Nortriptyline

How it works

     * 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