Key takeaways
Nortriptyline (Pamelor) and duloxetine (Cymbalta) are both used to treat depression, but they belong to different classes of medications. Nortriptyline is a tricyclic antidepressant (TCA) that works by adjusting levels of serotonin and norepinephrine in the brain, while duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) that also raises these chemicals. Nortriptyline is typically taken multiple times a day, whereas duloxetine is usually taken once daily. Duloxetine is also approved to treat anxiety, diabetic neuropathy, fibromyalgia, and long-term pain, making it more versatile than nortriptyline, which is sometimes used off-label for chronic pain and nerve pain. Both medications can cause withdrawal symptoms if stopped abruptly, but duloxetine has a higher risk of liver damage, especially if you drink alcohol. Nortriptyline may take longer to show full effects, typically 6 to 8 weeks, compared to duloxetine, which can start showing improvements in mood within 1 to 2 weeks. Both medications are available in generic forms, making them more affordable options.
