Antidepressants increase risk of suicidal thinking and behavior in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders. Nortriptyline not FDA approved for use in children. May worsen psychosis in some patients or precipitate shift to mania or hypomania in bipolar disorder. Monotherapy in bipolar disorder should be avoided. Nortriptyline not FDA approved for treatment of bipolar depression. May cause anticholinergic effects (constipation, xerostomia, blurred vision, urinary retention); use with caution in decreased gastrointestinal motility, paralytic ileus, urinary retention, BPH, xerostomia, or visual problems. Degree of anticholinergic blockade produced by this agent is moderate relative to other antidepressants. TCAs may rarely cause bone marrow suppression. May cause orthostatic hypotension (risk low relative to other antidepressants). May cause sedation. Use with caution in history of cardiovascular disease (including previous MI, stroke, tachycardia, or conduction abnormalities), in diabetes mellitus (may alter glucose regulation), in hepatic and renal impairment, and in risk of seizures, including patients with history of seizures, head trauma, brain damage, alcoholism, or concurrent therapy with medications which may lower seizure threshold. Use with caution in hyperthyroidism or patients receiving thyroid supplementation due to concerns of pro-arrhythmogenesis. Effects may be potentiated when used with other sedative drugs or ethanol. Use with caution in the elderly. Recommended to discontinue prior to elective surgery requiring general anesthesia. Therapy should not be abruptly discontinued in patients receiving high doses for prolonged periods. May increase risks associated with electroconvulsive therapy.