One of the most effective antidepressants isn’t routinely prescribed — and there’s a very good reason why. Amitriptyline (Elavil), a tricyclic antidepressant, ranked among the top antidepressants for efficacy in a landmark network meta-analysis published in The Lancet. So why isn’t it first-line treatment for major depressive disorder? Because effectiveness isn’t the whole story. Amitriptyline has a significant side-effect burden (anticholinergic effects, sedation, weight gain, postural hypotens