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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 Fascinating Depression Articles in Recent News

People say that you don’t notice how many pregnant women are in the world until you’re pregnant yourself. I’m finding a similar phenomenon now that I’m depressed again — I barely thought about depression for a couple years, but now that it’s back on my mind, I’m noticing articles everywhere. Three very different, very interesting articles on depression have caught my eye this week.

Why Don’t Antidepressants Work Faster? (Slate)
I’m pretty sure anyone who has taken antidepressants has wondered this very thing. This informative article from a Scientific American writer is easy to understand, but doesn’t skip over important scientific information.

Sleep Therapy Seen as an Aid for Depression (New York Times)
A newly published study found that helping depressed people overcome insomnia with a “cheap, relatively brief and usually effective” form of therapy could double their chances of a full recovery. The technique uses specialized cognitive-behavioral therapy and sounds kind of like typical sleep hygiene recommendations, but is actually quite different, according to researchers.

Gut Bacteria Might Guide the Workings of Our Minds (NPR)
Researchers are investigating whether the bacteria in our digestive systems could influence our moods and behaviors. Such a fascinating idea.

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Weaning Myself Off Antidepressants

Exciting news: I’m off all antidepressants for the first time in eight-and-a-half years! Going off them has been s-l-o-w going because I haven’t been willing to put up with any withdrawal symptoms, which even my doctor’s modest titration schedule resulted in. While I would never advise anyone to adjust their antidepressants without a doctor’s supervision, I’m sharing how I avoided withdrawal symptoms in case it helps anyone in a similar situation.

Wellbutrin was the easiest. I was taking four 100 mg tablets each day and cut back 100 mg every few weeks and had no symptoms.

Lamictal was next. I had a backlog from a mail order prescription, so instead of getting a prescription for a lower dose, I cut the tablets into smaller and smaller pieces as time went on. If I felt withdrawal symptoms, I’d take another small piece, effectively increasing the dose. It took me a couple months before finally stopping.

Cymbalta was the difficult one. With a starting dose 60 mg, even reducing by 10 mg was too much for me. My solution was inelegant and imprecise — and not medically recommended: I opened the capsules and counted out the pellets inside, subtracting a greater amount each week. Having a pharmacist divide the meds or, at the very least, using a scale would have been smarter, but I had another accumulation of meds from a mail order prescription, was impatient, and didn’t want to buy a scale just for this purpose.

It took some fiddling to determine the right amount to decrease by and how frequently to do so. There were about 220 pellets to begin with. By the time I got to 120, I was opening each capsule and counting up instead of down. I’d drop by 10 pellets every week. When I was down to about 50 pellets, I started dropping by five pellets every five days. The whole process took more than six months, but I did it with no increase in depression-like symptoms and no other withdrawal effects, like brain zaps, wooziness, or dizziness.

After a week being off all the drugs, I wrote: “I’m a little more teary — both sad and happy tears — though I find it hard to believe that five pellets of Cymbalta can really make a difference. Maybe I’m more emotive because of the work I’ve been doing in therapy. Or maybe my emotions are no longer dulled by drugs.”

Now that a couple more weeks have passed, I’ll admit that I definitely feel more non-specific sadness, a sort of generalized depression, than I did when I was on the meds. This could be a recurrence in depression symptoms or withdrawal symptoms. Again, it seems strange that going from only five pellets of Cymbalta a day to none could be the culprit in either case, but even just five pellets are the difference between some and none.

According to this Harvard Women’s Health Watch newsletter, if you take a dose of the medication and the symptoms stop immediately, it’s withdrawal and not a recurrence of depression. I finally gave in and tested this today. With only five pellets, the generalized sadness that’s been plaguing me lifted within a couple hours. So I may go back to taking a few pellets a day. I’d prefer to be off it entirely, but I’d much rather be on the drugs than slip into another depression.

Lest you’re worried about me, know that I’m being vigilant, tracking my mood carefully, and am keeping my therapist/naturopath updated on my symptoms, so I don’t relapse. I’ve been on antidepressants most of my adult life and really want to know what I’m like without them, especially now that I have tools for dealing with emotions that I’ve never had before. Still, I’m not willing to risk a slide into depression to find out, so I’m being extremely cautious.

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Chronic Pain & Depression

Wondering if your pain caused your depression or vice versa? The answer is yes (sort of). Here’s the Mayo Clinic‘s take:

. . . Doctors who treat chronic pain and depression have known for many years how closely these two conditions are linked. Some research shows that pain and depression share common pathways in the emotional (limbic) region of the brain — which may, in part, explain their association.

Depression may increase your response to pain, or at least increase the suffering associated with pain. Conversely, chronic pain is stressful and depressing in itself. Sometimes the two create a vicious cycle. In addition, both chronic pain and depression are influenced by genetic and environmental factors as well.

Confused by doctors prescribing antidepressants even though you aren’t depressed? Again, from Mayo: “Certain antidepressants may relieve pain in some people by reducing their pain perception, and improving their sleep and overall quality of life.”

So there you have it.

Can you tell I’m tired? The night migraines are less painful and I’m sleeping a bit better, but my body is still dazed. I saw an acupuncturist Monday and will go back today, so maybe that will help. Much more on acupuncture later, when I can process and explain all that I’m learning.