Stopping Nortriptyline: What to Expect
Abrupt discontinuation of nortriptyline after prolonged therapy may produce withdrawal symptoms including nausea, headache, and malaise, though these symptoms are not indicative of addiction. 1
Withdrawal Symptoms to Anticipate
When stopping nortriptyline, you may experience:
- Gastrointestinal symptoms: Nausea, vomiting, abdominal distress 1, 2
- Neurological symptoms: Headache, dizziness, light-headedness 1, 2
- General malaise: Fatigue, lethargy, flu-like symptoms 1, 3
- Psychological symptoms: Anxiety, agitation, mood swings, sleep disturbances 3, 2
These withdrawal manifestations are usually mild and self-limiting 2. However, tricyclic antidepressants like nortriptyline carry an increased risk of withdrawal symptoms compared to some other antidepressant classes 2.
Critical Timing
Withdrawal symptoms typically emerge within 24-48 hours after abrupt discontinuation or missed doses 3. Most symptoms resolve within days to weeks if they occur 2.
The Safest Approach: Gradual Tapering
To minimize or prevent withdrawal symptoms, nortriptyline should be tapered gradually over a period of more than four weeks rather than stopped abruptly. 2
Recommended Tapering Strategy:
- Reduce the dose slowly in decrements over several weeks 2
- Monitor for withdrawal symptoms during each dose reduction 4
- If symptoms emerge, slow the taper rate or temporarily return to the previous dose until symptoms resolve 3
A prospective study in pediatric patients demonstrated that scheduled gradual tapering of nortriptyline prevented withdrawal symptoms in most patients, with only brief gastrointestinal distress in a minority that did not require intervention 4.
Common Pitfalls and How to Avoid Them
Misdiagnosis Risk
Withdrawal symptoms are frequently misdiagnosed as relapse of depression or a new medical condition. 5, 2 This can lead to:
- Unnecessary medical testing 3
- Inappropriate reinitiation of antidepressants 5
- Missed work days and decreased productivity 3
Healthcare providers often fail to recognize antidepressant withdrawal symptoms, leading patients to seek advice from online forums rather than medical professionals 5.
If Symptoms Occur
- Mild symptoms: Reassurance that they are transient is often sufficient 3
- Moderate to severe symptoms: Reinstitute the previous dose and taper more slowly 3
- Do not dismiss patient reports of withdrawal symptoms as these experiences are real and can be distressing 5
Special Considerations
Never stop nortriptyline abruptly without medical supervision, especially if you have been taking it long-term 1, 2. The FDA drug label explicitly warns that abrupt cessation after prolonged therapy produces withdrawal symptoms 1.
Work with your prescriber to develop an individualized tapering schedule that minimizes withdrawal effects while monitoring for any return of the original condition being treated 2.