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Nortriptyline Abuse

A Case Report and Review of the Literature

Miller, John Jeffrey, MD*; Whiting, William L., DO; Catalano, Glenn, MD*†; Sanchez, Deborah L., MD, MPH*†

doi: 10.1097/WNF.0000000000000337
Case Reports

The tricyclic antidepressants have long been a tool in the physician's armament for numerous indications, the most prominent of which being depression. Although their efficacy and side effects have been well documented, less known is their abuse. Prior literature has discussed this more for the tertiary amines such as amitriptyline, but currently, there are no documented cases of abuse with the secondary amine nortriptyline. This article reviews the prior literature in regard to tricyclic antidepressants and anticholinergics as substances of abuse, the proposed mechanisms of this, and susceptible populations, as well as a case review of a patient who admitted to using nortriptyline for its “buzz.”

*Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Morsani College of Medicine; and

James A. Haley Veterans Hospital, Tampa, FL.

Address correspondence and reprint requests to Deborah L. Sanchez, MD, MPH, Mental Health and Behavioral Sciences Service (116A), James A. Haley VA Hospital, 13000 Bruce B. Downs Blvd, Tampa, FL 33612; E-mail:

Conflicts of Interest and Sources of Funding: None of the authors have any financial or other potential conflict of interest pertinent to this work. There was no source of funding or other sponsorship or support for this work.

All authors contributed to the conceptualization, data collection, literature review, manuscript preparation, and final approval of this work. This work has not been published or presented elsewhere.

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