Medically reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Last updated 5/7/2022
Antidepressants are impressive medications — they’re treatments designed to cross the blood-brain barrier and regulate your levels of various brain chemicals, helping you feel more in control, at peace and balanced.
All of these benefits, however, come with some risks of side effects, and nortriptyline is no exception to that rule.
Why would someone use nortriptyline or any other drug when there’s a big risk of side effects?
We’re glad you asked. Let’s start from the top.
Like other TCAs, nortriptyline helps regulate mood by affecting your brain’s serotonin and norepinephrine levels. Specifically, it prevents the reabsorption of these two neurotransmitters.
When your brain sees surplus neurotransmitters lying around, it cleans them up. But some brains can overdo it. This leads to a low supply of these neurotransmitters, which can mean you’re subject to extreme moods. When nortriptyline blocks the reabsorption (the clean up) of these neurotransmitters, your brain is able to better defend against uncontrollable mood blazes, like a firefighter with easy access to a hydrant.
Nortriptyline is an antidepressant, which means that it’s used to treat depressive disorders. This is the use for nortriptyline approved by the Food and Drug Administration (FDA), but there are also several off-label uses for which it’s commonly prescribed.
Other mood disorders like anxiety are commonly treated with antidepressants like nortriptyline. It has also shown benefits for people with neuropathy and neuropathic pain from diabetes.
Oh, and some research shows that, in some situations, it can help you stop smoking.
As antidepressants go, TCAs generally — and nortriptyline specifically — have been around for a while. They were first introduced in 1959, and have been effective at fighting depression, major depression and other mood disorders and mental health conditions for decades.
So, why isn’t everyone still using them?
In recent years, TCAs have somewhat fallen out of favor — more recent antidepressant advances like selective serotonin reuptake inhibitors (SSRIs) are generally seen as equally effective with fewer downsides and side effect risks.
Due to the lower side effect risk of SSRIs, nortriptyline and other TCAs are usually the second defense line for depression treatment. If you have a negative reaction (or don’t see any benefits) from SSRIs or other medication for depression, these are the big gun medicines your healthcare provider might bring out next.
Side effects of nortriptyline can range from mild to serious, but the most common ones fall into the following categories:
Nortriptyline may cause sleep-related symptoms. You may experience drowsiness, nightmares, tiredness and more.
Frequent urination, difficulty urinating and other issues with urinary function have been reported.
Nausea, changes in weight, changes in appetite and constipation have also been reported.
There are also some rarer side effects of nortriptyline that could be serious. These should be reported immediately to a healthcare professional, as you might need medical attention. They include:
Muscle spasms in the jaw, neck or back, a shuffling walk, uncontrollable shaking of a part of your body or slow or difficult speech might need emergency treatment.
Rash, fever, sweating and yellowing of the skin or eyes are all signs that something serious may be happening.
Experiencing signs of heart disease, such as irregular heartbeat, heart rate or blood pressure, or experiencing any difficulty with swallowing or breathing may all be signs of serious distress due to medication.
While TCAs are approved by the FDA for the treatment of depression in some patients, they do come with a “Black Box Warning” regarding a potential increase of suicidal thoughts. It may sound counterintuitive, but Black Box Warnings are common for antidepressants, including nortriptyline.
If you experience suicidal thoughts while taking nortriptyline, it’s important that you contact your healthcare provider immediately.
In addition to its risk of side effects, nortriptyline has several medication interactions that you should be aware of. Let your healthcare provider know if you’re taking any of the following before starting nortriptyline:
A monoamine oxidase inhibitor (MAOI)
Muscle relaxants or sedatives
Other antidepressant medications
Any prescription sleep aids
Also let your healthcare provider know if you have recently had a heart attack, currently have or have ever had an enlarged prostate or are planning to have surgery soon. These interactions and conditions can make it dangerous to take nortriptyline.
Okay, so that’s a pretty substantial list of side effects, and you may be wondering if this drug is even worth taking.
For people with depression, that may not be such a hard question to answer. Because TCAs are now largely considered second option medications, they’re usually only employed after another class of medication like SSRIs has failed or caused intolerable side effects like diminished libido.
So, if you’re suffering from side effects with other meds, nortriptyline may be the medication you’re looking for. And if you’re dealing with treatment-resistant depression, it almost certainly will be the medication for you.
Studies have shown that TCA patients with treatment-resistant depressive disorder do incredibly well with this treatment: over a third saw benefits, and more than 40 percent of patients saw response to the treatment in about six weeks — after SSRIs had failed.
You’ll likely start on a small dose and be safely brought up to the appropriate nortriptyline dosage by a healthcare provider, so you can rest assured that switching antidepressants will be safe.
Should you use this medication? If a healthcare provider prescribes it, it might be your best option.
We’re optimistic about nortriptyline’s benefit potential, but it’s important to make sure you take it exactly the way your healthcare provider prescribes.
Depression is a delicate condition, and using any medication the wrong way can lead to problems on that list of side effects we mentioned, as well as physical health problems and mental health issues like an increased risk of suicidality.
If you’re looking for depression treatment, trying to figure this out for yourself isn’t the best course of action. Instead, it’s time to talk to someone, to make sure you get the most effective and safest treatment possible.
Online counseling for mental health is just a few clicks away, and it’s the best and most effective way to get to the bottom of your own mental health needs. So skip the skimming on the internet, and get to talking to someone. Whether they prescribe you TCAs, SSRIs or some other abbreviated treatment, you’ll be SOL without support.