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Sensitivity to Drug Side Effects Increased by Migraine Attack

Nine days of dizziness following four days of migraine. That’s what I’ve been up to these last two weeks.

The migraines made sense. We had rainstorms that week and I’d blown off my diet a couple times. The dizziness, however, was surprising. Wellbutrin has been to blame every time I’ve been dizzy in the last 16 months, but it didn’t make sense. I haven’t changed my dose in a few months months. I’d eaten plenty before taking it each time and hadn’t missed a dose. Maybe I accidentally took too much one day? I skipped a dose intentionally, took it at different times, took 300 mg instead of 450 mg. When the dizziness did lessen, the reprieve never lasted long. It was as if the migraine attack had made me more sensitive to Wellbutrin’s side effects.

It seemed unlikely that one migraine attack would change how I reacted to medication I’ve been on for more than a year, but my headache specialist told me he’s seen it happen with other patients. As he put it, the brain you have after a migraine attacks is not the same brain as you had before it. Any medication that acts on the central nervous system, like antidepressants, could interact with this new brain in a different way than before, causing an increase in side effects. My dose hadn’t changed, my brain had.

The changes to your brain after an attack are not permanent, so please don’t let this scare you. It’s more like a storm with high winds came through and there’s still dirt and debris in the street. The street sweeper will get to it eventually, but it may take some time. (I live in a place with haboobs and dramatic thunderstorms. You can liken it to a snowstorm if that’s more familiar.)

I’ve been taking 300 mg of Wellbutrin for the last week. Today I can look at the computer without feeling like my head is melting as if in a psychedelic video, but I still have to be careful to minimize the chance of side effects whenever I take a dose. My fingers are crossed that this part of the change to my brain lasts and that I can keep the depression at bay on this lower dose.

My naturopath/therapist believes that my depression is directly tied to migraine attacks. Since I started seeing her almost two years ago, every increase in depression has followed a long migraine attack that didn’t respond to acute medications. This fits with my headache specialist’s explanation. I haven’t waited to see if the depression abates without medication, but I wonder if it would. Not enough to find out, but I will ponder it.

My fingers are crossed that I have the internal mess from this latest storm cleaned up. Now it’s time to attend to everything I haven’t been able to attend to while weathering it. I’m going to read and approve a slew of comments now, but it will take me a while to respond to all of them.

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Wellbutrin Side Effects

Dizziness is one of Wellbutrin’s most well-known side effects, one with which I’ve become intimately familiar. Since I know I need an antidepressant right now and refuse to take any with sexual side effects, I’ve become experienced in managing Wellbutrin side effects. In addition to dizziness, I’ve had some trouble with insomnia. This information stems from dealing with those problems, but it may be helpful for other side effects, as well.

The main points:

  • Try different release types
  • Take the meds with food
  • Try different ways of taking different dosages (example: for 300 mg, take 200 in the morning and 100 in the afternoon or vice versa)
  • Try generics from different manufacturers
  • Try the name brand drug, if possible

Wellbutrin (generic: bupropion) comes in regular release, sustained release (SR) and extended release (XL). I started on 200 mg of the generic sustained release. My diet is heavily restricted, so I don’t eat many calories at once and eat few carbohydrates, both of which seem to make me more susceptible to dizziness. I could manage as long as I consumed 800 calories before my first dose and took the second dose six hours later.

Then I increased my dose to 300 mg a day, which added insomnia to the dizziness. If I took 200 mg in the morning, I got dizzy and stayed that way all day. Taking 200 mg in the afternoon caused less dizziness, but made it difficult for me to fall asleep and stay asleep.

So I switched to 300 mg of the generic extended release, taken in two 150 mg tablets with breakfast. I still had a little bit of dizziness, but it was pretty mild, and no trouble with sleep. Then I started taking the 300 mg in a single tablet and wound up with intense dizziness that even kicked up when I rolled over in bed.

The question is whether I did better with two 150 mg tablets because there were two pills or because they are manufactured by a different company than the 300 mg tabs. I’m guessing the latter since generic drugs have the same active ingredient as name brand drugs, but the other ingredients may differ and, thus, may have different side effects.

Which leads to what will be my next experiment — taking two 150 mg tablets of Wellbutrin XL, the brand name extended release version. If my insurance company approves it, I’ll let you know how the experiment goes.

(And now you know why my posts have been sporadic and I’ve been slow to respond to email and comments the last few months. Computer time is the first thing to go when I’m dizzy. Today it feels manageable; we’ll see if that lasts.)

Update: I got the dizziness under control a few ways:

  1. I always take it with food, usually about 30 minutes after eating.
  2. I split the dose, one with breakfast and two around 3p. (It can cause insomnia, so you might need to take it earlier.)
  3. When those two things stopped being sufficient, I switched to name brand Wellbutrin XL (I was on generic XL before that).

