Nortriptyline

Nortriptyline, commonly sold under the brand name Pamelor, is a type of antidepressant known as a tricyclic antidepressant (TCA). This class of drugs includes some of the earliest antidepressants developed. They work by blocking the reabsorption of two neurotransmitters in the brain—serotonin and norepinephrine—in order to regulate mood and help relieve depression.

Following the development of TCAs in the 1960s, newer classes of antidepressants—including selective serotonin reuptake inhibitors (SSRIs)—have been developed that work differently and may result in fewer side effects.

Because nortriptyline can have significant side effects, it is not generally used as a first-line prescription treatment for depression. However, nortriptyline may still work well for some patients—particularly those for whom other treatments have not been effective.

At Brightside, our psychiatric providers specialize in personalizing treatment for each person. We give you the personal attention and expert advice you deserve and can count on—we explain all your options and use our expertise to find the medication that’s right for you. It’s important to us that you understand how medications work and what to expect so that your treatment is worry-free.

If you are prescribed nortriptyline, you should know that it is an FDA-approved medication for the treatment of depression in adults. Nortriptyline may also be prescribed for the treatment of chronic pain or ADHD symptoms.

At Brightside, we use nortriptyline to treat a number of conditions, including:

• Major Depressive Disorder 
• Persistent Depressive Disorder
• Postpartum Depression
• Seasonal Affective Disorder (SAD)

Nortriptyline can target and treat several indicators of low mood and general depression.

We use this medication to treat a number of symptoms, including:

• Depressed mood, feeling hopeless or sad
• Feelings of worthlessness 
• Loss of interest or pleasure in doing things
• Low energy
• Outbursts of anger, irritability, or frustration
• Poor appetite
• Sleeping too much or too little
• Thoughts of suicide or self-harm 
• Trouble concentrating
• Trouble falling or staying asleep

You may be wondering if your symptoms can be treated with nortriptyline. Making sense of different medications, their uses, benefits, and side effects can be challenging. That’s where we can help. Brightside providers have an in-depth knowledge of the strengths and drawbacks of each medication. You’ll get all the information you need to make an informed choice about your treatment.

At Brightside, we can help you find the right medication specific to your needs. We understand that you may be feeling a bit uncertain about starting a new medication and whether it will help you feel better. You’re not alone—many patients have similar questions, and we’ll work together with you to find the answers.

It’s important to keep in mind that some medications work better for certain people than others because each person is different. Your age, gender, genetic background, and other variables–including other medications you may be taking–can affect how well you respond to a certain antidepressant.

To ensure that your antidepressant is a fit for your personal health situation, our psychiatric providers will get to know your individual health history. We know that mental health concerns often can’t wait, so if you need to meet with a provider right away to discuss a new or existing medication, we offer consultation and telehealth services within 48 hours.

You can expect to see an improvement in your depression and anxiety symptoms within a few days of beginning nortriptyline, with full benefits of the medication evident within several weeks. We understand that this can feel like a long time, but it’s important to continue taking your medication even if you don’t feel improvement right away. In some cases, your provider may need to adjust your dosage for you to get the maximum benefit from the medication. At Brightside, our board-certified providers will closely monitor your progress to make sure this medication and dosage is right for you.

Before you start taking nortriptyline, you may have some questions about how long you’ll need to take this medication. The length of time for your nortriptyline prescription may vary, depending on your specific symptoms and response to the drug. Most providers suggest taking an antidepressant for at least six to 12 months after your symptoms begin to improve in order to stabilize them. Stopping too early could cause your depression and anxiety symptoms to return.

When you and your provider agree you are ready to stop taking nortriptyline, we’ll work with your to slowly decrease your dosage. Stopping suddenly can cause side effects, including nausea, headache, and tiredness.

Studies have shown that antidepressants relieve symptoms of depression about 40-60% of the time, and additional treatments (such as therapy and lifestyle improvements) on top of medication often lead to the best outcomes.

To get the best results with medication, it’s important to consistently measure progress during treatment. This is known as Measurement Based Care, and it’s the approach we use at Brightside. It’s common to adjust the dose and/or medication when starting antidepressants until you find just the right fit.

