Reviewed by Vicky Davis, FNP
Written by Our Editorial Team
If you’re struggling with a mood disorder such as depression, your mental health provider may suggest taking an antidepressant to reduce the severity of your symptoms. And if you’ve found us here, chances are that one of the medications you’ve discussed is nortriptyline.
Nortriptyline is a tricyclic antidepressant, or TCA. It works by increasing the levels of chemicals in your brain and body that may help to prevent the symptoms of depression.
Side effects are a source of concern for many people young and old, and if you’ve never taken an antidepressant before, you’ll know that side effects can be a source of anxiety in an already anxious or depressed world.
Like all antidepressants, nortriptyline can cause side effects. In fact, as an older antidepressant, nortriptyline has a slightly higher risk of causing side effects than newer depression medications, such as selective serotonin reuptake inhibitors (SSRIs).
The good news is that most of these side effects can be managed, either by adjusting your dose of nortriptyline, switching to another antidepressant or making other changes to the way you use your medication.
Below, we’ve talked about what nortriptyline is, as well as how it works as a common medication for the treatment of depression.
We’ve also listed the side effects and potential drug interactions you could experience while you use nortriptyline for depression.
Finally, we’ve shared some alternative options to consider, including other antidepressants that are less likely to cause adverse reactions or dangerous drug interactions.
Nortriptyline is a tricyclic antidepressant, or TCA. It’s approved by the FDA as a medication for major depressive disorder (MDD, or major depression). It’s also used off-label to treat several pain conditions, including diabetic neuropathy (nerve damage from diabetes).
As an antidepressant medication, nortriptyline works by increasing levels of neurotransmitters, or naturally-occurring chemicals, in your brain.
More specifically, nortriptyline increases levels of serotonin and norepinephrine, two chemicals that are closely associated with your ability to manage your moods, feelings, levels of physical arousal and regular daily functions such as falling asleep and waking.
Experts believe that by increasing levels of these neurotransmitters, antidepressant drugs like nortriptyline can produce improvements for people with depression.
Nortriptyline also affects the actions of several other naturally-occurring chemicals in your brain and body, including histamine, 5-hydroxytryptamine, and acetylcholine.
Although nortriptyline and other TCAs were once widely used to treat depression, they’re less common as first-line these days, as newer drugs like SSRIs tend to have similar benefits with fewer unwanted side effects.
However, your healthcare provider may prescribe a TCA like nortriptyline if you don’t respond well to other medications, or if you have persistent or severe depression.
Nortriptyline has been in use since the mid-1960s, meaning it’s been used to treat depression for approximately six decades.
Thanks to its lengthy track record as a treatment option for depression, we have a lot of data about the side effects of nortriptyline.
Nortriptyline can cause numerous side effects. Many of these side effects are mild and transient (meaning they may only last for a short time), while other adverse effects may be persistent and bothersome.
We’ve discussed the most common side effects of nortriptyline below and provided information about how each issue may affect you while using this medication.
Nortriptyline may cause you to feel drowsy and tired. You may notice that you have less energy after taking nortriptyline, or that you feel confused, disoriented and unable to pay close attention to things that normally wouldn’t be difficult for you.
It’s recommended that you avoid operating a vehicle or machinery until you’re familiar with how nortriptyline affects your energy levels and alertness.
This is a common side effect of tricyclic antidepressants that may be related to the effects of this type of medication on histamine, a naturally-occuring chemical that’s involved in wakefulness.
Nortriptyline may cause you to feel dizzy. You may experience a mild loss of coordination after taking this medication, making it more difficult for you to control your movements or do any type of physical activity.
Antidepressants such as nortriptyline can cause a variety of digestive issues, including nausea and vomiting. You may feel sick after eating food, or feel like you have an upset stomach even if you haven’t eaten anything unusual or unsafe. Nortriptyline may also cause constipation.
Like other antidepressants, nortriptyline may cause changes in your moods and feelings. You may feel anxious or agitated while using this medication, or experience physical symptoms of anxiety such as tremoring (shaking in your hands, legs, or other areas of your body).
Although many people feel drowsy after using nortriptyline, others experience difficulties with sleeping such as insomnia.
You may notice that your sleep patterns change while using nortriptyline, causing you to find it more difficult to fall asleep or stay asleep. Some people develop vivid dreams or nightmares while using nortriptyline and/or similar medications to treat depression.
Nortriptyline can cause urinary retention, meaning you may “hold water” in your bladder during the daytime and find it difficult to properly urinate. This may cause fluctuations in your weight based on the amount of liquid in your bladder throughout the day.
In some cases, nortriptyline and similar antidepressants may also cause you to need to pee on a more frequent basis than usual.
Nortriptyline can cause changes in your appetite, including loss of appetite or an elevated level of desire to eat. You might notice that you feel interested in eating more and gain weight while using nortriptyline, or that you eat less and lose weight.
Several antidepressants, including nortriptyline, can affect your sexual drive and function. You may feel less interested in sex while you’re using nortriptyline, or notice changes in your sexual performance.
According to research published in the World Journal of Biological Psychiatry, approximately 20 percent of people who use nortriptyline have sexual side effects after 12 weeks of treatment.
Nortriptyline can also cause other side effects, including dry mouth, blurred vision, excessive or persistent sweating, physical weakness, skin rash and galactorrhea, a form of nipple discharge unrelated to breastfeeding.
It’s important to talk to your healthcare provider if you develop any side effects from nortriptyline that are persistent or bothersome.
