SSRIs are the standard first line of treatment for depression, as they cause fewer side effects and have fewer health risks than other antidepressants. However, sometimes doctors choose older depression medications in cases where a patient has treatment-resistant depression.

Norpramin and amitriptyline are two medications a medical provider may suggest when a patient has treatment-resistant depression. In this article, Klarity Health takes a deeper look into these two antidepressants—we’ll explore how they work, their side effects, how much they cost, and other important details.

If you have depression, medications like Norpramin or Amitriptyline could be right for you. Klarity Health has already helped thousands of patients find reliable depression treatment online. We connect you with a fully-licensed mental health specialist who can provide a diagnosis and prescribe the safest antidepressant for you. Find your provider, and in 48 hours you can receive a personalized treatment plan and prescription for your depression.

	Norpramin	Amitriptyline
Drug Class	Tricyclic antidepressant	Tricyclic antidepressant
Brand / Generic Status	Brand name for desipramine	Generic (Brand name: Elavil)
Form(s) of the Drug	• Immediate-release tablets	• Tablets • Yellow, fruit-flavored liquid suspension
Standard Dosage	Tablets: • 10mg • 25mg • 50mg • 75mg • 100mg • 150mg	Tablets: • 10mg • 25mg • 50mg • 75mg • 100mg • 150mg Liquid suspension: • 10mg per dose
Conditions Treated	FDA-approved uses: • Major depressive disorder Off-label uses: • Anxiety • Various mood disorders • Nerve pain • Sleep disorders • Overactive bladder • Bulimia nervosa • ADHD • Irritable bowel syndrome (IBS)	FDA-approved uses: • Major depressive disorder • Anxiety disorder • OCD Off-label uses: • Chronic fibromyalgia pain • Nerve pain • Sleep disorders • Bladder pain • Irritable bowel syndrome
Cost	Generic form (desipramine): • $7.33 for a 30-day supply Brand name: • $52 to $61 for a 30-day supply	Generic form (amitriptyline): • $140 to $300 for a 30-day supply • $4 for a 30-day supply with insurance or coupon card
Side-Effects	Common side effects: • Nausea and vomiting • Loss of appetite • Headache • Dry mouth • Confusion, delusions, and hallucinations • Restlessness, anxiety, and tremors • Trouble sleeping (insomnia, nightmares) • Sun sensitivity • Weight changes • Breast growth in men Serious side effects: • Chest pain • Irregular heartbeat • Seizures • Fainting • Weakness on one side of the body • Eye pain, swelling, or redness • Changes in vision	Common side effects: • Drowsiness, blurred vision • Dry mouth, constipation • Weight gain • Difficulty urinating • Persistent heartburn • Easy bruising or bleeding • Black stools • Vomit that looks like coffee grounds • Muscle spasms, shaking • Severe abdominal pain • Decreased libido • Enlarged or painful breasts • Severe dizziness, fainting, seizures, confusion • Eye pain, redness or swelling, vision changes • Sweating
Warnings For Use	Drug interactions: • Heart medications • Blood pressure medications • Thyroid supplements • Seizure medications • SSRIs • Blood thinners • MAOIs	Drug interactions: • Quinidine • Cimetidine • Many other antidepressants: SSRIs • Type 1C antiarrhythmics • MAO inhibitors • Thyroid medication • Alcohol, barbiturates and other CNS depressants • Anticholinergic drugs

Amitriptyline and Norpramin Are the Same Class of Drugs

Amitriptyline and Norpramin are tricyclics. Coming into the market in 1959, tricyclics are the oldest prescription drugs used to treat major depressive disorder (MDD). They are comparably as effective as other antidepressants for treating depression.

Though they come with many more side effects due to their mechanism of action, this characteristic makes tricyclics more effective at treating treatment-resistant depression.

What Are Tricyclics? How Do They Work?

Essentially, tricyclics and other antidepressants help elevate the amount serotonin and norepinephrine in the brain. These neurotransmitters act as chemical messengers to allow neurons to communicate. Since people with depression are typically low in serotonin and neuropinephrine, tricyclics can effectively alleviate some symptoms of depression, anxiety, and other disorders in patients.

Newer antidepressant drugs are more selective, meaning they only affect specific receptors in the body. Selective serotonin reuptake inhibitors (SSRIs) are exactly that—selective in the receptors they block.

Tricyclics are not selective. Because they block many different types of receptors across the body, tricyclics come with more side effects and have a lower toxicity threshold, meaning it is easier to overdose on them.

Though all tricyclics produce similar results in patients, slight differences in the chemical structures between different kinds means that each has a slightly different side effect profile.

Amitriptyline and Norpramin for Depression

Tricyclic antidepressants are most often prescribed to treat major depressive disorders. However, medical providers may prescribe them to treat psychiatric conditions such as anxiety and neuropathic conditions like fibromyalgia or diabetic neuropathy pain.

What Else Does Amitriptyline Treat?

