What Is Nortriptyline Used For?

Nortriptyline is an antidepressant. If you’ve recently been prescribed this medication to treat a form of depressive illness or another condition, you might be surprised to learn that the reason you’re taking it isn’t necessarily the same as someone else. 

Nortriptyline is used to treat a variety of conditions, from common psychiatric disorders such as depression and anxiety to neuropathic pain and migraines. It’s even used as a cessation aid for people trying to give up smoking.

Used as prescribed, nortriptyline can offer numerous benefits, including major improvements in your wellbeing and quality of life.

Below, we’ve explained what nortriptyline is, as well as how it works as a medication for clinical depression, neuropathic pain and other conditions. 

We’ve also explained what you should know before you start taking nortriptyline to treat any of these conditions. 

Finally, we’ve shared a few alternative treatment options that you might want to consider if you have been prescribed nortriptyline. 

Nortriptyline is an antidepressant medication. It belongs to a class of antidepressant drugs that are referred to as tricyclic antidepressants, or TCAs. Nortriptyline is available as a capsule and as an oral solution.

Tricyclic antidepressants like nortriptyline work by preventing the reuptake of naturally-occurring chemicals called neurotransmitters. Neurotransmitters act as chemical messengers that let your nerve cells communicate across your brain and body. 

More specifically, nortriptyline and similar TCAs work by stopping the reuptake of serotonin and norepinephrine -- two neurotransmitters that are responsible for regulating your moods, feelings, thoughts and certain aspects of your behavior.

Low levels of serotonin and norepinephrine are linkedto a higher risk of several forms of mental illness, such as major depressive disorder (MDD) and anxiety. 

By preventing the reuptake of these neurotransmitters, nortriptyline helps to increase their levels in the brain, which may treat the symptoms of depression. 

Nortriptyline and other TCAs also inhibit the activity of other naturally-occurring chemicals, such as histamine, acetylcholine and 5-hydroxytryptamine.

TCAs like nortriptyline were originally developed throughout the 1950s and 1960s as treatments for depression. They were revolutionary at the time, as they fought a range of symptoms caused by depression and even offered benefits for other mood disorders.

However, as time went on, tricyclic antidepressants like nortriptyline were gradually replaced by newer antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs).

While these newer antidepressants aren’t markedly different from TCAs in their benefits, people who use them typically report fewer adverse effects, making them better tolerated as treatments for depression. 

We’ve discussed these medications, as well as other alternatives to TCAs such as nortriptyline, in more detail further down the page. 

So, what is nortriptyline used for? Nortriptyline is most commonly used to treat depression -- the only condition for which it’s currently approved by the FDA. However, like other medications, it’s also prescribed off-label to treat a wide range of mental and physical conditions.

Depression

As an antidepressant medicine, it’s no surprise that the most common use for nortriptyline is the treatment of depression.

Nortriptyline has been used to treat depression since the 1960s. Decades of research show that it’s effective as a treatment for depression, including treatment-resistant depression (depression that fails to improve with other forms of treatment).

If you’re prescribed nortriptyline for depression, your healthcare provider will likely start you on a dose of 25mg, taken three to four times per day. This may be adjusted over time based on the antidepressant effects of nortriptyline and the severity of your depression symptoms.

Neuropathic Pain

Nortriptyline is also commonly used as an off-label treatment for certain types of neuropathy, a form of pain, muscle weakness and dysfunction caused by damage to your nerves. 

Common forms of chronic pain treated with nortriptyline include: 

• Diabetic neuropathy (damage to your nerves caused by diabetes)

• Persistent myofascial pain (pain that affects your muscles)

• Trigeminal neuralgia (sudden, severe facial pain)

• Postherpetic neuralgia (nerve damage from shingles)

As an off-label usage, there’s no exact recommended dosage for nortriptyline as a treatment for neuropathic pain. Your healthcare provider might suggest a starting dosage of 10mg, which may be increased to 75mg per day based on your response to the medication.

Smoking Cessation

Nortriptyline is occasionally used off-label as a smoking cessation aid, meaning a medication for assisting with the process of quitting smoking.

Research suggests that nortriptyline is generally effective as a medication for people working to quit smoking, and that it can approximately double quit rates. Nortriptyline is typically used at a dosage of 75 to 100mg per day for its smoking cessation benefits.

Migraines

Like other tricyclic antidepressants, nortriptyline is sometimes prescribed to prevent migraines -- severe headaches that can involve throbbing pain. Your healthcare provider may prescribe this medication at a dosage of 10mg per day, which might be gradually increased over time.

As a tricyclic antidepressant, nortriptyline generally isn’t used as a first-line treatment option for depression (meaning the first medication prescribed for this condition).

This is because tricyclic antidepressants like nortriptyline, although effective, have a higher risk of causing side effects than newer depression medications.

However, nortriptyline is still frequently prescribed as an antidepressant when other medications aren’t fully effective. Research suggests that it’s particularly effective at lowering the severity of treatment-resistant depression, which often fails to get better with conventional treatments.