Most side effects of nortriptyline are mild. However, nortriptyline may also cause more severe side effects, including some that you should discuss with your healthcare provider if they ever affect you.
These include orthostatic hypotension (low blood pressure when standing), hypertension (high blood pressure), fainting, impaired bowel movement, low white blood cells, damage to the liver and swelling under your skin.
In some cases, nortriptyline can cause cardiovascular side effects, including heart arrhythmias (abnormal heart rhythms), changes in the electrical signaling that controls your heartbeat, and even serious cardiovascular events such as heart attack or stroke.
Nortriptyline can also cause something called angle-closure glaucoma -- a rare side effect that could cause blindness. Symptoms of this include increased eye pressure, blurred vision or eye pain.
To reduce your risk of developing side effects while using nortriptyline, it’s important to tell your healthcare provider about any existing medical conditions you have, including common issues such as heart disease.
Make sure to inform your healthcare provider if you use any cardiovascular medications, such as medications to treat arrhythmia or blood pressure medications.
It’s also important to seek immediate medical attention if you develop any severe or concerning side effects or signs of allergic reactions while using nortriptyline.
Nortriptyline can interact with other medications, including other antidepressants that increase serotonin levels.
When used together, these medications may cause serotonin syndrome -- a potentially serious condition in which your serotonin levels increase beyond a normal amount, causing a range of adverse effects.
Symptoms of serotonin syndrome include changes in blood pressure, shivering, tremor, dilated pupils, sweating and hyperactive reflexes. When severe, serotonin syndrome can cause muscle stiffness, highly elevated temperature and extreme swings in heart rate.
Severe cases of serotonin syndrome can cause serious health issues, including seizures, renal failure, coma and even death. Because of this, it’s important to talk to your healthcare provider about all medications you currently take or have recently taken before using nortriptyline.
It’s especially important to inform your healthcare provider if you’ve used any other medications for depression, such as monoamine oxidase inhibitors (MAOIs) within the last 14 days.
You should never stop taking any medication just because you experience adverse effects, and antidepressants and TCAs are no exception to this.
If you begin to develop side effects while taking nortriptyline, do not stop taking your medication abruptly. Instead, it’s best to reach out to your healthcare provider and let them know that you’re experiencing issues from your medication.
They may suggest adjusting your dosage, changing the time of day that you take nortriptyline or switching to a different type of antidepressant.
Although stopping nortriptyline may seem like an easy way to put an end to side effects, this can cause withdrawal symptoms referred to as antidepressant discontinuation syndrome.
Common withdrawal side effects of nortriptyline include headaches, nausea, physical weakness, dizziness, anxiety and other issues.
Ending treatment with nortriptyline abruptly may also reverse depression improvements caused by this medication and could contribute to a relapse of your depression.
If you need to stop using nortriptyline, your healthcare provider will likely suggest slowly tapering your dosage to reduce your risk of experiencing withdrawal symptoms.
As a tricyclic antidepressant, nortriptyline generally isn’t prescribed as a first-line treatment for depression due to its risk of causing side effects.
If you’re prescribed nortriptyline and have side effects, you may want to talk to your healthcare provider about switching to a different type of antidepressant.
We’ve listed alternatives to nortriptyline below and discussed how each type of antidepressant may help to treat your symptoms without causing unpleasant or unwanted side effects.
A newer class of antidepressants, SSRIs are more selective than TCAs, meaning they have a lower risk of causing certain side effects. SSRIs are some of the most commonly prescribed medications today and are generally used as first-line treatments for depression.
In addition to treating major depressive disorder, many SSRIs can reduce the severity of some anxiety disorders.
Another modern class of antidepressants, SNRIs reduce the severity of depression symptoms by increasing levels of serotonin and norepinephrine. These medications are also commonly used as first-line treatments for depression.
If you have a specific side effect from nortriptyline, such as a reduced sex drive or other form of sexual dysfunction, your healthcare provider may suggest using an “atypical” antidepressant to treat your depression while reducing the severity of this side effect.
One atypical antidepressant that’s often used to treat sexual side effects from other medications is bupropion (Wellbutrin®).
Our full list of antidepressants goes into more detail about other medications that are commonly used to treat depression.
Depression isn’t just treated with medication -- it can also improve dramatically with treatments such as psychotherapy.
Psychotherapy, or talk therapy, involves working with a therapist to learn new ways to think and behave. These new methods of thinking can help you to better deal with the emotional factors that often contribute to depression.
One of the most popular forms of therapy for depression is cognitive behavioral therapy (CBT), which involves changing dysfunctional or unhelpful thought patterns and behaviors that play a role in the development of depression.
You can learn more about the different forms of therapy used to treat depression in our guide to the types of therapy.
If you’re experiencing side effects from taking nortriptyline, some of them may be fairly normal and might gradually disappear with time.
However, if your side effects persist or reduce your quality of life, you should reach out to your healthcare provider to discuss them before stopping treatment with nortriptyline.
They may address your concerns by switching you to another antidepressant medication or by supporting your medication-based treatment with therapy or lifestyle changes.
They may also suggest making changes to the way you use nortriptyline, such as adjusting your dosage or taking your medication at a different time of day.
Interested in talking to a professional about your mental health? You can connect directly with a licensed psychiatry provider from home using our online psychiatry service. If appropriate, you’ll receive evidence-based medication to treat conditions such as depression or anxiety.
Start your mental wellness journey today.