Nortriptyline or Pamelor falls into the tricyclic antidepressant family that also includes amitriptyline, imipramine and clomipramine. Anxiety related disorders constitute the approved indications for nortriptyline, however the drug is frequently prescribed for a long list of off label conditions.

Among the reasons doctors find to prescribe nortriptyline are neuropathic pain, fibromyalgia, irritable bowel syndrome, insomnia, bedwetting and insomnia. Even with newer more specific alternatives, nortriptyline still appears useful as a cost effective method of preventing migraine headaches.

Reliance on nortriptyline and other TCAs to treat depression precipitously declined with introduction of the SSRIs – selective serotonin reuptake inhibitors. While the SSRIs may cause fewer side effects in general, nortriptyline counteracts depression as well as the newer drugs such as Prozac, Celexa, Zoloft and Lexapro. Interestingly for those more severely depressed, especially with the so-called melancholic depression, nortriptyline and related TCAs appear more effective than the SSRIs.