If you’re prescribed nortriptyline, your healthcare provider will inform you about how to take this medication safely.

If you’re switching from a different antidepressant to nortriptyline, they’ll also help you to switch medications while limiting your risk of drug interactions or dangerous side effects. 

Here’s where things get interesting. Despite being more likely to cause side effects than newer antidepressants, research suggests that nortriptyline is often a more effective treatment option for depression.

As we mentioned above, nortriptyline is frequently prescribed to people affected by depression that just doesn’t seem to improve with other medications.

In a study published in the Journal of Clinical Psychiatry in 2003, researchers found that about 40 percent of people with treatment-resistant major depression showed improvements with the use of nortriptyline. 

Many of these people had previously used other medications for depression but didn’t achieve any relief of symptoms.

So, if nortriptyline is effective when other medications aren’t, why isn’t it prescribed as a first-line depression treatment? The main reason is that nortriptyline can cause side effects, typically at a higher rate than other antidepressants.

The side effects of nortriptyline can vary in severity. Most side effects are mild, but some can be persistent and bothersome.

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

• Urinary retention

• Abnormal sensations

• Tremoring

Nortriptyline can also increase your sensitivity to sunlight, making it important to wear sunscreen and keep yourself protected from bright light using protective clothing and/or sunglasses in peak sunlight hours. Learn more about nortriptyline side effects in our full guide.

Although uncommon, nortriptyline can also cause more serious adverse reactions, including eye pain, changes in your heart rate, orthostatic hypotension (low blood pressure after standing up), low blood platelet count, chest pain, suicidal ideation and glaucoma.

In rare cases, nortriptyline may contribute to serious cardiovascular events, such as heart attack or stroke. 

If you experience any severe side events while using nortriptyline, it’s important to seek medical attention as soon as you can.

Nortriptyline can cause drug interactions, including when it’s used with other antidepressants or supplements that increase serotonin levels in your body. These medications can increase your risk of serotonin syndrome -- a harmful, potentially life-threatening condition. 

To avoid interactions, make sure to inform your healthcare provider about all medications you’re currently taking, or medications you’ve taken within the past 14 days, before taking nortriptyline to treat depression or any other condition. 

It’s especially important to inform your healthcare provider if you’ve used a monoamine oxidase inhibitor (MAOI) medication, as these may cause persistent elevated serotonin levels.

Like other antidepressants, nortriptyline can cause withdrawal symptoms if treatment is stopped abruptly. Common issues associated with nortriptyline withdrawal include nausea, headaches, vomiting, restlessness and anxiety.

If you’d like to stop taking nortriptyline, don’t suddenly reduce your dosage. Instead, talk to your healthcare provider so that they can help you to gradually taper your dosage to avoid unwanted withdrawal symptoms, allergic reactions or other issues. You can learn more about nortriptyline dosage here.

Because of its side effect risk, nortriptyline generally isn’t used as a first-line treatment for most forms of depression. 

Instead, your healthcare provider will likely prescribe a newer type of antidepressant, such as a selective serotonin reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor (SNRI) or an atypical antidepressant.

These medications are also effective at treating depression and have a lower risk of producing side effects than older antidepressants such as nortriptyline.

We offer several SSRIs online, including fluoxetine (the active ingredient in Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®) and escitalopram (Lexapro®). We also offer several SSRIs, such as duloxetine (Cymbalta®) and venlafaxine (Effexor®). 

These medications help your brain maintain a steadier supply of serotonin by preventing it from being reabsorbed. This, in turn, means that your brain and body have more consistent access to this important neurotransmitter for mental balance.

You can access these medications using our online psychiatry service, which involves an online evaluation and ongoing follow-up care with a licensed psychiatry provider who will determine if a prescription is appropriate. 

In addition to medication, depression often improves with non-pharmacological treatments, such as cognitive behavioral therapy (CBT) and lifestyle changes.

Small, simple changes to your habits, such as eating a healthy diet, keeping yourself active and spending time with your close friends and family, can often make a big difference and, as part of a combination treatment with antidepressants, help you make progress and feel better.

You can access therapy from home using our online therapy service, which allows you to easily find and connect with a licensed counselor for personalized, private online sessions. 

You can also learn more about changing your habits and lifestyle to deal with depression in our guide to self-help strategies for depression. 

Depression is a slow, crushing mood disorder that can rob you of your joy and happiness. If you feel concerned that you may be affected by depression, it’s important to get medical advice from an expert in mental health. 

They may suggest taking medication to relieve your symptoms. If more modern antidepressants such as SSRIs or SNRI don’t seem to work for you, this might mean taking nortriptyline.

Nortriptyline is effective, but its potential for side effects mean it’s important to closely follow the dosage instructions provided by your healthcare provider. 

Ready to take the next step for your mental health? Our mental health services include a range of options for dealing with depression, from medication to non-pharmacological treatments such as anonymous support groups. 

You can also learn more about your options for dealing with depression, anxiety and many other common mental health concerns using our free online mental health resources.