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Nortriptyline For Depression Treatment

Kristin Hall

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 8/22/2022

When depression occurs, it can have a devastating effect on your life, affecting everything from your moods and feelings to your ability to sleep, maintain social relationships and perform other daily functions. 

Unfortunately, depression is alarmingly common. In fact, data from the 2020 National Survey on Drug Use and Health (NSDUH) suggests that an estimated 8.4 percent of US adults deal with at least one depressive episode on an annual basis. 

If you’re one of the tens of millions of adults affected by depression every year, your healthcare provider may prescribe an antidepressant to help you control your symptoms.

One such antidepressant is nortriptyline, a tricyclic antidepressant (TCA) that’s approved by the FDA to treat major depressive disorder.

Although nortriptyline isn’t as common as other antidepressants, research shows that it’s usually effective at reducing the severity of depression symptoms. 

However, like with all antidepressant medications, there are several things that you should know before using nortriptyline for depression treatment.

We’ve explained these below, from how nortriptyline works to potential adverse effects and drug interactions to be aware of while using this medication.

What is Depression?

Now that you know a good number of people deal with depression at some point in their life, it may also be helpful to have a better understanding of this mental health condition.

Depression is a common mental illness that can have a serious impact on your well-being and quality of life. It can affect the way you think, feel and behave, and have a negative impact on just about every aspect of your daily life.

There are several types of depression, including major depressive disorder (MDD), persistent depressive disorder (dysthymia), seasonal affective disorder (SAD) and perinatal depression -- a form of depression that can develop during pregnancy.

There are also a number of symptoms of depression. Some people with depression only show a few symptoms, while others experience many. Depressed patients also experience symptoms in different severities.

Common depression symptoms include:

  • Pervasive feelings of sadness, anxiety or hopelessness 

  • Feeling irritable or worthless

  • Low energy

  • Tiredness

  • Being restless 

  • A loss of interest in things you once enjoyed

  • Weight gain or loss

  • Isolating yourself 

  • Having trouble sleeping

  • Thoughts of self-harm, death or even suicide

In order to be diagnosed with a form of depression, you’ll generally need to experience several of these symptoms over a period of two weeks or longer, with symptoms occurring on a daily or near-daily basis.

Our guide to the signs of depression in women goes into more detail about these symptoms, as well as how they may affect you if you're depressed.

Taking Nortriptyline for Depression

Nortriptyline is an antidepressant. More specifically, it’s a tricyclic antidepressant that works by increasing the amount of serotonin and norepinephrine -- two important neurotransmitters -- in your brain and body.

Neurotransmitters are naturally-occurring chemicals that transmit information between neurons, or nerve cells.

Although the precise link between neurotransmitters and depression isn’t clear, research shows that low levels of these neurotransmitters are associated with a higher risk of developing mental health issues such as depression and anxiety.

This is where antidepressants come in. By increasing serotonin and norepinephrine levels in the brain, medications like nortriptyline can ease your depression symptoms and give you a greater quality of life.

Nortriptyline can be purchased as a generic medication, but it’s also sold under the brand name Pamelor®. It comes as an oral tablet and as an oral solution, with a recommended initial dosage of 25mg taken three to four times per day. 

So, is nortriptyline effective? Research generally shows that people affected by depression who use medications such as nortriptyline have less severe symptoms and are more able to recover than people who don’t receive treatment. 

It also suggests that nortriptyline is often effective when other, newer medications for depression don’t fully work. 

For example, one study published in the Journal of Clinical Psychiatry in 2003 found that around 40 percent of people affected by treatment-resistant depression (meaning depression that didn’t improve with other forms of treatment) showed improvements after using nortriptyline.

With this said, nortriptyline -- like other antidepressants -- generally needs some time to produce noticeable improvements in depression. 

On average, it takes four to eight weeks of use before medications like nortriptyline are effective at treating depressive symptoms. In short, the effects of nortriptyline are real, but they can take some time to begin. 

They can also require dosage adjustments. Over time, your healthcare provider may adjust your daily dosage of nortriptyline based on your response to the medication, as well as your adverse effects.

Side Effects of Nortriptyline

There are side effects associated with taking any antidepressant, and nortriptyline certainly isn’t an exception. 

In fact, as a tricyclic antidepressant, nortriptyline has a slightly higher risk of causing side effects than newer antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Common side effects of nortriptyline include: 

  • Drowsiness

  • Constipation

  • Dizziness

  • Blurred vision

  • Impaired coordination

  • Physical weakness

  • Nausea and vomiting

  • Xerostomia (dry mouth)

  • Excessive sweating

  • Disorientation

  • Confusion

  • Insomnia

  • Anxiety

  • Agitation

  • Restlessness

  • Changes in libido

  • Skin rash and/or itchy skin

  • Galactorrhea (nipple discharge)

  • Changes in blood sugar levels

  • Breast gland tissue growth 

  • Increased need to urinate

  • Sensitivity to sunlight

  • Urinary retention

  • Abnormal sensations

  • Tremoring

Nortriptyline can also cause less common, more severe side effects, including glaucoma, heart rhythm changes, orthostatic hypertension (low blood pressure while standing), leukopenia, low blood platelet count, eye pain, heart attack and stroke.

It’s important to inform your healthcare provider if you notice any side effects while you’re using nortriptyline to treat depression. It’s also important to inform your healthcare provider about any medical conditions before using nortriptyline or any other type of antidepressant.

If you experience any severe adverse events while using nortriptyline, you should seek medical attention as soon as you can. 

