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Nortriptyline For Anxiety & Panic

Katelyn Hagerty

Medically reviewed by Katelyn Hagerty, FNP

Written by Our Editorial Team

Last updated 4/20/2022

If you’re dealing with anxiety, you understand how deeply it can affect your life. It can make you dread everyday situations and leave you with both psychological and physical symptoms.  

Because of this, people with anxiety often look for treatment options — as they should. 

Medication is a common option for those with anxiety. One such medication is called nortriptyline, an antidepressant used for a variety of anxiety disorders, including panic disorder. While commonly used for depression, it may also be prescribed for anxiety. 

Below, we’re sharing what you need to know about it. But first, learn a bit more about anxiety.

What You Need to Know About Anxiety and Panic

Feeling anxiety at some point in your life is a totally normal occurrence. 

But if you feel it often, you may have an anxiety disorder. One of the most common disorders is generalized anxiety disorder (GAD). It’s defined by having a tough time controlling your anxiety more often than not over the course of six months. 

If you have GAD, you may find yourself worrying when there really is no reason to.

Physical signs you have GAD include dry mouth, heart palpitations, sweating, shortness of breath, nausea and more. There are also some psychological symptoms you should be on the lookout for, which include nightmares, excessive worry, flashbacks of trauma and trouble sleeping.

Another relatively common anxiety disorder is panic disorder. Nearly 5 percent of the population in the United States deals with this disorder at some point and it’s more likely to affect women than men (though everyone experiences it).

Feelings of fear, heart palpitations, chest pain and shortness of breath are all symptoms of panic disorder. Panic attacks are another major sign.

Some signs you are having panic attacks include: 

  • Sweating

  • Chills

  • Dizziness

  • Tingly hands

  • Chest pain

Using Nortriptyline for Anxiety

Nortriptyline (sold under the brand name Pamelor) is FDA-approved to treat symptoms of depression. It falls under a class of medications called tricyclic antidepressants. In addition to being used to address depressive disorder, nortriptyline is sometimes used to help with anxiety — specifically panic disorder.

This antidepressant comes in two forms — an oral tablet or oral liquid. It is thought to work by boosting the neurotransmitter norepinephrine in the brain, which can help keep depression or anxiety in check.

When tricyclic antidepressants are used to treat panic disorder, they generally take three to four weeks to kick in and make a difference.

As for the research, there aren’t a ton of recent studies that show the effects of nortriptyline on anxiety and panic disorders. 

One small study from 1988 found that 67 percent of patients who took nortriptyline stopped having panic attacks.

An even smaller study from 1994 found that nortriptyline may decrease sympathetic activity in patients with panic disorder. 

Your sympathetic nervous system is what regulates your fight or flight response. When activated, as it is during a panic attack, it can lead to an increased heart rate (amongst other things). 

Before you start taking nortriptyline, it’s important to let a healthcare professional know if you’re taking any other medications, as it can interact poorly with other things. You should also never stop taking this antidepressant cold turkey. If you do, you may experience withdrawal symptoms. 

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Side Effects of Nortriptyline

With any medication, nortriptyline comes with some potential side effects. Most side effects are mild and should go away after a little while. 

Some of the most common side effects include: 

  • Dry mouth

  • Nausea

  • Tiredness

  • Excessive sweating

  • Excitement

  • Dizziness

  • Nightmares

  • Constipation

  • Changes in appetite and weight gain

  • Frequent urination or difficulty urinating

If any of the above side effects present as severe or do not go away, you should speak with your healthcare provider. 

Along with these adverse effects, there are sometimes more serious issues caused by taking nortriptyline. If you notice any of the below, reach out to a healthcare provider immediately. 

  • Difficulty breathing

  • Slow speech

  • Yellowing of the skin or eyes

  • Uncontrollable shaking

  • Jaw, back or neck spasms

  • Fever

  • A shuffling walk

  • Rash

  • An irregular heartbeat

Other Ways to Treat Anxiety

In addition to a tricyclic antidepressant, there are other medications that can be used to treat anxiety — which is great news, because anti-anxiety medication can be very helpful. 

