Nortriptyline is a tricyclic antidepressant used to treat depression, panic disorder, childhood bedwetting, irritable bowel syndrome, migraine headaches, several types of chronic pain, and labile affect. With the exception of low doses for childhood bedwetting, the medication is generally not recommended for children under 12 years of age.

Nortriptyline for Depression

Available on the market since the 1950s, in more recent times nortriptyline has been largely replaced by modern antidepressants, which generally work better with fewer side effects. However, nortriptyline is still one of the best medications for melancholic depression; that is, depression with significant melancholy factors, like the inability to find pleasure and the inability of mood to improve in response to positive events.

Patients with melancholic depression tend to rise early in the morning with a worse mood, which gradually improves, to some extent, through the day. Melancholic depression is not a response to loss or grief, and is thought to be inherited in many cases.

Nortriptyline is also used in other depressive cases when other antidepressants cannot be used, due to allergies or other factors; sometimes other antidepressants simply don't work.

Regardless of the cause or type of depression, treatment is largely the same:

• Take 25 mg three or four times per day; or
• Take 100 mg once per day.
• Do not exceed 150 mg per day.

Treatment typically starts with lower doses for a couple of weeks and is titrated up to 75-100 mg per day, taken in multiple smaller doses or one large dose. Results will be noticeable after a couple of weeks of treatment, with full effects felt within one month.

Treatment is generally long-term, spanning at least nine months.

Nortriptyline for Bedwetting

Nortriptyline is used to prevent bedwetting in young children, ages 5 and up, provided other reasons, such as physical issues, have been ruled out. Treatment cycles for bedwetting are three months, after which time treatment ends.

Doses are typically very small, usually 10 mg per day, sometimes 15 mg per day, taken shortly before bed. The medication has an antispasmodic effect on the bladder, which is likely what helps reduce wetting. Unfortunately the majority of patients relapse once treatment ends, though a few do remain dry.

Other Uses

In other uses---migraines, chronic pain, irritable bowel syndrome, and so forth---treatment is more variable. Patients would do best to speak with a doctor about dosage and duration of treatment, which may range from days to years. Treatment can also be as-needed, common for some types of panic attacks.

Note that for migraines, nortriptyline has been shown to reduce the frequency and severity of migraine headaches, but will not address pain when a migraine does happen. Other medications, such as triptans, should be utilized during a migraine episode.

It is common for other medications to be taken along with nortriptyline to help manage these other conditions, though it is also effective on its own.

Important Precautions

Nortriptyline can worsen bipolar disorder; it should not be taken by those who suffer from this condition.

Individuals who have recently had a heart attack should not take nortriptyline; it can cause arrhythmia or another heart attack. This is especially true if there is a history of hyperthyroidism or medications to address hyperthyroidism are being taken.

Nortriptyline may worsen seizures in patients who have a history of such. If a seizure happens while taking nortriptyline, discontinue use and speak with a doctor.

Those with a history of high eye pressure, glaucoma, or urinary retention will need to attend regular doctor visits so the condition can be monitored.

The effects of this medication on unborn or nursing babies is unclear; women who are pregnant or breastfeeding should discuss risks versus benefits with a doctor.