You should know that nortriptyline has been successfully used to treat depression in adults for decades. However, research has suggested that certain selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, may be more effective than nortriptyline in treating major depression. Still, nortriptyline may be a good option for patients who have not responded well to other types of antidepressants.

Many people worry that antidepressants will alter their personality or change who they are. As long as you’re taking the right dosage, nortriptyline will not change your personality or blunt your emotions. Actually, it will help you feel like yourself again by improving your mood, reducing your anxiety, and helping you let go of worries.

Just remember that your symptoms won’t improve overnight. Keep taking your medication as prescribed—even when you start to feel better—and talk to your Brightside provider if you have any questions or concerns.

When prescribing any medication, our providers work to make sure you experience as few side effects as possible.

It’s important to understand that nortriptyline may be slightly more likely to cause unwanted, temporary side effects when compared to newer classes of antidepressants. As a result, providers may prescribe nortriptyline as a second- or third-line treatment option for patients who have not had success with other antidepressants.

Side effects from nortriptyline are usually temporary, but talk to your provider if any of these symptoms become severe or don’t go away:

• Changes in sex drive or ability
• Confusion
• Constipation
• Difficulty urinating or frequent urination
• Drowsiness, weakness, or tiredness
• Dry mouth
• Excessive sweating
• Excitability or nervousness
• Headaches
• Nausea
• Weight gain or changes in appetite

In rare cases, nortriptyline can also cause severe side effects. Contact your provider if you experience any of the following symptoms:

• Difficulty breathing or swallowing
• Fainting or dizziness 
• Irregular heartbeat
• Slowed speech 
• Swelling or yellowing of the eyes
• Uncontrollable shaking
• Vision changes

Do not take nortriptyline if you are also taking a monoamine oxidase inhibitor (MAOI) such as phenelzine, tranylcypromine, or isocarboxazid. MAOIs are often prescribed to treat depression, Parkinson’s disease, or bipolar disorder. Combining an MAOI with nortriptyline can lead to a severe reaction, including a sudden spike in body temperature, extremely high blood pressure, or seizures.

Patients who have recently had a heart attack should also not take nortriptyline.

Some patients using nortriptyline have reported an increased risk of suicidal thoughts or actions. Call 911 and seek immediate medical attention if you experience thoughts of suicide or self-harm while taking any antidepressant.

At Brightside, your health and safety are our highest priorities. We make sure you get individual attention and guidance to make sure you feel your best.

Antidepressants are not physiologically or psychologically addictive, but they can cause a discontinuation syndrome if stopped abruptly.

The discontinuation syndrome is a consequence of abruptly stopping certain types of antidepressants––particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Discontinuation syndrome can include a range of symptoms that may occur in patients who suddenly stop their SSRIs or SNRIs. These are the most common symptoms of discontinuation syndrome: 

• Feeling anxious
• Feelings of vertigo
• Odd sensory symptoms, such as tingling feelings in the skin or what some people describe as a “zapping” sensation in the brain
• Trouble sleeping

Make sure to talk to your provider before stopping or changing how you take your medication so they can create a plan that gives your body enough time to adjust. This will keep you feeling well and prevent symptoms from returning.

If you are pregnant or plan to become pregnant, you’ll want to talk with your provider to weigh the benefits and risks of beginning a nortriptyline prescription. Nortriptyline is categorized as a Pregnancy Category Class C drug by the FDA. This classification means that while extensive research on pregnant women has not been done, research using animals suggests that nortriptyline could potentially negatively impact a developing baby.

If you already use nortriptyline, discuss your case with your provider to see if the benefits of continuing with nortriptyline during pregnancy outweigh any potential risks to your baby.

Research has shown that nursing mothers can use nortriptyline with caution. Nortriptyline excretes into the breast milk of nursing mothers, but the amount is small and believed to pose no harm to developing infants.

Nortriptyline is generally considered non-addictive and is not habit-forming. However, it’s important to remember that you may still experience withdrawal symptoms if you stop taking it suddenly.

You can view the FDA black box warning for nortriptyline here. If you have questions about whether the black box warning for nortriptyline applies to you, please talk to your provider.