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Option (Evidence Strength: Grades B, B, C, and B) Amitriptyline (Evidence Strength: Grade B ) One randomized controlled trial reported efficacy of oral amitriptyline (25 mg daily titrated over several weeks to 100 mg daily if tolerated) to be superior to placebo (63% of treatment group clinically significantly improved compared to 4% of placebo group) at four months

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The challenge with making sense of these associations is that I’ve not seen a single study in a pregnant population that is not also supplemented with high doses of folic acid