Nortriptyline is a second-generation tricyclic antidepressant marketed as the hydrochloride under the trade names Sensoval, Aventyl, Pamelor, Norpress, Allegron and Nortrilen. It is used in the treatment of major depression and childhood nocturnal enuresis (bedwetting). In addition, it is sometimes used for chronic illnesses such as chronic fatigue syndrome, chronic pain and migraines, and labile affect in some neurological conditions.

Nortriptyline (Pamelor, Aventyl) is a older and inexpensive tricyclic which is as effective or better than the SSRIs. It is a dual action agent, increasing both norepinepherine and serotonin effects. While it is quite popular among major university researchers, it is not used as often by clinical psychiatrists, since it is not being heavily promoted by any drug company due to its low cost.

Nortriptyline is an excellent initial anti-depressant or for treatment-resistant depression. It causes no weight gain. It’s most common side-effect is dry mouth, which is easily relieved by bethanechol. Other side effects include dizziness, constipation, and increased heart rate. These may improve with time, but 15-20% of patients will have to stop nortriptyline due to side-effects, a typical rate for other anti-depressants. Patients often need to try more than one antidepressant to find a good match. Stool softeners and yogurt may help the constipation. Nortriptyline has a high safety index in overdose cases according to a very large British study.

Indications
Nortriptyline is FDA-approved for the treatment of major depression. In the United Kingdom, it may also be used for treating nocturnal enuresis, with courses of treatment lasting no more than three months. It is also used off-label for the treatment of panic disorder, irritable bowel syndrome, migraine prophylaxis and chronic pain or neuralgia modification (particularly TMJ disorder).[3] It can also aid in quitting smoking, with one study showing a six-month abstinence rate of 14% for subjects receiving nortriptyline compared to 3% for subjects not undergoing pharmacological treatment.[4] Research has been done suggesting it can reduce symptoms of ADHD.[citation needed] It should be noted, however, that the co-administration of Tricyclic Antidepressants and stimulant ADD medications is highly inadvisable. Due to the blocking effect such medications have on both norepinephrine and serotonin, the stimulant properties of ADD medications can be severely potentiated, resulting in a risk of hypertension, tachycardia, and central overstimulation.

Some facts about Nortriptyline
- Nortriptyline Included in STAR*D for Treatment Resistant Depression
- Nortriptyline Did Better than Fluoxetine (Prozac) in Small DB
- Nortriptyline Better than Fluoxetine in Poststroke Depression
- Fluoxetine (Prozac) as Good as Nortriptyline in Post-Stroke Depression
- Nortriptyline Alone as Good as Nortriptyline plus Perphenazine in Elderly Psychotic Depression
- Post-Partum Depression: Nortriptyline as Good as SSRIs
- Nortriptyline Helps Tinnitus With Depression
- Long-term Nortriptyline Maintenance Recommended for Elderly Over Age 70

Other Uses of Nortriptyline
- Nortriptyline Favored for Smoking Abstinence
- Nortriptyline Most Cost Effective for Pain Control of Antidepressants and Antiepileptics
- Nortriptyline or Fluoxetine Help Stroke Victims Live Longer
- Nortriptyline as Good as Narcotics for Postherpetic Neuralgia

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