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The Current Silence

Between the excellent American Headache Society symposium, the American Headache and Migraine Association patient conference, and some exciting new discoveries about my health, I have a ton I want to share with you. Unfortunately, one of the complications of my current regimen is an extreme susceptibility to medication side effects. In particular, Wellbutrin (which is definitely helping my depression) is making me dizzy and the dizziness is exacerbated by looking at screens. It’s a short-term issue, but one that’s keeping me from writing about all these topics I’m so eager to tell you about.

I’ve received worried messages from readers, so I wanted to let you know that I haven’t been overtaken by horrendous migraines or depression. I’m actually in good spirits and feel like I’m on the verge of uncovering a new course of treatment, but getting to that point requires traversing a very bumpy road. I’ll be writing as much as I can as soon as I can.

I hope you’re enjoying the holiday season and doing as well as possible. xoxo

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Taking Antidepressants: An Act of Radical Self-Care

I resisted going off the supplement that was causing depression-like symptoms, then I resisted starting antidepressants when I realized the depression hadn’t lifted. I told myself I didn’t want the side effects of antidepressants or to complicate my migraine variables. Those excuses are partly true, but mostly I didn’t want to acknowledge that I’m depressed enough to require medication.

The day I started back on Wellbutrin, my mood lifted. The antidepressant medication didn’t change my mood in a single day; the decision to take care of myself did. I don’t want to be depressed, but wishing it away is a fruitless endeavor. Instead of continuing to hide from the truth, I both recognized and accepted the depression and chose to treat it in the only way that’s ever been effective for me.

I am not out of the woods. It will take weeks to ramp up to a full dose of Wellbutrin and could take even longer to know how well it’s working for me. If it doesn’t, I could spend months trying to find the right medication (or medications) and dose. As I’m figuring all that out, I can take comfort in my decision to start taking antidepressants.

Self-care often falls by the wayside when a person is depressed. It doesn’t help that depression saps one’s motivation and hope. Overcoming all these factors makes for a gigantic first step. I’m proud of myself for taking it.

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Depressed. Again.

Maybe the 5-MTHF was the depression trigger, but it was presumptuous to conclude the supplement was the only factor for my depression. I felt great for a few days after discontinuing 5-MTHF, then the depression returned, building each day until I awoke at 4 a.m. Monday morning to suicidal ideation. Don’t worry, suicide is not on my agenda and I’m fully aware these are not my own thoughts, but are fueled by depression. I’m not going anywhere, but it’s still terrifying to have these thoughts pop into my head.

So, after slowly tapering off antidepressants over three years, I’m back to them. I haven’t started any yet, but I’ve requested a Wellbutrin prescription from my therapist/naturopath (fortunately, naturopaths have full prescribing rights in Arizona). I chose Wellbutrin because it has fewer sexual side effects than other antidepressants, it has been effective for me in the past, and it’s relatively easy to taper off when I’m ready to stop taking it.

Even yesterday I was resistant to starting another antidepressant. It’s not that I’m against medication, but I don’t look forward to adding any more side effects to my life and I’m already juggling so many migraine-related variables that I’m reluctant to add one more factor to the mix. Still, the constant teariness and feelings of hopelessness, not to mention suicidal ideation (which hasn’t happened since Monday morning), aren’t doing me any favors.

I’m a little quieter than usual and now you know why. Contrary to my typical depression pattern, I’m still writing a lot of drafts, though getting them to a publishable state is beyond my current ability. I’m sad and frustrated and in a mental fog, but I’ll be OK. I’ve been through much worse depression before and feel fortunate to have caught this one fairly early. I’m also grateful to have an excellent therapist to help me this time around. Please don’t worry about me, though I always welcome your good thoughts, positive energy, prayers, or whatever it is you offer to others in times of need. I really will be OK, I just need some time — and some drugs — to get there.

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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?