In addition to treating depression, low doses of amitriptyline can help improve sleep and treat anxiety symptoms. Amitriptyline might be suitable for people with treatment-resistant depression and anxiety.

Amitriptyline is also prescribed for pain management. At low doses, it can help reduce pain associated with fibromyalgia, arthritis, and even migraines. Additionally, amitriptyline is used to treat peripheral neuropathy in diabetic patients or for individuals experiencing nerve pain.

What Else Does Norpramin Treat?

Norpramin and amitriptyline treat similar illnesses because they work in similar ways. Like amitriptyline, Norpramin treats depression and anxiety, along with other mood disorders. It helps improve sleep quality and helps people feel more energized.

Additionally, like amitriptyline, it helps patients manage chronic pain resulting from arthritis, fibromyalgia, or nerve pain.

Doses, Dosage Form, and Side Effects of Norpramin

Common Norpramin Doses and Forms

Norpramin is available in oral tablets of 10mg, 25mg, 50mg, 75mg, 100mg, and 150mg. The common starting dose for adults is between 100 mg and 200 mg, with a maximum dose of 300 mg.

This medication can cause sleepiness and should be taken at night before bed.

Norpramin Side Effects

Some common side effects that may occur while taking Norpramin are

Nausea and vomiting
Loss of appetite
Headache
Dry mouth
Confusion, delusions, and hallucinations
Restlessness, anxiety, and tremors
Trouble sleeping (insomnia, nightmares)
Sun sensitivity
Weight changes
Breast growth in men

Seek medical attention immediately if you experience rarer, more severe side effects

Chest pain
Irregular heartbeat
Seizures
Fainting
Weakness on one side of the body
Eye pain/swelling/redness
Changes in vision—seeing rainbows or halos around lights in the dark

Common Norpramin Drug Interactions

Before starting Norpramin, inform your healthcare provider about all the medications and supplements you are currently taking. Norpramin can interact with drugs used to treat heart conditions, high blood pressure, thyroid supplements, and some seizure medications. It’s also advised to avoid medications used as mood regulators, such as SSRIs, and to avoid blood thinners, like aspirin or warfarin.

Patients should stop taking MAO inhibitors 14 days before starting amitriptyline. MAO inhibitors to avoid are Isocarboxazid, Linezolid, Phenelzine, Rasagiline, Selegiline, and Tranylcypromine.

How Much Does Norpramin Cost?

The cost of Norpramin (desipramine) depends on several factors, including dosage, your pharmacy, and whether or not you have health insurance. 90 tablets of 25 mg desipramine, the generic form, costs about $22.

Doses, Dosage Form and Side Effects of Amitriptyline

Common Amitriptyline Doses and Forms

Amitriptyline is available in tablets of 10mg, 25mg, and 50mg. It is also available in a liquid solution at three different doses: 10mg, 25mg, and 50mg. For adults, the initial dose is 50mg daily but can go as high as 150mg.

This medication can cause sleepiness and should be taken at night before bed.

Amitriptyline Side Effects

Some common side effects seen when taking amitriptyline include:

Constipation
Nauseous and vomiting
Feeling sleepy, fatigued, or tired
Headaches
Weight gain or loss
Low sex drive
Dizziness
Dry mouth and dehydration

Seek medical attention immediately if you experience these rare, but severe side effects

Black stools
Vomit that looks like coffee grounds
Severe dizziness
Fainting
Seizures
Eye pain/swelling/redness
Vision changes—seeing rainbows or halos around lights at night

Common Amitriptyline Drug Interactions

You must provide your healthcare provider with a complete list of all medications and supplements you are currently taking. Amitriptyline should not be taken alongside thyroid supplements, medications that treat bleeding disorders, NSAIDs (like ibuprofen or naproxen), medications for high blood pressure, and antidepressants like SSRIs.

Patients should stop taking MAO inhibitors 14 days before starting amitriptyline. MAO inhibitors to avoid are Isocarboxazid, Linezolid, Phenelzine, Rasagiline, Selegiline, and Tranylcypromine.

How Much Does Amitriptyline Cost?

Any medication’s exact cost might differ depending on your insurance, dosage, and pharmacy. But to give you a rough estimate, a 25mg amitriptyline oral tablet would cost around $14 for 28 tablets.

Other Tricyclic Side Effects

Due to the chemicals serotonin and norepinephrine increasing, their levels in the brain might get dangerous. While taking this medication can cause certain side effects that can be detrimental to your health.

What is Serotonin Syndrome?

When the brain absorbs too much serotonin, it can cause a serious condition called serotonin syndrome. This occurs when the brain is deeply saturated and heavily built up with serotonin. Some symptoms you could experience include high fevers, agitation, palpitations, and muscle rigidity.

Pregnancy and Breastfeeding on Tricyclics

There has not been enough research to determine if taking tricyclics is safe during pregnancy. It should be avoided if possible and advised only to take it during the first trimester to avoid any risk to your baby. However, it’s recommended not to take tricyclics while breastfeeding since it does transfer into breast milk and can potentially harm nursing infants.

