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Sidelined by Side Effects

Yesterday I increased my Wellbutrin, started taking Lamictal and cut my Cymbalta dosage in half. And I’m feeling it. I’m shaking, my mouth is dry, my brain is fuzzy, and I’m a little nauseated and lightheaded. Based on my previous pattern, it should all wear off in a couple weeks, so I’m not worried about these symptoms. I’m just not thrilled with them.

Tonight a friend is having a party she’s referring to as the Gaggle of Gals. The last gaggle gathering was an outrageous blast. I think instead I will spend the evening reading and watching a baseball game.

I hope you all are enjoying the weekend and feeling relatively well.

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Adjusting Depression Meds

Today was my appointment with the psychiatrist to adjust my meds. The plan is to increase the Wellbutrin from 300 to 400 mg a day, decrease the Cymbalta from 120 to 60 mg a day and add Lamictal to the mix.

Lamictal, an antiepileptic med that is also a mood stabilizer, is used in patients with epilepsy (surprise, surprise) and bipolar disorder. It is closely related to Depakote, a commonly prescribed headache preventive, and both may reduce pain levels. Unlike Depakote, Lamictal also has antidepressant properties.

It will be about 6 weeks before I know if the adjusted doses of Wellbutrin and Cymbalta combined with Lamictal will be the right cocktail for me. To use a phrase I despise, I’m cautiously optimistic that this will be the right cocktail in the long run. But I can’t shake the knowledge that I’ve yet to find the right headache mix. If one disease isn’t fixable, then maybe the other isn’t either.

I’ve been treating depression as a minor relative to the consuming disease of migraine, and I really want to keep it this way. I don’t think I can handle having two diseases that require constant attention and upkeep. But I won’t torture myself with such thoughts right now.

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Depressed

For the last couple months, I’ve been tired, had no appetite, haven’t felt like doing much and have had no motivation to do anything. I blamed all these symptoms on pain, but began to wonder if I might be depressed too.

I saw my psychiatrist for a med check at the beginning of August, and he gave me two terrific pieces of information. The first is that that one or maybe two of my symptoms could be related to pain, but that when they start adding up, depression is much more likely.

He also told me that I’m prone to backsliding quickly. That the medication may work fine for a while, but that if it stops working, I will rapidly sink back into depression. Another doctor told me several years ago that when an antidepressant works, it doesn’t stop working. Operating under this wrong information, I’ve spent much more time depressed than necessary.

Anyway, the new cocktail that my psychiatrist prescribed a month ago didn’t help. I know that sorting out depression meds is one more part of balancing migraine and it’s comorbidities (for me), but it’s a pain in the butt. Even when the pain is unbearable, managing all the other symptoms and related problems isn’t a big deal unless those related problems sap my energy and motivation. Fortunately I’m already scheduled for another med check next week, so the medication trial and errors will continue (and hopefully work) without me having to expend too much energy.

This has been a particularly rough week with the hurricane and the stampede in Iraq. Adding an already existing depression, a horrendous migraine on Wednesday and a Vicodin hangover on Thursday to the news left me sobbing. Both my pain levels and mood are much better today, but I’ve decided to take the weekend off from reading news. I hope you all enjoy your weekends and are relatively pain-free. Take care of yourselves. I’ll be back on Tuesday.

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Antidepressants for Pain

“Why did my doctor prescribe an antidepressant? I’m not depressed, I have outrageous headaches!” I’m convinced that every headache sufferer asks this question at some point. If doctors don’t explain the reasons or if patients don’t understand them, we feel dismissed or as if our doctors didn’t listen to us.

But there are good reasons behind the drug choice. Some of the same brain chemicals are thought to be shared between the two diseases, so antidepressants can adjust the imbalance of migraine-related chemicals. Also, many antidepressants have pain-soothing properties.

Tricyclic antidepressants, including Elavil (amitriptyline), Tofranil (imipramine) and Pamelor (nortriptyline), have a long track record in treating pain. SSRIs, like Prozac, Effexor and Zoloft, don’t have as much proof supporting their efficacy for pain, but there is some evidence that they help reduce pain as well as treat other symptoms related to migraine, like anxiety.

Mayo Clinic provides an overview of why tricyclics are used for pain, how they work and side effects. The best description of SSRIs for headache that I’ve found is Headache 2005 from the Robbins Headache Clinic. Getting to it requires wading through a PDF, but it’s worthwhile. The SSRI information begins on page 32.

11/18/05: Turns out the chemical imbalance theory of depression is off-kilter. Antidepressants may work on the same areas of the brain affected by headache, but a chemical imbalance isn’t the place.