* Nortriptyline may be used to relieve the symptoms of depression.
Experts aren't sure exactly how nortriptyline works but it is
thought to inhibit the activity of some chemicals in the brain and
increase the release of others and has a combined
stimulant/depressant effect.
* Nortriptyline belongs to the class of medicines known as tricyclic
antidepressants.
Upsides
* May be used to treat the symptoms of depression in people with
diagnosed Major Depressive Disorder (MDD).
* May be used off-label to treat other conditions.
* Generic nortriptyline is available.
Downsides
If you are between the ages of 18 and 60, take no other medication or
have no other medical conditions, side effects you are more likely to
experience include:
* Dizziness, headache, blurred vision, trouble with eye focusing or
vision problems, dry mouth, constipation, heart palpitations,
tiredness, and a drop in blood pressure on standing. May increase
the risk of heart attacks or glaucoma.
* May increase the risk of suicidal thoughts or behavior in young
adults (similar to other antidepressants).
* May cause drowsiness and affect a person's ability to drive or
operate machinery. Some people may develop tolerance to this
effect. Avoid alcohol.
* May not be suitable for some people including those with
pre-existing cardiovascular disease, undiagnosed bipolar disorder,
or taking other medications such as cimetidine, chlorpropamide, and
SSRIs.
* People who are poor metabolizers of CYP 2D6 may experience higher
than expected concentrations of nortriptyline. Tell your doctor if
your side effects are excessive.
* May interact with some other medications including monoamine
oxidase inhibitors (a type of antidepressant), ketoconazole,
rifampicin, linezolid, and methylene blue. Interaction or
overdosage may cause serotonin syndrome (symptoms include
agitation, hallucinations, fast heart rate, dizziness, muscle
tremor, nausea, vomiting, diarrhea).
* May cause withdrawal symptoms with abrupt discontinuation (symptoms
include nausea, headache, and generalized tiredness).These are not
indicative of addiction. Taper dosage off slowly under medical
supervision.
* Not recommended for children. Lower initial dosages should be used
in the elderly or adolescents.
Notes: In general, seniors or children, people with certain medical
conditions (such as liver or kidney problems, heart disease, diabetes,
seizures) or people who take other medications are more at risk of
developing a wider range of side effects. For a complete list of all
side effects, [84]click here.
Bottom Line
Nortriptyline is an effective antidepressant but it may cause
drowsiness initially and a withdrawal syndrome with abrupt
discontinuation.
Tips
* Take higher dosages late afternoon or in the evening to minimize
daytime sedation.
* Do not stop suddenly as withdrawal symptoms may occur. Slow dosage
reduction over weeks to months is recommended.
* Tell your doctor if you experience any new or worsening mood
symptoms or suicidal thoughts, have trouble sleeping, symptoms of
serotonin syndrome, or develop eye pain or vision problems.
* May increase the risk of sunburn; protect yourself from the sun
when outdoors and avoid exposure to tanning beds.
* Do not take any other medication (including that brought
over-the-counter) before checking with your doctor or pharmacist
that it is safe to take with nortriptyline.
Response and Effectiveness
* Peak concentrations of nortriptyline are reached within 7 to 9
hours; however, it may take several weeks for the full
antidepressant effect to develop.
References
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