Questions about Nortriptyline


I have had no luck with the migraine diet, so I started Nortriptyline last week. My doctor started me at 10mg and has me titrating up by 10mg every two weeks. I take it before bed and I notice that it makes me tired. I also notice that I sleep very heavily, but then I wake up around 2:30 in the morning to use the bathroom and am wide awake until about 4am. I then fall back asleep, again heavily and wake up momentarily groggy. Is this normal and will it pass? I haven’t noticed any other side effects outside of that. Also, when did people start to feel an effect if it had one? Immediately? 4-6 weeks in like with most antidepressants?

I have read some of the previous postings, but it’s hard to tell.

Btw, my primary symptoms are constant dizziness and off-balance. It started with vertigo over a year ago…I have had four vertigo episodes…the last one in April. But I have been left with this horrible dizzy/off-balance sensation.

Thank you,

Hi Kim
I haven’t tried Nortryptaline, but did try Amitryptaline since I was having problems sleeping as well. Originally, it made my dizziness worse and I felt odd…not super bad or anything, but strange…I started at 5mg then 10 and up to 20. It helped my mood, but increased dizziness so I had to come off it.
My point is that there are a myriad of side effects from these meds, as the neurochemicals they affect really affect many systems in the body. If you are only getting that side efffect, I would consider yourself lucky and keep on going. Best of luck! Many neuros use Nort as a first line med.
Keep us posted!

Hi Kelley,

Thank you for your response…I do consider myself lucky seeing as docs tried a whole bunch of SSRIs last year thinking I had anxiety and they sent my dizziness and anxiety through the roof. I had a paradoxical effect from them…which is interesting because I used Zoloft when I was 30 for about two years and was fine. This time, it was a mess. The docs think that my pregnancy altered something in my brain chemistry which caused the problems.

Hopefully, my ability to tolerate the Nortriptyline means that I will see some relief in the dizziness.

Have you found a drug yet that works for you?


I’m also on Nortriptyline, my first med trial and I’m 10 weeks into mine. Started at 10mg and have just increased it up to 40mg (I’m also going up 10mg at a time, every 3-4 weeks) Havent noticed any improvements yet but from what I’ve read from others its definately worth sticking it out. If I dont see any improvement I may move on to another after 70mg or so

Also, it took me 3 attempts to get from 20mg to 30mg…Twice I reacted horribly and had 2 horrific days on both occasions.On the 3rd attempt it was pretty seemless. I’ve had a difficult few days since going up from 30mg to 40mg but nothing like the previous times.What I’m trying to say is take your time and if you do have a bad reaction, go back down, let it settle and try again later

An extra note, 4 years ago I was put on Amitripyline for a prostate problem, I was taking 75mg for a few months, it worked wonders for me and I never noticed any side effects or any withdrawl…75mg was the starting dose aswell!!! I think our bodies can cope with alot more than we know at times


Hi Chris,

Thanks for your feedback! Would you mind telling me what you mean by a “bad reaction” when you increased your dose? I’m a pansy when it comes to experiencing bad reactions and I would probably just stop the drug…so it’s good to know that you were able to move past it. But, you said that you haven’t noticed any improvement yet?


My ‘bad reaction’ was that it just increased my symptons 3 fold, head felt horrific, dizziness increased etc…The problem was (I believe) that I got carried away and increased from 10mg to 20mg after 1 week with no problems whatsoever, then tried to increase again a week later and it was too much…Its that we all get desperate to find a cure I think that makes us do these things…After that I decided to take it slowly (but not too slowly)

I wish I could say I was feeling an improvement but I cant.I have noticed less ear pain and popping but thats not what really bothers me so its little consolation at the moment


Hi Kim,
I started taking Nortriptyline last July and moved from 10 mg to 40 very slowly. …so moved up I guess every 6 weeks / 2 months , I arrived at 40 mg in March and have been there ever since feeling more or less great all the time.
I had no side effects at all, but was told to take it at 6pm so by the time I feel drowzy I am ready for bed. I do hit a wall about 10.30 / 11 pm and have to sleep.
I see a doctor in the UK and think there they tend to increase meds more slowly that USA doctors.
I think it is worth sticking out for a while to see of you settle down, but we are all different and I realize I have been one of the lucky ones to find a med that works first time…for now anyway !