Increased Bleeding Risk With Tricyclics

There is a significant risk of bleeding while taking tricyclics with other medication for blood, like warfarin. However, it’s okay if you are only taking tricyclics alone. Patients are advised to avoid taking blood thinners or aspirin if they can. If their underlying condition is not compensable, it’s best to avoid getting treatment with tricyclics.

Speak to a Healthcare Provider Online About Depression Medication Today

If you have depression, medications like SSRIs, or SNRIs, or tricyclic antidepressants may be able to help you manage your symptoms. However, the varying side effect profiles, dosages, and interactions mean that you should never attempt to self-medicate your symptoms. Always consult with a trusted healthcare provider before starting Norpramin, Amitriptyline, or any other prescription drug.

Klarity Health can connect you with a licensed healthcare provider in your state for simple, effective online depression treatment. Your provider will be able to evaluate your symptoms and determine which antidepressant, if any, is right for you.

Schedule an appointment, and if applicable, you could have a prescription for depression medication sent right to your local pharmacy within just 48 hours.

Licensed providers on Klarity provide personalized treatment. Find a provider that matches your needs and preferences.

Norpramin and Amitriptyline Frequently Asked Questions

What is Norpramin?: Norpramin (desipramine) is a tricyclic antidepressant prescribed to treat depression. This drug increases serotonin and norepinephrine levels by preventing their reabsorption and keeping them in the synaptic cleft, where they are most useful.

Norpramin is not the first-choice treatment for depression and should be avoided in patients with underlying circulatory issues, heart conditions, seizures, and glaucoma. Patients with diabetes should avoid taking Norpramin.

Norpramin is also used to treat diabetic neuropathy in patients with normal sugar levels.
What is Amitriptyline?: Amitriptyline (Elavil) is a tricyclic antidepressant that helps regulate mood and treat nerve pain. Elavil has a number of side effects and should be prescribed after careful consideration. Patients need to weigh whether or not the pros outweigh the cons.

Amitriptyline is not habit-forming and can be used for patients that have a history of addiction.
Are Norpramin and Amitriptyline the same drug?: Tricyclics are the same class of drugs and work through the same mode of action. They increase levels of serotonin and norepinephrine, which can provide relief from depressive symptoms.

Where they do differ is in their side effect profile.

For example, Norpramin is contraindicated for patients with underlying health conditions such as heart disease. Norpramin has more side effects than traditional SSRI antidepressants. Both are not the first-line treatment for depression but can benefit certain patients who have treatment-resistant depression or who can’t take SSRIs.
Do I Need A Prescription for Amitriptyline or Norpramin?: Yes, patients need a prescription to receive amitriptyline and Norpramin.
What’s better for anxiety? Norpramin or Amitriptyline?: Both medications are sometimes prescribed as off-label treatments for anxiety when traditional anxiety medications cannot be prescribed, and when SSRIs have proven ineffective.
What’s better for depression? Norpramin or Amitriptyline?: Overall both TCA antidepressants are beneficial for patients that are seeking treatment. By comparing the two medications, amitriptyline is more commonly used to treat prevalent depression in patients with other underlying conditions, such as anxiety.
Can I drive on TCA antidepressants like Norpramin or Amitriptyline?: Norpramin and amitriptyline both have sedative effects, especially when first starting them. Patients are advised to take both medications before going to sleep. However, medications don’t always produce the same effects for each individual. Some people can drive while taking TCA antidepressants after they know how the medication affects them.
Can I drink alcohol on Norpramin or Amitriptyline?: No, you should not. Drinking alcohol while taking TCA medications can make side effects much worse, creating mood swings and excessive drowsiness.
Does it matter what time of day I take Norpramin or Amitriptyline?: Norpramin and amitriptyline can make you feel sleepy. Take both medications during the night before bedtime.

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R. Morgan Griffin. “How Different Antidepressants Work.” WebMD. https://www.webmd.com/depression/how-different-antidepressants-work

WebMD Staff. “Amitriptyline HCL – Uses, Side Effects, and More.” WebMD. https://www.webmd.com/drugs/2/drug-8611/amitriptyline-oral/details

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“What is Amytriptyline?” Versus Arthritis.
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How we reviewed this article: This article went through rigorous fact-checking by a team of medical reviewers. Reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the author. Learn more about the editorial and medical review process and standards for the HelloKlarity site.

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The information provided in this article is for educational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health. Providers on Klarity Health are independent practitioners with clinical autonomy. Nothing in this article is intended to diagnose or treat any condition, including guaranteeing prescription medication of any kind or dosage. Not all providers on Klarity Health prescribe all medications, particularly medications that are controlled substances.

If you’re having a mental health crisis or experiencing a psychiatric emergency, it’s crucial to seek immediate help from a mental healthcare professional, such as a psychiatrist, psychologist, or therapist. You can also call your local emergency services, visit your nearest emergency room, or contact a crisis hotline, such as the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.