Begin with the standard starting dose, which rarely produces incapacitating sleepiness or other side effects. The standard starting dose of Elavil, 75mg. In practice nearly everyone with MS Depression requires 100 -125 mg of Elavil each day. Some people need 150 mg. A few MSers need more.
Some people complain of uncomfortable sleepiness, even on the standard starting dose.
If this happens, decrease the dose. Once your body has adjusted to the medication, go back to 75mg at bedtime. The effective dose is usually the same, despite early side effects. Plan to increase your total dose to 100 - 150mg per day, as other people do, but more slowly. Once you reach any dose, remember the long biological half life and wait the required period of time before increasing the dose.