Does Nortriptyline Cause Weight Gain?

If you’re one of the estimated 8.4 percent of American adults affected by depression every year, your healthcare provider might give you a type of medication called an antidepressant to reduce the severity of your symptoms and help you feel and function better.

Antidepressants are generally effective. However, like all medications, they can potentially lead to side effects.

Nortriptyline is a tricyclic antidepressant (TCA) that’s often used to treat depression when other medications aren’t effective. 

If you’re prescribed nortriptyline, you may be wondering if the rumors about one particular side effect are true. Namely, does nortriptyline cause weight gain?

Research generally suggests that nortriptyline is associated with a small to moderate degree of weight gain during treatment. However, the good news is that if you’re concerned about weight gain, there are simple steps that you can take to control your weight while using nortriptyline.

Below, we’ve explained what nortriptyline is, as well as how it works as a medication for clinical depression. 

We’ve also discussed nortriptyline’s effects on weight, as well as what you can do to maintain a healthy body weight while you’re prescribed nortriptyline for depression.

Nortriptyline is a tricyclic antidepressant, or TCA, that’s approved by the FDA as a treatment for major depressive disorder (MDD). 

Like many other antidepressants, nortriptyline is also used off-label to treat a range of conditions other than its FDA-approved indication. Common off-label uses for nortriptyline include:

• Diabetic neuropathy

• Persistent myofascial pain

• Postherpetic neuralgia

• Trigeminal neuralgia

• Other forms of chronic pain

• Smoking cessation

• Preventing migraines

Nortriptyline works by increasing levels of serotonin and norepinephrine -- two neurotransmitters that are involved in regulating certain aspects of your moods, thoughts and behavior.

Although the precise link between neurotransmitters and depression isn’t fully understood, most research suggests that low levels of these naturally-occurring chemicals are associated with an elevated risk of certain mental health issues, such as depressive disorders and/or anxiety.

Nortriptyline is available as a capsule and as an oral solution. It’s usually prescribed at a dosage of 25mg three to four times each day to treat depression, although your healthcare provider may adjust your dosage based on your depressive symptoms and response to treatment.

Antidepressants have long been associated with certain side effects, and modest weight gain is arguably one of the most well known.

If you have a friend or family member who has taken an antidepressant before, you might have heard them mention weight gain as a potential side effect.

Although the link between antidepressants and excess weight gain isn’t as strong as generally thought, there is scientific evidence to suggest that nortriptyline can contribute to some degree of weight gain.

For example, a small, somewhat old study published in the Journal of Affective Disorders in the 1980s found that several tricyclic antidepressants, including nortriptyline, caused weight gain of 1.3 to 2.9 pounds per month in people treated for depression.

Over the course of six months of treatment, participants in the study gained between three and 16 pounds in total.

While this sounds like a significant degree of weight gain, it’s important to keep in mind that this study was far from perfect. It assessed weight in patients in a small group, with a total of just 40 participants, and didn’t feature any control group.

This means that some of the weight gain may have occurred as a result of changes in appetite that can occur when recovering from depression, not necessarily use of nortriptyline.

Other research suggests that while weight gain from nortriptyline can occur, it typically isn’t that significant in severity.

For example, a study of elderly people prescribed nortriptyline published in the 1990s found that only 17.2 percent of participants gained weight while using nortriptyline, with 24 percent losing a clinically-significant amount of weight during the study period.

The researchers concluded that nortriptyline does not appear to be a promoter of weight gain, at least not in the group tested.

More recent research published in the journal JAMA Psychiatry claims that nortriptyline causes a lower degree of weight gain than certain selective serotonin reuptake inhibitors (SSRIs), such as the medication citalopram (Celexa®).

In general, although nortriptyline is linked to weight gain, the exact amount of weight gained by study participants varies from no weight gain at all to only a few pounds, to, in some cases, 10 pounds or more.

Details are fairly scant on the exact functions through which nortriptyline may cause you to gain weight, but from what we’ve read, the key element seems to be another side effect: an increase in appetite.

Increased appetite is a known side effect of nortriptyline. While you’re using this medication, you may notice that you feel like eating more frequently than before starting treatment, or that you’re more satisfied after eating larger portions.

Left to our own devices, most of us only have a limited amount of self-control each day. If you’re prone to eating more after starting treatment with nortriptyline, you may notice some increase in absolute weight over the course of a few weeks or months.

There’s nothing wrong with snacking occasionally, of course, and it’s important to remember that many people could benefit from an increased appetite or extra calories, especially if you found it difficult to eat a normal amount of food while you were depressed. 

It’s also possible that changes in appetite occur not as a side effect of nortriptyline, but simply as a result of your major depression symptoms becoming less severe.

Although the precise symptoms of depression can vary from one person to another, losing your appetite is a known issue. 

Experts believe that this may be associated with reduced activity in your brain’s reward circuitry and regions of the brain responsible for monitoring your physiological state. 

If you eat less while you’re depressed, then return to your usual eating habits after successfully treating your depression with nortriptyline or a similar antidepressant, you may experience mild weight gain as you gradually get back to your normal weight.

So, is this moderate weight gain associated with nortriptyline unhealthy? Well, that depends. If you are underweight, or suddenly lost a significant amount of weight while you were depressed, gaining a small amount of weight while using nortriptyline could be a good thing.

However, gaining an excessive amount of weight can lead to obesity, which is associated with a significantly elevated risk of several major health issues.

These include an increased risk of cardiovascular disease and heart attack, diabetes, certain types of cancer, non-alcoholic fatty liver disease (NAFLD), obesity hypoventilation syndrome, gallstones, stroke and sleep apnea.

