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Psychiatry & Medication

Pamelor for Anxiety

 May 11, 2020

By  Natalie Kirilova

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The Bottom Line

  • Pamelor is a tricyclic antidepressant prescribed for depression treatment.
  • FDA-approved for depression treatment.
  • Off-label use includes anxiety, stress, and chronic pain management.
  • Available in capsules and oral solution.

What is Pamelor?

Pamelor is a medication from the tricyclic antidepressants (TCAs) class. It is indicated for use in patients with depression and as a relief for its accompanying symptoms of anxiety, stress, chronic pain. Doctors occasionally prescribe it to treat endogenous depression caused by genetic, hereditary or biological reasons rather than by specific triggers. Off-label use includes the treatment of panic disorder, migraine, and help with quitting smoking.

Pamelor is administered orally and comes in capsules of 10, 25, 50, 75mg strengths and oral solution. Nortriptyline is a generic name for Pamelor. Alongside nortriptyline hydrochloride, the active ingredient of Pamelor, the capsules contain gelatin, silicone fluid, starch, titanium dioxide, a yellow coloring agent.

Can Pamelor be taken for Anxiety? 

Pamelor can be taken for anxiety treatment. Specifically, a doctor may prescribe it when anxiety comes as an accompanying symptom of depression. The precise mechanism of how Pamelor works for anxiety is not clearly understood. However, Pamelor is a tricyclic antidepressant which is believed to work by regulating the reuptake of neurotransmitters in the brain that affect the mood. Pamelor exhibits antidepressant effects and relieves symptoms of anxiety or stress. 

Is Pamelor FDA approved for anxiety?

Nortriptyline is approved by the Food and Drug Administration (FDA) to treat depression. Pamelor is known to be used off-label for anxiety, stress and pain management, quitting smoking, migraine. This medication has a black box warning from the FDA, as it has the potentiality to increase suicidal thinking in adults. It is not approved for pediatrics. 

What research supports Pamelor for anxiety?

There is lack of research on the stand-alone use of Pamelor for anxiety disorder treatment, however, its efficacy in treating anxiety symptoms resulting from depression has been supported by several studies.

  • Nortriptyline (Pamelor) was studied against Sertraline on efficacy and safety in adults over 60 with a depression diagnosis. For 12 weeks the patients were administered with Nortriptyline 25-100mg and Sertraline 50-150mg daily. Both medications showed improvements, over the same time frame, and efficacy in the long-term applications
  • Nortriptyline was studied against the placebo on efficacy in mood improvements in patients with chronic obstructive pulmonary disease. 30 subjects took Nortriptyline over a 12-week trial. The results have demonstrated that it improved anxiety scores, certain respiratory issues, and the overall well-being.
  • Nortriptyline and Fluoxetine were studied against the placebo in depression and recovery after a stroke treatment. The groups were divided. Subjects from 1 group took Nortriptyline 25-100mg, 2 group took Fluoxetine 10mg and 3 group took placebo over 12 weeks. Nortriptyline group has been linked to higher response in treating poststroke depression, relieving anxiety symptoms, and boosting energy.

What do experts say about Pamelor for anxiety?

Mark Sullivan, MD, Ph.D., a professor of psychiatry at the University of Washington in Seattle says “Many patients struggle with insomnia and anxiety as they taper opioids. It’s important that prescribers don’t add medications such as sedatives, benzodiazepines, or muscle relaxants that can increase risk of opioid overdose in unpredictable ways. Tricyclic antidepressants, like nortriptyline, can provide a safer alternative treatment for anxiety and insomnia.”

What are the possible side effects? 

Pamelor has not been linked to distinctive side effects during the clinical trials.

Pamelor side effects:

  • hypertension;
  • stroke;
  • hallucinations;
  • insomnia;
  • anxiety;
  • ataxia;
  • tremors;
  • skin rash;
  • dry mouth;
  • nausea;
  • vomiting.

Abrupt discontinuation of Pamelor use after long-term treatment may cause withdrawal symptoms:

  • nausea;
  • headache.

Pamelor has a potentiality to impair alertness and driving abilities. Inform your doctor if you operate heavy machinery or if you drive. 

Does Pamelor have interactions with other medications? 

Certain medications may interact with Pamelor. Always speak to your doctor about an extensive list of all possible interactions, and inform the doctor about your current intake of medication, herbs and health supplements.

There are potential interactions of Pamelor with the following medications:

  • Anticholinergics;
  • Sympathomimetics;
  • Cimetidine;
  • Chlorpropamide;
  • Monoamine oxidize inhibitors (MAOI);
  • Selected antidepressants including other tricyclic medications;
  • Serotonergic.

Abstain from grapefruit juice while taking Pamelor, as it may cause unwanted side effects and increase plasma concentrations of the medication.

Pamelor’s side effects include increase suicidal thinking, worsen depression, cause drowsiness in adults if taken with alcohol. Also, interactions of tricyclic antidepressants with alcohol have been linked to overdose events. Caution is required.

Can you take Pamelor while pregnant or breastfeeding?

There is a lack of evidence about the safety and efficacy of Pamelor in pregnant women. It is important to speak to your doctor about its application during pregnancy.

Pamelor excretes into human milk but in small concentrations. It has not been linked to side effects in newborns, but still, it is recommended to assess all the benefits over the risks with a doctor. 

Can children take Pamelor for anxiety?

Pamelor is not usually prescribed to children with anxiety and depressive symptoms. The Food and Drug Administration (FDA) does not approve it for pediatric use.

How to take Pamelor?

Pamelor is individually prescribed for anxiety and depression treatment based on age, symptoms, and medical history. 

The capsules and liquid are administrated orally. It is best to take Pamelor in the evening, one hour before sleep.

Adults. 25mg 3-4 times per day.

Seniors. 30-50mg one time per day in divided doses.

Take it as directed with or without food. Do not increase the dose at your sole discretion without consulting your doctor. If you do not feel better during the treatment with Pamelor, speak to your doctor about increasing or reducing the dosage. A doctor should gradually adjust the intake regimen.

Are there alternatives to Pamelor?

Prescription medications as Alternatives to Pamelor for Anxiety

Pamelor is a medication that is primarily prescribed to treat depression. The anxiety treatment is prescribed off-label and may not fit your particular case. Speak to your doctor about other prescription medications, as they are many:

  • Klonopin
  • Valium
  • Lexapro
  • Prozac
  • Paxil
  • Xanax
  • Inderal
  • Cymbalta
  • Tofranil
  • Hydroxyzine
  • Zoloft

There are various alternatives. If you’d like to learn more about whether Pamelor, another medication or treatment modality is right for you, we recommend that you speak with a licensed psychiatrist. Here are the best online psychiatry platforms so you can speak with someone right away!

Therapy as an Alternative to Pamelor 

Learn more about different therapy options for anxiety here

Energy & Holistic Modalities as an Alternative to Pamelor 

Learn more about different energy & holistics modalities for anxiety here

Tech & Devices as Alternative Treatments to Pamelor

Learn more about tech & devices for anxiety  here

Disclaimer: This website does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on our Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Natalie Kirilova


Natalie is a writer with a focus in medical research with over 10 years of experience

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