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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 an anxiety disorder, you’ll understand how deeply it can affect your life. It may make you dread everyday situations and experience both mental and physical symptoms, from headaches and muscle pain to a constant feeling of being “on edge.”

Because of this, people with anxiety often look for treatment options, as they should. If you’ve been diagnosed with a form of anxiety, your healthcare provider may prescribe the medication nortriptyline to help you control your symptoms.

Nortriptyline is an antidepressant. In addition to treating depression, it’s also commonly used to treat anxiety disorders, including panic disorder.

Although nortriptyline is often effective at treating anxiety, there are a few things that you should know before using this medication.

Below, we’ve covered the basics of using nortriptyline for anxiety and panic, from how this type of medication works to its potential side effects.

We’ve also discussed some other options that you and your mental health provider may want to consider to help you manage your anxiety symptoms, from other medication to simple habits for reducing the severity of your anxiety and improving your quality of life.

What You Need to Know About Anxiety & Panic

Feeling anxious at some point in your life is a totally normal occurrence. We all develop feelings of anxiety from time to time, and when these occur occasionally, it doesn’t mean that we have a form of mental illness.

However, if you feel anxiety often, or if your anxiety symptoms are severe and overwhelming, it could be a sign that you have an anxiety disorder.

Anxiety disorders are common. According to the National Comorbidity Study Replication, more than 19 percent of US adults experience anxiety disorders per year, with anxiety most common in women.

This means that if you’re concerned that you may have an anxiety disorder, you’re certainly not alone.

One of the most common anxiety disorders is generalized anxiety disorder (GAD), a persistent type of anxiety that’s defined by feelings of restlessness, fatigue, irritability, worry, irritability and other issues, including sleep difficulties and difficulty concentrating.

Physical symptoms of generalized anxiety disorder include headaches, stomachaches, muscle soreness and other forms of discomfort.

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. Like other forms of anxiety, it affects everyone, but is generally more common in women than in men.

Panic disorder can involve a range of symptoms, including a pounding heartbeat and fast heart rate, sweating, trembling and chest pain. During a panic attack, you may feel a sense that you have no control over yourself and strong feelings of impending doom. 

Although generalized anxiety disorder and panic disorder share several symptoms, they’re very different disorders. Our guide to panic disorder vs. generalized anxiety disorder goes into more detail about their symptoms, as well as how each form of anxiety may affect your life.  

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What is Nortriptyline?

If you’ve been diagnosed with an anxiety disorder, your healthcare provider may suggest using medication to control your symptoms.

A variety of different medications are used to treat anxiety, and nortriptyline (sold as Pamelor® and under other brand names) is one of them. 

Nortriptyline is a tricyclic antidepressant, or TCA. It works by increasing the levels of serotonin and norepinephrine -- two essential neurotransmitters -- in your brain. These natural chemicals help to regulate certain aspects of your thoughts, feelings and behavior.

Low levels of some neurotransmitters, such as serotonin, are associated with an elevated risk of depression and anxiety.

Currently, nortriptyline is only approved by the FDA as a treatment for depression. However, like with many other prescription medications, it’s often prescribed off-label to treat other conditions, including anxiety disorders such as panic disorder.

Using Nortriptyline for Anxiety

If you’re prescribed nortriptyline for anxiety, your healthcare provider will inform you about how and when to take your medication.

A typical dose of nortriptyline is 25mg taken three to four times per day. However, your mental health provider may adjust your dosage based on the severity of your symptoms and your level of response to the medication. 

As a tricyclic antidepressant, it generally takes three to four weeks for nortriptyline to reduce the severity of the symptoms of anxiety.

If you’re prescribed nortriptyline and don’t feel any improvements right away, make sure to keep taking your medication as advised by your healthcare provider. You may notice that your anxiety symptoms gradually become milder as nortriptyline starts to work.

So, does nortriptyline work for adults with anxiety disorder? Several studies have looked into the effectiveness of antidepressant treatments like nortriptyline as anxiety medications, with largely positive results. 

In one small study published in the Journal of Clinical Psychopharmacology in 1988, a group of researchers looked at the effects of nortriptyline for patients with panic disorder or agoraphobia with panic attacks.

They found that most people with panic disorder or agoraphobia with panic attacks experienced improvements after taking nortriptyline.

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

Your sympathetic nervous system is what regulates your body’s fight or flight response. When activated, as it is during a panic attack, it may result in an increased heart rate and other panic symptoms.

While these studies certainly suggest that nortriptyline may offer benefits for panic disorder, it’s important to keep in mind that they’re much less comprehensive than the research backing up other treatments for anxiety, such as selective serotonin reuptake inhibitors (SSRIs). 

There’s also significantly less scientific evidence to support nortriptyline as an anxiety treatment than there is for anti-anxiety medications.

As such, your healthcare provider may prescribe nortriptyline if other medications don’t seem to work for you, or if it’s the most appropriate form of treatment based on your symptoms.

Nortriptyline Side Effects & Drug Interactions

As a tricyclic antidepressant, nortriptyline has a slightly higher risk of causing side effects than many newer medications for anxiety and depression. 

