Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 4/28/2022
If you’ve recently been prescribed a medication called nortriptyline, you might be surprised to find that the reason you’re using it isn’t necessarily the same as someone else.
Nortriptyline is used for a variety of therapeutic purposes in the treatment of everything from psychiatric disorders to diabetic neuropathy.
And it can do that effectively — as long as it’s used as prescribed.
Nortriptyline works by interrupting the reabsorption of serotonin and norepinephrine within your brain, which thereby creates a higher supply of both neurotransmitters for your brain to use to regulate your mood. More regulating chemicals equals a more balanced mood.
First brought to market in 1959, TCAs were revolutionary at the time — they fought a variety of symptoms associated with depression and even offered benefits for other mood disorders and mental health conditions.
As time went on, however, the use of the tricyclic antidepressant faded from the spotlight. Part of the reason for this is the advent of newer classes of medication, including selective serotonin reuptake inhibitors (SSRIs) and others.
While these newer antidepressants aren’t markedly different from TCAs in their benefits, what separates them is people who use them report fewer adverse effects and other common side effects overall (more on that later).
Nortriptyline is primarily used to treat mood disorders like depression.
Officially, it can help in the regulation or treatment of any mood disorder associated with a chemical imbalance of natural substances in the brain.
Other uses for nortriptyline include the treatment of nerve-related pain conditions like neuralgia, as well as in the treatment of certain types of anxiety disorder like panic disorder.
In some cases, nortriptyline can be used to help people stop smoking.
Okay, we’ve covered how this medication is used, but who should use it?
Typically, nortriptyline and other TCAs are prescribed for daily use for people who need medicinal support for a variety of mood disorders or certain nerve-related chronic pain in adults.
In some cases, TCAs may be a second option for people who have responded poorly to medications like SSRIs, which are considered the most effective antidepressant medicine currently available.
Whether it’s your first medication for depression or you’ve been down this road before, your healthcare provider will likely start you on a small or low daily dose of nortriptyline and gradually increase it over time until you see the desired benefits.
Here’s where things get interesting. Nortriptyline is extremely effective in treating mood disorders like depression.
In fact, nortriptyline is effective not just in the treatment of depression, but in the treatment of treatment-resistant depression. That’s an important kind of antidepressant treatment.
Studies show that over one third of patients with treatment-resistant depression saw effective treatment, and more than 40 percent of patients saw some sort of response after about six weeks of treatment.
Keep in mind, these are the numbers for people who have already tried something else — typically SSRIs — and didn’t see their condition improve.
So if this medication is so effective at treating depression where others fail, why is it not the first medication on everyone’s list? Simple: dangerous side effects.
Side effects of nortriptyline include nausea, drowsiness, weakness, constipation, urinary retention (and other urinary problems), sweating, low sex drive and other changes in sex drive, nightmares and dry mouth.
You should contact your healthcare provider and seek emergency medical assistance immediately if you experience muscle spasms, difficult or slow speech, uncontrollable shaking, fever, rash, or difficulty breathing or swallowing.
Seek medical attention immediately if you see yellowing of your skin or eyes, experience eye pain, blurred vision or experience chest pain and irregular heartbeat or heart rate.
There are also some drug interactions and risk factors to be aware of.
You should not use this medication if you have a genetic heart condition, or if you’ve experienced heart disease or recent heart problems, like a heart attack.
You should also talk to your healthcare provider first if you are taking MAOIs, as these can cause a dangerous drug interaction. Additionally, speak to your healthcare provider if you have an enlarged prostate, plan to have surgery, have diabetes, liver or kidney disease or if you have schizophrenia.
If you’re being hindered in your work performance or general happiness by the symptoms of depression, it’s time to get treatment.
TCAs may be one effective form of treatment, especially if you’ve tried other things in the past, but if you’re new to this diagnosis (or don’t have a formal diagnosis yet), there are first steps you can and should take for effective treatment for depression.
The first of these is to explore therapy. Therapy is an important element of mental illness treatment, and in conjunction with medication therapy, it has been shown to provide great relief from this mood disorder.
While all forms of therapy may benefit depressive disorders, studies show that cognitive behavioral therapy (CBT) is among the most effective. The strategy here is simple: CBT users address their depressed thoughts and responses as they happen, and learn to control these thoughts with time and practice.
A healthcare provider may also treat depressive disorder in your case with other, newer antidepressant medications. And as we mentioned, they’re likely to start managing your mood with a selective serotonin reputake inhibitor (SSRI).
These medications help your brain retain a steadier supply of serotonin by preventing it from being reabsorbed, which in turn means that your brain has steadier access to this important neurotransmitter. Over time, these antidepressant effects help your brain better balance moods.
Other treatment options might also become part of the solution for people with depression, including yourself. Ask a healthcare professional for medical advice about changes you might make to your lifestyle, diet and exercise routine.
Depression is a slow, crushing mood disorder that can rob you of your joy and happiness.
If you have depression or treatment-resistant depression, TCAs like nortriptyline may be the solution you’re searching for.
They also may not be.
Either way, it’s a conversation that begins with a board-certified healthcare professional. Talking to a healthcare professional is the best way to figure out what will help you, and the quickest way to see results where your mood disorder is starting to harm your quality of life.