Good Luck



I was on Nortrip for one month earlier this year but had to stop because of the terrible insomnia it gave me. I would go to bed dead tired at 9 or 10PM, would fall asleep within seconds. Then I would be wide awake from 11:30 to 3:00 or 4:00, night after night. My clock would go off at 5:15 and I had to drag myself out of bed. I tried taking it in the morning but same thing, I tried every other day but that didn’t work either. Finally I said the H*** with this.

My experience is very unusual. I asked the pharmacist if he thought it would get any better and he said probably not. I was very disappointed that this didn’t work for me. I thought it was going to be the wonder drug as I’ve heard such good things about it. Also hoped it would work on my depression, but I don’t think I gave it long enough for that nor was I taking enough as I never got beyond 10 mgs. I never did get to a point where I noticed an improvement in symptoms.

Try sticking it out if you can. If it doesn’t work for you don’t kick yourself. There are other drugs out there to try.


Hi Penny,

I am so happy to hear about your success on Nortriptyline! That is great! Do you mind my asking when you started feeling better? Was it when you hit the 40mg mark? Or was it earlier on?

And yes, it seems that docs in the UK are a lot slower titrating up the dosage…my doc wants me to go up 10mg every two weeks until I hit 40mg…so tonight I will try 20mg and see what happens.

Thank you,

Hi KIm,
I started to feel slightly better right from the start after about 3 weeks on 10…by then I had also been doing the migraine diet for 2 months.
Each time I upped it I realized that although I had thought I felt a little better, I then felt even better with the higher dose.
On 30 I felt almost normal but still felt it was all hovering just below the surface and went very slightly up and down. After about 3 or 4 weeks on 40 I realized that I had many days when I really didn’t think about it at all…now after 6 months on 40 I have to say…touch wood, I am back to my old self with the exception of a bad turn during a very bad storm, and a little blip after a flight.
I hope you have success with it , I still follow the diet 100 % as I am too scared to bring back food that may bring back the dizziness.
Take care,

Thank you so much Penny! I hope I am able to enjoy the same success as you have. And I assume you are following the migraine diet…correct?


Hi Everyone,

So, here is an update for those who are interested. I have been on Nortriptyline for over 3 weeks. I felt no improvement for the first 3 weeks, however in the last 4 days, I have seen a large diminishment in symptoms. I have a lot less off-balance feeling and the dizziness and lightheadedness is a lot more mellow than before. I took 10mg for the first two weeks and last week titrated up to 20mg. This is the first time in months that I can honestly say that I have had an okay day…still symptomatic, but more manageable.

I should also mention that I did notice a change in symptoms when I started going to the Bioset clinic and working with Dr. Cutler. Before I tell you what she does, I have to say that I have always been more conventional in my outlook on medicine…probably passed down through my parents, but after being sick with this for 14 months, one is willing to try anything that may help. I found that more and more over time, I was able to eat less and less foods…I was having dizzy reactions from almost everything…and prior to this MAV, I never suffered from any (noticeable) allergies…except that I sneezed from dark chocolate.

A friend in NY who is suffering from MDD told me about Dr. Cutler and how she uses digestive enzymes to stabilize your gut and figures out what foods and things you are sensitive/allergic to and then she developed this technology where she can clear the allergy/sensitivity. I thought it was total BS, but I decided to give it a try since I live in SF (she is located in Mill Valley) and nothing else was working. Interestingly, I have strong sensitivity to meats, dairy, some veggies…fine with fruit, wheat, corn…anyway, since she has done some clearings, I have tested foods that I had eliminated for the migraine diet and that were making me dizzy and I have had no problems…I also tested other things that have not been cleared…ie pancetta, onions…and they made me dizzy almost instantly…

I don’t know what is making my symptoms decrease whether it’s just the Nort, the food/thing allergy treatment or both…but I know that something is doing it. I offer this info only as more food for thought (no pun intended!)…because I know how desperate I have been and I have started to see some relief…let’s hope it continues and I see some more improvement. I will share more in a week or two…whether I am feeling good or not.