Nortriptyline: Uses, Side Effects and Warnings

What nortriptyline is

Nortriptyline belongs to the tricyclic group of antidepressants. MedlinePlus says it comes as a capsule and an oral liquid. It is sold under its generic name.

NIMH explains that older antidepressants such as tricyclics are associated with more side effects than the medicines most often prescribed now, but that they can suit some people well. If a prescriber has raised nortriptyline with you, asking why it might fit your situation is a good and ordinary question.

Approved use and off-label uses

The FDA label says nortriptyline is for the relief of symptoms of depression, and that what it calls endogenous depressions are more likely to be relieved than other kinds. Safety and effectiveness in children have not been established, and it is not approved for treating bipolar depression.

MedlinePlus says it is also sometimes used for panic disorders and for post-herpetic neuralgia, the burning or stabbing pain that can last after shingles. Both of these are off-label, meaning the FDA label does not list them. MedlinePlus advises talking with your doctor about the possible risks of using it for your condition.

How it is thought to work

The label is frank that the way tricyclics lift mood is unknown. It says nortriptyline is not an MAOI, that it blocks the activity of histamine, serotonin and acetylcholine, and that studies suggest it interferes with how the body moves, releases and stores chemical messengers such as norepinephrine. MedlinePlus puts it more simply: it increases certain natural substances in the brain that help maintain mental balance.

What taking it can be like

NIMH says antidepressants usually take time to work, and that sleep, appetite, energy and concentration often improve before mood does. So a small change in energy or sleep can be worth noting even when mood has not yet shifted. Follow-up visits are the place to talk about what you are noticing.

MedlinePlus says to keep taking it even if you feel well, and not to stop without talking to your doctor. Stopping suddenly after long use can cause nausea, headache and a general unwell feeling. The label says these symptoms are not a sign of addiction, and a prescriber will usually lower the amount gradually.

Some everyday things can change too. The label warns it may affect your ability to drive or use machinery, and your response to alcohol may be stronger. MedlinePlus suggests avoiding long or unnecessary time in the sun and wearing protective clothing and sunscreen.

Side effects and warnings

Boxed warning, in plain words: in short-term studies, antidepressants raised the risk of suicidal thoughts and behavior in children, teens and young adults. Adults over 24 did not show that increase, and adults 65 and older showed a lower risk. People of all ages should be watched closely for worsening mood, suicidal thoughts or unusual behavior, and families should tell the prescriber about changes. In a crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services. See our crisis resources for more.

MedlinePlus lists these side effects: nausea, drowsiness, weakness or tiredness, excitement or anxiety, nightmares, dry mouth, changes in appetite or weight, constipation, trouble urinating or urinating often, changes in sex drive, and heavy sweating.

• MAOIs: use together, or within 14 days of each other, is contraindicated because of serotonin syndrome. The same goes for beginning it during treatment with linezolid or intravenous methylene blue.
• Heart: it is contraindicated during the acute recovery period after a heart attack. The label calls for close supervision with heart disease. Brugada syndrome, a heart condition that can cause fainting and sudden death, has been reported since approval.
• Eyes: angle-closure glaucoma has been reported. MedlinePlus advises talking to your doctor about an eye exam.
• Seizures, thyroid problems and trouble urinating call for extra care, and the label notes blood sugar may rise or fall.
• It can also bring on mania in people with bipolar disorder or worsen psychosis in schizophrenia.
• Cimetidine, which is sold over the counter, and quinidine can raise levels in the blood. Tell your prescriber about everything you take, and tell them if you are pregnant, planning a pregnancy or breastfeeding.

Managing it online in Pennsylvania and New York

Nortriptyline is taken at home, and the label does not limit it to a certified healthcare setting. A video visit works well for talking about mood, side effects and daily life. It cannot do a physical exam or a heart tracing, so people with heart concerns should ask how those checks would be arranged.

A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine (DO) with more than three decades of practice, provides online depression treatment and medication management by secure video. You must be physically located in Pennsylvania or New York during each visit. Our therapists do not prescribe.

Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help through our medication contact form. Reaching out with a question is a strong and ordinary first step.