tap-water? After all, we’re heading that way, aren’t we? With statins. And vitamin D. And HRT, now that we know it’s good, not bad. Though, admittedly, then you’d need his’n’hers taps.
It’s wonderful, it makes me happy, and I’m not even taking it
Whatever. To me, the answer is a no-brainer. Because there’s a drug out there that cures everything. It sorts out migraine. Tension headaches. Sciatica. Neuropathy. Chronic back pain. Burning tongue. Insomnia. Anxiety. IBS. Painful bladder syndrome. Painful anything syndrome. In fact any situation where you’re hesitating over what to do, and where to go, next. Answer: go to amitriptyline.
It’s a panacea. I prescribe it so much that, when I key in ‘A’ then ‘M’ into my prescribing template, my computer defaults to amitriptyline rather than amoxicillin. But that’s OK, because it probably cures chest infections, too.
And I haven’t even mentioned depression yet which was, of course, its original indication. But I will, because it’s absolutely perfect for treating that significant subgroup of patients who are depressed but fail to recognise or accept that fact – I can say to them no, no, no, don’t worry, I’m giving you amitriptyline for your IBS/sciatica/migraine etc, not because I think you’re depressed, even if you are weeping, complaining that life is crap and making me want to speed-dial Exit.
Marvellous. It’s just a pity it’s off patent, because, if it wasn’t, I would gladly give up medicine and accept funding from whichever pharma company agrees to send me to exotic venues to extol its virtues. And I wouldn’t be selling my soul, because I truly believe what I’m saying: amitriptyline works, either by a genuine effect on the primary problem, or by an equally genuine effect on the secondary anxiety caused by the primary problem, which vanishes once the secondary anxiety is cured. It’s wonderful, it makes me happy, and I’m not even taking it.
The only downside, of course, is that the Patient Information Leaflet does inevitably bang on about depression. And that’s a real bummer, because the patient who was depressed, thought he wasn’t, but agreed to take the drug because I said it was for his ‘IBS’ now realises I think he is, so he won’t, and believes I’ve lied to him, which I have. And that’s why he flushes it down the bog. Upside, though: this way it really will end up in the tap water.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield