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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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Why I’m Doing Better, Part 1: Climate & Medication

After my recent glowing posts, many people have inquired why I’m feeling better. I’d like to give you a clear, definitive answer, but migraine is never that simple. There are a number of factors, from climate and medication to exercise, meditation and forgiving myself for being sick. I’ll talk about the first two today and the others, which have probably had a greater impact on my health and suffering than medication, later this week.

Climate
Moving to Phoenix, away from the clouds and rain of Seattle and the ever-changing weather of Boston, has had the biggest influence on my migraine frequency, duration and severity. Storms and clouds have been rolling through Phoenix the last week and I’m on migraine day six. Though migraines aren’t always present when there’s weather, particularly if I’m on vacation, the correlation holds about 90% of the time. I wonder if the issue is barometric pressure changes, though Seattle’s barometric pressure is relatively steady, so parts of my hypothesis fail there.

Indomethacin
I began taking this nonsteroidal anti-inflammatory drug in June because the sand-in-my-eye symptom pointed to the slight possibility that I had an abnormal presentation of hemicrania continua. This rare headache disorder is completely responsive to indomethacin. Though my headache pain lessened, it did not cease, which means my diagnosis is still migraine. My doctor kept me on a daily dose of 225 mg of the medication, though he warned that it is not recommended for long-term use as it is hard on the stomach. I’m sticking with it for now because it is the only medication on which I’ve noticed a decrease in the frequency and severity of my migraines.

Discontinuing Wellbutrin and Lamictal
In 2005, I was prescribed Cymbalta, Wellbutrin and Lamictal for depression. I stayed on them far longer than I intended, especially considering that I was still majorly depressed while taking them. I finally went off of them this summer after determining that my dizziness, tremor, hot flashes, fatigue, cold hands and feet, mental fogginess, nausea, and increased pulse were not migraine symptoms, but medication side effects. I believe Wellbutrin was the culprit, but I wanted to stay off all three if I could. When my depression symptoms returned, I went back on Cymbalta. I’m happy to say that the depression is at bay and I’m not experiencing any other side effects.

Namenda
I’m in love with this medication, which is an Alzheimer’s treatment that is used off-label for migraine. I don’t know if it has had an effect on the migraine severity or duration, but it has cleared the mental blah that has plagued me as the migraines worsened. I credit Namenda with returning the mental wherewithal necessary for me to resume blogging and restoring my sense of intelligence. The feeling dumb aspect of migraine, which is not addressed frequently enough, has been one of my most limiting symptoms and has caused the greatest loss of my sense of identity and purpose. Did I mention that I love this drug?

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Whoa! I’m Depressed

I’ve been debating all week whether I’m down or if my clinical depression is creeping back. Arriving a day late for the psychiatry appointment I scheduled a month ago was just what I needed to confirm my suspicions.

Even though I could reschedule for an hour later this afternoon, I was crushed. Not like a soda can that’s been stepped on from the top; more like one crumpled in a fist. Still, the anguish was disproportional for the event. Even after I found the Tully’s coffee in the hospital, settled in with tea and a cookie, and pulled out my magazine, I was near tears.

That made it pretty clear that my:

  • Exhaustion isn’t just migraine-related
  • Fall’s arrival is not why I want curl up on the couch
  • Lack of focus on and interest in blogging isn’t because The Daily Headache has run its course
  • Increased frustration with having a chronic illness doesn’t mean I’ve lost my ability to cope with it
  • Lack of interest in sex isn’t just a Cymbalta side effect

Convenient that I had an appointment with my psychiatrist. For two years, my cocktail has been 400 mg of Wellbutrin, 200 mg of Lamictal and 60 mg of Cymbalta. Because my doctor thinks that some of my disinterest in sex is from Cymbalta — and because doubling that dose two years ago wasn’t helpful — I’m increasing Lamictal to 300 mg. I’m also going to add ginkgo to see if it helps the sexual side effects.

I’m relieved. Having an aha! moment reminded me that beating myself up won’t do a bit of good. I am, however, sick of the constant vigilance required with depression. Maybe that’s another sign that I’m depressed.

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Unexpected Migraine Treatments

Even when you feel like you’ve tried everything, there’s almost certainly more out there. This is something I’ve been posting about and e-mailing people a lot lately. Without knowing everything they’ve tried, it’s hard to point someone in the right direction.

Top 10 Unexpected Migraine Treatments, a HealthTalk webcast scheduled for Wednesday, April 18 will get to right to the point. Guessts will be Brian D. Loftus, MD and John Claude Krusz, MD PhD.

In the meantime, here are some other resources:

A fairly comprehensive list of available preventive and abortive medications, including some of the newer ones, like Lyrica and Cymbalta. (These websites describe the drugs, but don’t talk specifically about headache. They are both prescribed off-label (read comments at this link) as Topamax was for a long time.)

The National Headache Foundation‘s podcasts: The Condition of Migraine, Symptoms and Triggers, Migraine Treatments, Latest Migraine News and Information. It’s good stuff, particularly the one on migraine treatments (not surprising, huh?).

The American Council for Headache Education has a collection of articles on treatment (the second heading on the page). They cover a wide range of topics, but some of the articles are old. If something catches your eye, I recommend doing some further research on the topic. I’m happy to answer questions when I can.

The World Headache Alliance also covers various treatments. Most topics are supported by recent research. Non-Pharmacological Therapies. The Treatments section covers a huge variety of topics. They include studies that contradict each other, which is good to get both sides. Check out the news section, too.

Sorry for such a link-heavy post!

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More News Than You Want to Read

I’ve attempted to gather the news I’ve missed, but articles are surely missing. If you know of something, please post a comment with a link to it if you have it.

Under each heading the articles are vaguely ordered by relevance.

Research
Acupuncture May Ease Impact of Headaches
Adding acupuncture to standard medical treatment may improve the quality of life for people who suffer from frequent headaches, according to a new study.

Botox May Ease Facial Pain: Benefits Lasted for 60 Days in Small Study
A shot of Botox may ease a type of facial pain called trigeminal neuralgia, doctors report.

Pain Affects Black Women More Intensely
The far-reaching effects of chronic pain may be worse for black women than they are for white women.
(via Kevin, MD)

Websites Bolster Chronically Ill
Using interactive websites can help people with long-term conditions that include depression, heart disease and HIV/Aids, a study has found.
(via Medical Humanities)

Drugs
Eli Lilly Expands Cymbalta Liver Warning: FDA
Eli Lilly and Co. has expanded its warning about possible liver-related problems with its depression drug, Cymbalta, and cautioned doctors against its use in chronic liver disease patients, U.S. health regulators said on Monday.

EU Body Gives Old Pain Drugs Clean Bill of Health
Europe’s drug watchdog said on Monday it had no new safety concerns over older pain medicines like ibuprofen and naproxen, following an extensive review of side effect issues.

Another Way to Cut Drug Costs: Split Pills
Smart shoppers can’t resist a two-for-one sale. But should you purchase prescription drugs the same way you buy pizza or canned corn? For years, people who take daily medications have saved money by asking their doctors to prescribe pills with double the dose they need, which they then cut in half with a knife.
(via Kaiser Network)

Pain Meds Scarce in Black Neighborhoods: Study Finds Medicines Understocked
Pharmacies in black neighborhoods are much less likely to carry sufficient supplies of popular opioid painkillers than those in white neighborhoods, a new study has found, leading researchers to conclude that minorities are routinely undertreated for chronic pain.
(via Kevin, MD)

PhRMA Lawsuit Challenges D.C. Rx Drug Price Control Law
The Pharmaceutical Research and Manufacturers of America filed suit against the Washington, D.C., government last week alleging that a new price-control law on prescription drugs will cut supplies, hinder development and cause a “limitless parade of lawsuits.”

Drug Panels ‘Have Financial Links’
Doctors around the world are being advised to prescribe specific drugs by experts with close financial links to the pharmaceutical industry, it has been claimed.
(via Kevin, MD)

Healthcare Costs
Is Complementary Medicine Cost Effective? BMJ
The cost-effectiveness of using complementary treatments in the United Kingdom has been the subject of much speculation and controversy.
(via Kevin, MD)

Treated for Illness, Then Lost in Labyrinth of Bills
When Bracha Klausner returned home after an extended hospital stay for a ruptured intestine three years ago, she found stacks of mail from doctors and hospitals waiting for her.
(via Kevin, MD)

Dying to Pay, New Bankruptcy Laws Hurt Seriously Ill
New bankruptcy rules that went into effect on Monday, don’t just affect those who’ve run up their credit cards due to poor spending habits.

They also affect people who have little choice about their cash flow, people who’d give anything ‘not’ to be in the situation they’re in.
(via Kevin, MD)

Insurance
Workers May Be in For Health Plan Sticker Shock
USA Today on Friday examined the shift toward higher employee contributions to health care costs as employers try to curb their health care spending. According to USA Today, employers are utilizing various methods, including coinsurance, restrictions on prescriptions, high-deductible plans and wellness incentives.
(via Kaiser Network; quote from USA Today Examines Rising Health Insurance Premiums, Out-of-Pocket Costs for Employees)

Wall Street Journal Examines UnitedHealth Group’s Move to Consumer-Driven Insurance Plans
The Wall Street Journal on Monday examined Minnesota-based UnitedHealth Group’s move to “so-called consumer-driven health care” in the face of “steadily eroding business” as a traditional health insurer. Consumer-driven plans are based on the idea that people will consider health care spending more carefully if they have to pay a larger proportion of the cost themselves.

High Deductible, High Risk: ‘Consumer-Directed’ Plans a Health Gamble
Elizabeth Fowler can be called an educated health care consumer: An expert on health care policy, she used to be the chief health and entitlements counsel for the Senate Finance Committee. But she was pushed to the limits of her knowledge and patience keeping track of her so-called consumer-directed health plan — a type of insurance designed to protect consumers from catastrophic medical costs while prompting them to shop wisely for routine care.
(via Kaiser Network)

Policy
Canadians Still Waiting: 18-week Delay for Medical Care Reduced by a Day
Large increases in health-related spending have only marginally reduced the waiting times for medical services in this country from record-high levels in 2004, a new report says.
(via Kevin, MD)