As a comparison, I saw significant benefits from Amitriptyline within 3 days! Within 2 weeks that was very significant. (Still not silver bullet though: it all but eliminated migraines but not vestibular attacks). Appreciate itās very personal.
One of the tricyclics is next for me if this doesnāt work out. I think Effexor is slightly favored over here by doctors due to the comparatively good side effect profile
2 Likes
Depends which doctor you speak to? Venlafaxine is harder to wean off of.
The only lasting (whilst on med) side effect for me was slow bowel. My friend on venlafaxine had that so bad she ended up having a gastroscopy! (An entirely unnecessary one I might add: the doctor was clueless about SNRIās) So pick your poison!
1 Like
statistically, tricyclics have a significantly worse side-effect profile. Iāve heard that weaning off venlafaxine is hard, but its nothing compared to more addictive substances like benzos and opioids. probably the most extreme ssri/ssnri drug withdrawal
venlafaxine is probably more uncomfortable but none of the side effects are potentially medically dangerous. tricyclics are probably easier on the patientās experience of the drug, but there is appreciable risk of cardiac side effects, and weight gain.
they are probably very even overall when it comes to a side by side comparison, but based on everything iāve read so far, venlafaxine is clean when it comes to side effects and might be slightly more effective, but it all depends on the individual.
pick your poison sounds right!
1 Like
Source please. I think thatās a very controversial statement.
Tricyclics are extremely old, so thereās a lot of experience with them and generally well tolerated.
1 Like
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630974/
Tricyclics are first generation antidepressants. Although effective, we developed other drug classes down the road because of the side effect profile
2 Likes
Couple of issues with that source:
-
This is about vestibular health, not depression!! Tricyclic anticholinergic effects (marked here as a āside effectā) are often desirable in patients with dizziness as they constitute a vestibular suppressant. This aspect was very helpful for me. The ācardiotoxic SEā have been recognised for a long time and as such those drugs are not prescribed to people who are susceptible to that issue. Nausea SE is dubious as reported here: Amitriptyline is often prescribed precisely to get rid of the nausea and it was excellent in this respect for me. Most importantly: you donāt take TCA in anything like the doses you do for depression (e.g. ~20mg nocte versus ~10x for depression!!), so a lot of these āissuesā are a complete non-issue! (especially when you get used to the drug after a few months).
-
The list of SEās for SNRIās therefore appears longer?
James I think youāre misunderstanding what Iām trying to say. When physicians prescribe these medications, theyāre balancing risk and reward.
Itās not about which side effect list is longer or shorter but rather which drug has the highest potential return on investment for the lowest danger to the patients health. Itās not even about which drug has the best experience for patients (all you have to do is look at the reviews for both of these drugs to figure out which is the clear favorite, and itās not venlafaxine)
These drugs are all used off-label for MAV, so unfortunately most if not all the literature for side effect profiles has to do with what the drugs were originally approved for. You can do a literature search yourself and come up with the same conclusion.
Iām thrilled for you that you had such a good response to amitriptyline, but here Iām talking about the complete ensemble of data instead of individual experiences.
When it comes to physicians preference of Effexor over tricyclics, itās probably because they have equal efficacy while the (small) risk for potential dangerous side effects do not exist. Thatās all Iām saying. Itās a risk calculation that slightly favors venlafaxine, but if patients experience dictates otherwise, they can easily just use the other drug.
1 Like
But your ādataā(?) is for ādepressionā
What risk ācalculationā? I see no calculation here for patients suffering with vestibular complaints.
Iām also not saying that one drug is better than the other! More to explain why physicians have preferences of one over the other.
I wanted to start with Nort, but I was told no. I understand why, but that was my preference
1 Like
As I explained, the literature is sparse for off-label use, but if you want data spelled out in the gold standard of drug-comparison, you can see the below randomized trial which discusses my exact point that although same in efficacy, venlafaxine has a slightly better side effect profile when it comes to comparison against TCA.
https://www.sciencedirect.com/science/article/abs/pii/S0303846722000324
2 Likes
But this is not migraine, this is at best āvestibular migraineā, which is not the same thing! The vestibular aspect cannot be ignored. They may have completely different aetiologies.
The dosages are the same. I really donāt know what to tell you other than to dig around for yourself. You seem to have a really heavy bias towards amitriptyline because youāve been on it, which is great. Again Iām happy for you.
Itās okay that amitriptyline has a worse side effect profile! Thatās not taking away from your experience nor is it saying that itās a worse drug! Itās just something that has to be considered when a prescription is written
1 Like
Iām concerned at you saying things like this:
without data. Taking ~30mg of amitriptyline is very unlikely to be risky!
I sourced the data. You just didnāt like the source.
If 30 mg is unlikely to cause side effects i actually think the onus is on you now to produce data that backs that claim up.
30 mg is a dose thatās close to the one that was included in the clinical trial that I referenced, and it had a higher adverse effect rate.
1 Like
Because itās totally inappropriate for the level of dosage involved and the condition itās treating.
Itās completely appropriate to use a side effect profile that was developed through clinical trials for prescription decision making, even if it was for another disease. The second source I listed includes the dose range that you want, which is 25 mg and still had a higher side effect rate.
Iām not responding to this topic anymore and requests to cherry-pick data, because I think the literature stands for itself!
1 Like
Thatās not how I see it. Whilst the dosages of the second reference are much more inline with treatment for MAV/VM, again, it mentions the SF due to anticholinergic effects, which as I pointed out are actually a potential benefit for vestibular patientsā¦
Iām not arguing that Venlafaxine canāt be effective for people, and Iām not suggesting that Amitriptyline is the better drug, but Iād like to see a directly applicable study for MAV/VM specifically. It surely must exist, because I agree, that many US doctors seem to favour Venlafaxine (but sometimes medicine goes through fashions ā¦). My main concern was your statement āstatistically, tricyclics have a significantly worse side-effect profileā. If data exists for that against benefits of symptom reduction (because that really matters too) all round for MAV/VM then please share that.
Letās take a break from this debate, the topic will automatically re-open.
This topic was automatically opened after 4 days.