From the FDA Drug Label
Withdrawal Symptoms—Though these are not indicative of addiction, abrupt cessation of treatment after prolonged therapy may produce nausea, headache, and malaise.
- Nortriptyline withdrawal symptoms may include:
- Nausea
- Headache
- Malaise Abrupt cessation of nortriptyline after prolonged therapy may produce these symptoms 1.
From the Research
Nortriptyline withdrawal should always be managed through a gradual tapering process under medical supervision, prioritizing the reduction of withdrawal symptoms and minimizing the risk of relapse, as suggested by the most recent and highest quality study 2.
Key Considerations for Tapering
- The tapering process should be personalized, taking into account the patient's dosage, duration of treatment, and individual factors that may influence the severity of withdrawal symptoms.
- A gradual reduction in dose, rather than abrupt cessation, is crucial to mitigate withdrawal symptoms, which can include dizziness, nausea, headache, irritability, insomnia, and flu-like symptoms, as well as "brain zaps" or electric shock-like sensations.
- The severity of withdrawal symptoms depends on various factors, including the dosage and duration of nortriptyline treatment, emphasizing the need for a tailored tapering schedule.
Tapering Schedule
- While specific guidelines on dose reductions are limited, the principle of gradual tapering is supported by studies on antidepressant withdrawal, including those on SSRIs 3 and other antidepressants.
- The process involves reducing the dose by a certain percentage (e.g., 25%) every few weeks (e.g., 2-4 weeks), with continuous monitoring of symptoms and adjustments to the tapering schedule as necessary.
Importance of Medical Supervision
- Medical supervision is essential throughout the tapering process to manage any withdrawal symptoms that may arise and to adjust the tapering schedule accordingly.
- Regular communication with the healthcare provider about experienced symptoms is vital to ensure the tapering process is safe and effective.
Underlying Mechanism
- The withdrawal occurs because the brain has adapted to the medication's effects on neurotransmitters like serotonin and norepinephrine, and it needs time to readjust to functioning without it, as implied by the effects of antidepressants on the brain 2.
Managing Withdrawal Symptoms
- If withdrawal symptoms become severe, the doctor might temporarily slow the tapering schedule or prescribe supportive medications to manage specific symptoms, highlighting the importance of close monitoring and flexible management strategies.