Common side effects of nortriptyline 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 over time, you should talk to your health care provider and let them know. 

Although uncommon, nortriptyline can cause more serious side effects. If you notice any of the adverse effects below, it’s important to contact your healthcare provider as soon as you can:

  • Difficulty breathing

  • Yellowing of the skin or eyes

  • Slowed speech

  • Uncontrollable shaking

  • Jaw, back or neck spasms

  • Shuffling walk

  • Irregular heartbeat

  • Fever

  • Rash

Nortriptyline can cause interactions when used with other medications, including antidepressant medications, other psychiatric medications and substances that increase serotonin levels.

One potential issue that you should be aware of before using nortriptyline is serotonin syndrome -- a condition that can occur when your serotonin levels become excessively high.

To reduce your risk of serotonin syndrome, it’s important not to take nortriptyline with any other medications, supplements or other substances that increase serotonin levels.

Inform your healthcare provider about all medications you currently take or have recently taken before taking nortriptyline, particularly other antidepressant drugs such as monoamine oxidase inhibitors (MAOIs).

It’s also important to inform your mental health provider about any other medical conditions you have, including chronic conditions or previous medical events such as heart attack or stroke.

If you develop side effects from nortriptyline, or feel that it doesn’t adequately treat your anxiety symptoms, it’s important not to stop taking it suddenly.

Like other antidepressants, nortriptyline can cause withdrawal symptoms if it’s stopped without a tapering period. Common antidepressant withdrawal side effects include headache, nausea and physical weakness. 

If you’d like to stop taking nortriptyline, it’s important to tell your healthcare provider. They’ll help you to gradually taper your dosage so that you can stop taking nortriptyline without dealing with unwanted side effects or withdrawal symptoms. 

Other Options for Treating Anxiety

Nortriptyline is far from the only option for treating anxiety. In fact, as a tricyclic antidepressant, it’s not very common for nortriptyline to be prescribed as a first-line treatment for most forms of anxiety. 

Other options for treating anxiety and panic disorders include anti-anxiety medications such as benzodiazepines, newer antidepressants such as SSRIs, and non-pharmacological treatments such as psychotherapy. 

Other Medications for Anxiety

Several other types of medication are often used to treat anxiety and panic disorders, including benzodiazepines and SSRIs.

Benzodiazepines work by slowing down activity in certain parts of your central nervous system, producing a calming effect. They provide nearly immediate relief from the symptoms of anxiety, but can become less effective over time as you develop a tolerance.

Some benzodiazepines can also lead to physical dependence, meaning they’re only prescribed for short periods of time.

SSRIs are antidepressants that work by increasing serotonin levels. They’re often prescribed as longer-term anxiety treatments, as they usually take several weeks to start reducing the severity of anxiety symptoms. 

We offer several SSRIs online via our online psychiatry service, including  fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®) and escitalopram (Lexapro®). 

Psychotherapy

Psychotherapy, or talk therapy, is a form of treatment that involves talking with a mental health provider about your anxiety symptoms, then working together to change the way you think and behave to make them less severe and/or easier to manage. 

Several forms of therapy are used to treat anxiety, including cognitive behavioral therapy (CBT) and exposure therapy. Many of these forms of therapy can also provide relief from symptoms of depression, bipolar disorder and other common mental health issues. 

If you have an anxiety disorder, your healthcare provider may suggest taking part in therapy on its own, or combining therapy with the use of medication to better control your symptoms.

We offer online therapy, allowing you to connect with a licensed provider from home and take part in regular sessions without any need to drive to your provider’s office. 

Habits and Lifestyle Changes

Sometimes, making simple but meaningful changes to your habits and daily life can make the symptoms of anxiety and panic easier to deal with. These include:

  • Keeping yourself physically active

  • Avoiding stimulants and other drugs

  • Practicing mindfulness and meditation

  • Limiting your alcohol consumption

  • Using other stress management techniques

Many of these habits may also reduce the severity of other psychiatric disorders and improve other aspects of your daily life. 

Your mental health provider may inform you about specific changes that you can make to your habits and lifestyle to improve your results from anxiety treatment.

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The Bottom Line on Taking Nortriptyline for Anxiety

Although nortriptyline typically isn’t used as a first-line treatment for anxiety, your healthcare provider may prescribe it if you suffer from panic disorder and haven’t noticed improvements with other medications. 

Make sure to follow your healthcare provider’s instructions and take nortriptyline as directed, whether you’re prescribed nortriptyline capsules or oral solution. 

Before you start taking nortriptyline, it’s important to tell your medical provider if you’re taking anything else, as this medication can cause drug interactions. 

It’s also important to let your healthcare provider know if you feel like nortriptyline isn’t working well for you, or if you have severe or bothersome side effects.

Ready to take action and improve your mental health? We offer several mental health services online, including psychiatry and anonymous support groups.

You can also learn more about your options for treating anxiety, depression and other forms of mental illness using our free online mental health resources and content

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.

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  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
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  5. Panic Disorder. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/statistics/panic-disorder
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  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
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  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/
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  16. What is Cognitive Behavioral Therapy? American Psychological Association. Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

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. Learn more about our editorial standards here.

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