If name brand Wellbutrin isn’t an option (insurance companies often don’t cover it), you could try generic bupropion from a different manufacturer. Ingredients vary enough from one manufacturer to the next that switching to another generic can do the trick. The downside is that you may have to try generics from multiple companies to find one that doesn’t have side effects for you. To switch, find out which company makes the bupropion that’s causing your dizziness (it should be on the bottle or your pharmacist can tell you). Then ask your pharmacist if they stock another brand or are able to order a different brand for you. This usually is no problem, but there’s a chance you’ll need to try a different pharmacy.

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Three Good Things Each Day

Listing three good things that happen in your life each day can boost your mood and increase your happiness in just a few weeks, according to research. They don’t have to be grand accomplishments; small things that make you smile are just as powerful.

When my migraines were at their absolute worst, life felt bleak. Despite my normal ability to see the good in even the smallest things, I couldn’t see anything good in my life. Experience had taught me that if I was going to succeed in finding relief, I’d need a better attitude. I was so sick, though, that it needed to be an easy, low-effort attitude adjustment. So I challenged myself to think of three good things that happened each day.

I can still picture myself in bed in the bedroom of our Boston apartment — a spot I could stay for days at a time, save for when I got up to go to the bathroom (I spent a lot of time daydreaming about how great a catheter would be) — mentally listing my three good things before I went to sleep each night. At first, they were miniscule: I enjoyed a podcast, my meds and water were in easy reach when I needed them, I survived another day. Then they got a little bigger: Hart and I laughed together, my new headache specialist was kind, I identified a trigger. In time, I no longer had to force myself to see the good, I was noticing it frequently.

Still, I continued with the practice. It had become a sort of meditation or, if I were into that sort of thing, a prayer. Consciously attending to the positive in life reinforced my ability to find good things no matter what was happening. Despite this, I eventually fell out of the habit. To get back into it, I issued a sort of challenge to Migraine.com readers to list their three good things on a forum thread each day of November.

Will you join us? Not necessarily on Migraine.com, but in listing your three good things each day, privately or publicly, written or mentally. It’s a simple technique that’s surprisingly powerful.

My three good things for today: 1. I wrote this blog post, 2. I ate pasta made from semolina flour without it triggering a migraine, 3. I appear to have gotten the smoke smell out of the microwave, so I may not have to replace it. What are your three good things today?

My Migraine.com article, “What are your three good things?,” explains some of the research and you can post your three things on the Three Good Things forum thread. A good, more general, summary of the practice and research is at Find Three Good Things Each Day.

 

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Checking In

Worried emails come in whenever I’m quiet for long, so here’s a brief update. My mood is pretty good and my migraines have been a bit better (though I have an ugly one right now). Wellbutrin is still making me dizzy when I work on the computer, so I’m not writing much. I’ve chugged a Tolerex with breakfast the last two days, which seems to have kept the dizziness at bay. My fingers are crossed that I’ll be fully functional again soon.

I’m now 38 and had a lovely, low-migraine birthday (though Hart had a migraine that day!). I decided to indulge in dinner out and homemade yellow cake with buttercream frosting. A migraine followed, but it was mild and worth it.

If you’re looking for new writing from me, Migraine.com is a good place to check. They have a backlog of articles from me that they publish as needed and usually post one new one from me each week. Here are some recently published posts:

I apologize for letting your comments languish; I hope to reply this week. And I hope to get at least one new post up this week. I hope you’re doing as well as possible!

 

 

 

 

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I’m Out of Cope Due to Depression

After posting Food and Migraine Frustrations: I’m All Out of Cope, I finally looked at all the pieces that were frustrating me (and how I was overreacting to everything and felt helpless) and realized they added up to depression. I was still waffling until the day I woke up and didn’t want to get out of bed. Then I knew it was time to increase my Wellbutrin.

I started feeling better almost immediately. It’s highly unlikely that the Wellbutrin made such a difference so fast, but recognizing what was happening and taking steps to change it was a big relief. I’m also seeing some improvement in my diet and pinpointing the foods (and possibly a supplement) that have been problematic. And one day out of every four is (usually) trigger-free.

Unfortunately, I’m not getting enough calories to support 300 mg of Wellbutrin without side effects. Like happened when I was on Tolerex in December, I get dizzy looking down or working at the computer. Once again, it’s keeping me from working much.

I’m still frustrated, but no longer feel helpless or overwhelmed. I’m taking each hour as it comes and trusting I’ll figure this out eventually. (That sounds so trite, but it’s totally true.) I’m not sure what “this” looks like, how long it will take or how many migraines a week (or day) it will mean. And that’s OK.