Tricyclic antidepressants (TCA’s) like nortriptyline often have more side effects than newer antidepressants like Prozac. However, TCA’s are more effective for most types of pain. However, the good news if that many people get benefit from TCA’s as low doses such as those you’re using, so can sometimes use low doses and get benefit before getting too many side effects.

Older people and those on other medications in addition to the TCA often get more side effects.

Some suggestions to discuss with your doctor:
1. You might see if a slower increase in dose lets your body get adjusted to the medication, and if side effects subside with time.
2. If you find that you can only tolerate 10 mg, you might find that even at this dose you get at least some benefits. Sometime even a little does something for you.
3. Sometimes slowly or slightly decreasing other medication when you add a TCA overall gives you a better balance between benefit and side effects. (Again, make sure to discuss with your physician before doing this.)
4. While nortriptyline is a TCA usually with fewer side effects, it might be worthwhile to try other low-dose TCA’s to see if you can tolerate another one better. Or, trying a newer medication formulated like the TCA’s but with often less side effects might be another option.

Good luck, and certainly give your doctor feedback about this experience, so she/he can discuss other options with you.