Because of nortriptyline’s effects on your sensitivity to sunlight, it’s important to wear protective clothing and apply sunscreen when you spend time outdoors, particularly during summer or on bright, sunny days.

Like other antidepressants, nortriptyline can cause interactions when it’s used with certain other drugs, including herbal products and antidepressant treatments. 

For example, nortriptyline can interact with other medications that increase serotonin levels and cause a potentially dangerous condition called serotonin syndrome.

Symptoms of serotonin syndrome include high blood pressure, a rapid heart rate, elevated body temperature, hyperactive bowel sounds and pressured speech.

When severe, serotonin syndrome can cause serious symptoms, including dramatic changes in blood pressure and heart rate, seizures, metabolic acidosis, renal failure, difficulty breathing and even coma or death.

Medications that may cause serotonin syndrome include other antidepressants, methylene blue, linezolid and others. In particular, a class of antidepressants referred to as monoamine oxidase inhibitors (MAOIs) can contribute to a high risk of serotonin syndrome. 

Make sure to let your healthcare provider know about all medications you currently use or have recently used (for example, medications you have taken within the last 14 days) before you use nortriptyline. 

Other Treatment Options for Depression

As a medication for the treatment of depression, nortriptyline offers several benefits, including its high rate of effectiveness. 

However, it’s far from the only treatment option available, nor is it necessarily the best option for most people with depression.

If you have a form of depression, your mental health provider may suggest using a different type of medication, taking part in therapy or making changes to your daily habits to help you get relief from your symptoms and make progress towards recovery.

Other Antidepressants

Because of its risk of side effects, nortriptyline generally isn’t used as a treatment for depression unless other medications aren’t fully effective.

If you suffer from major depression, your healthcare provider will likely suggest using an SSRI or SNRI before trying a tricyclic antidepressant such as nortriptyline. 

SSRIs and SNRIs are more selective than tricyclic antidepressants. Most research shows that they’re equally effective at treating depression in patients, albeit with a lower risk of producing side effects. As such, they’re widely used as first-line depression treatments.

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

We also offer several SNRIs and atypical antidepressants, including duloxetine (Cymbalta®), venlafaxine (Effexor®) and bupropion (Wellbutrin®).

Because of their more selective mechanism of action within your body, these medications may provide better results if you’re prone to adverse effects from older drugs such as nortriptyline. 

Psychotherapy

Although medication is often an important element of treating depression, it isn’t the only piece of the puzzle. 

In addition to using medication, many people with clinical depression experience improvements by taking part in psychotherapy, or talk therapy. 

Therapy involves meeting with a mental health professional to discuss your symptoms and find ways to change your thoughts and behavior. Several different forms of therapy are used as part of this process, including cognitive behavioral therapy (CBT). 

We offer online therapy as part of our range of mental health services, allowing you to find and connect with a licensed therapy provider from your home. 

Healthy Habits and Lifestyle Changes

Sometimes, making changes to your habits and lifestyle can help to reduce the severity of your depression symptoms and improve your quality of life.

Good habits for treating depression include:

  • Relaxing and practicing self-care

  • Keeping yourself physically active

  • Eating a healthy, balanced and nutritious diet

  • Maintaining a regular bedtime and wake-up time

  • Spending time with other people, such as friends and family

  • Avoiding alcohol, nicotine and illicit drugs

  • Delaying major decisions until you feel better

Our list of ways to help depression goes into more detail about the techniques that you can use to reduce the severity of your symptoms and make progress towards recovery.

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The Bottom Line on Nortriptyline for Depression

If you’re dealing with depression, you’re not alone. Depression is alarmingly common, and many people affected by depression fail to seek professional treatment. 

As a tricyclic antidepressant, nortriptyline generally isn’t the first medication your mental health provider will choose if you have depression.

However, thanks to its effectiveness for treatment-resistant depression, you may be prescribed nortriptyline if other psychotropic medications, such as SSRIs or SNRIs, don’t work well for you or only provide partial relief from your symptoms.

Interested in learning more about your options for treating depression? You can connect with a psychiatry provider via our online psychiatry platform and, if appropriate, receive medication to help you manage depression, anxiety and other mental health conditions.

You can also learn more about successfully dealing with your mental health concerns using our free online mental health resources and content

10 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. Major Depression. (2022, January). Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression
  2. Depression. (2022, July). Retrieved from https://www.nimh.nih.gov/health/topics/depression
  3. Merwar, G., Gibbons, J.R., Hosseini, S.A. & Saadabadi, A. (2022, June 16). Nortriptyline. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482214/
  4. Hyman, S.E. (2005, March 8). Neurotransmitters. Current Biology. 15 (5), PR154-R158. Retrieved from https://www.cell.com/current-biology/comments/S0960-9822(05)00208-3
  5. Brain Hormones. (2022, January 24). Retrieved from https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/brain-hormones
  6. Nierenberg, A.A., et al. (2003, January). Nortriptyline for treatment-resistant depression. The Journal of Clinical Psychiatry. 64 (1), 35-39. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12590621/
  7. Moraczewski, J. & Aedma, K.K. (2022, May 2). Tricyclic Antidepressants. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557791/
  8. Nortriptyline. (2017, August 15). Retrieved from https://medlineplus.gov/druginfo/meds/a682620.html
  9. Volpi-Abadie, J., Kaye, A.M. & Kaye, A.D. (2013). Serotonin Syndrome. The Ochsner Journal. 13 (4), 533-540. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865832/
  10. Chu, A. & Wadhwa, R. (2022, May 8). Selective Serotonin Reuptake Inhibitors. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554406/

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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