I'm having a hard time figuring this one out. Amitriptyline and nortriptyline when added to my SSRI (haven't tried them alone) immediately eliminate every trace of anxiety I have. I sleep better, wake up with energy, and don't have that constant feeling of panic that I do without it.
Unfortunately, they also come with nasty side effects. At 25mg I get chest pain, urinary retention, and epididymitis (?!).
I'm trying to track down what is responsible for amitriptyline's anxiolytic effect and/or what's causing the side effects. I'm pretty sure it's not a1 or 5-ht2c antagonism, nor norepinephrine reuptake since I've tried things like mirtazapine/mianserin, carvediol. Sigma receptor agonism? Channel blocking? Muscarinic receptor antagonism?
Anyone here have any ideas?