Obesity is also associated with high systolic and diastolic blood pressure, which can increase your risk of a number of serious health conditions.

It’s important to remember that no two people are exactly alike, and the health-related effects associated with weight gain can be very different depending on who you are.

If you’re physically active and in good health, gaining a small amount of weight may just be a minor inconvenience in your depression treatment process.

However, if you notice your weight increasing significantly while using nortriptyline, it’s a good idea to talk to your healthcare provider about how it may affect your health, as well as options for treating depression that may have less of an effect on your body composition. 

As a tricyclic antidepressant, nortriptyline has a slightly higher risk of causing adverse effects than newer treatments for depression, such as SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs).

Most of these side effects are mild and temporary, although some can be more persistent and bothersome.

In addition to weight changes, other common side effects of nortriptyline include: 

• Drowsiness

• Constipation

• Dizziness

• Blurred vision

• Impaired coordination

• Physical weakness

• Nausea and vomiting

• Xerostomia (dry mouth)

• Excessive sweating

• Disorientation

• Confusion

• Insomnia

• Anxiety

• Agitation

• Restlessness

• Skin rash and/or itchy skin

• Galactorrhea (nipple discharge)

• Changes in blood sugar levels

• Breast gland tissue growth 

• Increased need to urinate

• Sensitivity to sunlight

• Urinary retention

• Abnormal sensations

• Tremoring

Like other antidepressants, nortriptyline may cause sexual side effects, including a low interest in sex during treatment. In men, nortriptyline may cause erectile dysfunction and other sexual performance issues.

Although less common, nortriptyline can cause more serious side effects, including high blood pressure, orthostatic hypotension (low blood pressure while standing), fainting, impaired bowel movement, low white blood cells, swelling and liver damage.

Nortriptyline and similar tricyclic antidepressants may also affect your heart rhythm, causing an irregular heart rate and an increased risk of serious cardiovascular events.

Like other antidepressants, nortriptyline may cause drug interactions. When used at the same time as other medications that increase serotonin production, it may contribute to an elevated risk of serotonin syndrome.

Our guide to the side effects of tricyclic antidepressants explains these potential issues in more detail. 

To keep yourself safe while using nortriptyline, make sure to inform your healthcare provider if you notice any severe or persistent side effects.

It’s also important to tell your healthcare provider about any underlying medical issues, as well as any medications you currently use or have used in the last 14 days, before you start taking nortriptyline or any other antidepressant medication. 

If you find yourself gaining weight, there’s a chance that it could be related to your medications, especially if you’re using TCAs like nortriptyline. But to know for sure, it’s important to see your healthcare provider for an exam and a discussion about changes.

To maintain a healthy weight while using nortriptyline, try to:

• Eat a healthy, balanced diet. If you feel more motivated to eat than before, try to focus on eating healthy foods such as fruits, vegetables, whole grains, lean sources of protein and other nutritious ingredients, all while limiting high-salt or processed foods.
  
  

• Monitor your total calorie intake. If your weight is starting to increase, pay attention to the total energy value of the food you eat. Even many healthy foods are high in calories, meaning they can contribute to unwanted weight gain when eaten frequently.

  
  

• Keep yourself physically active. Exercising not only burns calories and helps to keep your weight in the healthy range -- it can also stimulate the release of natural chemicals called endorphins, which may improve your mood and reduce depression symptoms.
  
  

• If you feel unhappy about your weight, talk to your healthcare provider. If you feel like your weight is increasing too quickly, try reaching out to your healthcare provider to let them know.
  Your healthcare provider may provide medical advice to help you maintain your weight, or switch you to a different type of antidepressant that’s less likely to affect your eating habits or body composition.

Because of their risk of causing side effects, nortriptyline and other tricyclic antidepressants tend not to be used as first-line forms of treatment for depression.

If you’re currently taking nortriptyline and feel like it might not be right for you due to weight gain or other side effects, it’s important to let your healthcare provider know.

Other options for treating depression are available, including newer antidepressants that have a lower risk of causing treatment-induced weight gain and other adverse effects.

These include selective serotonin reuptake inhibitors (SSRIs), which are more selective in their effects within your body than tricyclic antidepressants such as nortriptyline.

We offer several SSRIs online, including fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), citalopram (Celexa®), escitalopram (Lexapro®) and fluvoxamine (Luvox®).

We also offer several serotonin-norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta®) and venlafaxine (Effexor®). 

If you notice severe or persistent weight gain from nortriptyline or another antidepressant, your mental health provider may recommend switching to a medication called bupropion. 

The active ingredient in Wellbutrin®, bupropion is an atypical antidepressant that’s less likely to cause weight gain than similar medications. In fact, some research suggests that bupropion can help to promote modest weight loss in people who are overweight or obese. 

We offer bupropion through our online psychiatry platform, with all prescription medications for depression and anxiety requiring an online evaluation with a licensed psychiatry provider. 

We also offer a range of other mental health services, including online therapy and anonymous online support groups. 

Nortriptyline offers real benefits for treating depression. However, as a tricyclic antidepressant, it can cause side effects, and for many people, weight gain is one of these. 

Although the average amount of weight gained while taking nortriptyline isn’t that significant, it is noticeable for many people. As such, it’s always best to talk to your healthcare provider if you’re prescribed nortriptyline and notice any unwanted weight effects.

Your healthcare provider may switch you to a medication with a more favorable weight profile, or suggest changes that you can make to your eating habits and daily routine to help you maintain a stable, healthy weight. 

They may also have additional recommendations to help you better manage your mental health condition, which may include therapy.

Interested in learning more about maintaining good mental health? You can find out more about dealing with depression, anxiety and other common mental health concerns with our free online mental health resources and content.