Some of the medications often prescribed for anxiety include selective serotonin reuptake inhibitors (SSRIs), beta-blockers and benzodiazepines. You should know that medication doesn’t cure anxiety, but rather helps to diminish its symptoms.

Medication for anxiety must be prescribed by a healthcare professional. If you’re wondering if taking medication could help your anxiety, Hers offers online consultations that allow you to meet virtually with someone.

In addition to prescription medication, talk therapy may be recommended. Most often, cognitive behavioral therapy (CBT) is used. In CBT patients work with their mental health provider to identify patterns of behavior that enhance their anxiety and come up with ways to adjust that behavior.

Often, therapy and medication are used in conjunction with one another. 

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Taking Nortriptyline for Anxiety

Nortriptyline is a tricyclic antidepressant that is FDA-approved to treat depressive symptoms. It is also sometimes prescribed to treat anxiety disorder — commonly panic disorder.

There are some older studies that suggest it can effectively help with the symptoms of anxiety (like by lowering one’s heart rate). 

Before you start taking nortriptyline, it’s important to tell your medical provider if you are taking anything else, as this medication can have poor drug interactions with other things. 

Once you start taking nortriptyline, it may take three to four weeks to notice the effects. You’ll need to take a daily dose of it for it to work. You should also never stop taking nortriptyline cold turkey because you may experience withdrawal symptoms. Instead, you’ll need to work with your healthcare provider to slowly wean off it.

Side effects of nortriptyline include nausea, dizziness, dry mouth, weight gain and more.

In addition to nortriptyline, there are a variety of other medications that can be used to help with anxiety. Talk therapy is also something that is suggested. 

If you’d like to explore ways to treat your anxiety, you should start by speaking with a mental health professional

16 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. Generalized Anxiety Disorder (GAD). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad
  2. Anxiety Disorders. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders#symptoms-and-causes
  3. Anxiety Disorders. Anxiety and Depression Society of America. Retrieved fro
  4. https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/symptoms
  5. Panic Disorder. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/statistics/panic-disorder
  6. What are the five types of anxiety disorders? U.S. Department of Health and Human Services. Retrieved from https://www.hhs.gov/answers/mental-health-and-substance-abuse/what-are-the-five-major-types-of-anxiety-disorders/index.html
  7. Panic Disorder: When Fear Overwhelms. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/publications/panic-disorder-when-fear-overwhelms
  8. Nortriptyline. Johns Hopkins. Retrieved from https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/peripheral_nerve/patient_info/nortriptyline_2007.pdf
  9. Nortriptyline. Medline Plus. Retrieved from https://medlineplus.gov/druginfo/meds/a682620.html
  10. Nortriptyline. National Cancer Institute. Retrieved from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/nortriptyline
  11. Saeed, S., Bruce, T., (1998). Panic Disorder: Effective Treatment Options. American Family Physician. Retrieved from https://www.aafp.org/afp/1998/0515/p2405.html
  12. Munjack, D J., Usigli, R., Zulueta, A., et al., (1988). Nortriptyline in the treatment of panic disorder and agoraphobia with panic attacks. J Clin Psychopharmacol. Retrieved from https://pubmed.ncbi.nlm.nih.gov/3379145/
  13. Yeragani, VK., Srinivasan, Y., Pohl, R., et al., (1994). Effects of Nortriptyline on Heart Rate Variability in Panic Disorder Patients: A Preliminary Study Using Power Spectral Analysis of Heart Rate. Neuropsychobiology. Retrieved from https://www.karger.com/Article/Pdf/119054
  14. Alshak, M., Das, M., (2021). Neuroanatomy, Sympathetic Nervous System. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK542195/
  15. Anxiety Disorders. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/
  16. What is Cognitive Behavioral Therapy? American Psychological Association. Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
What’s next?

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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