Effexor question/ Dr.Hain

Recently I had a flare up and unfortunately didn’t get support/guidance from my otologist. So, I stared searching the forum and web again, looking for some answers.
I’m on klonopin, started by my initial neuro-otologist, and have weaned back from his prescribed dose of 3 mg/day to 2 mg/day, but haven’t been able to go lower, despite wanting to get down to 1 mg/day.
I read Dr. Hain’s page on migraine, and was intrigued with his use of effexor, especially with his thought that it helps with people who are visually triggered/ or over dependent on vision.
I just couldn’t understand how, with the short acting form available as 25 mg, but the XR as 37.5, you could start the 12.5 he recommended on the page. I wrote and asked, and he wrote back that either half of the generic short acting effexor 25 mg, or spilll out half to 2/3 of the long acting 37.5 capsule (which isn’t generic yet.)
What a great site, and what a helpful, kind person.
I’m orignally from Chicago, and I live near Boston now, but if I was in Chicago, that’s who I would see.
dizziness-and-balance.com/di … e/mav.html
dizziness-and-balance.com/di … RAIN6.html
dizziness-and-balance.com/di … visual.htm

It was so upsetting to take a turn for the worse, and it’s so helpful to get some information about a possible treatment that might be helpful for the furture. I’m scheduled to see the otologist in 2 weeks, but just in case, I’m scheduled to see my ENT shortly afterwards (and he’s much more willing to help on a daily basis.)
Kira

Hi Kira, thanks heaps for the links, they’re great. I found my latest med, metapropol listed as a beta-blocker. I’ve just hit my full strength prescription and should see how it goes over the next 4 weeks. Only problem is, I had a setback too, with stress being the trigger (son dislocated shoulder!!) so I’ve suffered for a week (starting 2 wks ago) with dizzies and nausea and then the past week, rather strong, but not immense migraine headaches. I also take klonopin and sandomigran, so if the metapropol helps, I can start reducing the sandomigran as I can’t stand the weight gain. The links are really informative and give hope that these meds really can help! :stuck_out_tongue:
regards judy (ps: this information is so good as it gives me something to take to the table when I see my neuro every 4 months. Because I’ve had the condition for the past 2 years, he’s more than willing to talk to me about the issues I’ve raised and I feel much more informed and not left in the dark!)

I agree completely, it is important to have something to take to the table. When I told my oto-neuro what Dr. Hain emailed me the preventatives he was using: (80% of his practice being Topamax and Effexor, the other 20% being verapamil with occasional Neurontin), my doc said that he trained with Tim Hain, had the highest respect for him and was willing to incorporate anything he was doing into his own practice. My doc would never have considered effexor if i hadn’t researched for that info myself.

This is one of the many reasons this forum is so helpful. Docs all seem to have their favorite short lists and who are we to tell them different.

Julie

I just started Effexor after noticing it on Dr Hain’s site also … I was surprised when someone mentioned here that Effexor and Topamax made up 80% of his treatment for migraine-associated vertigo.

I did as suggested - I used XR and poured out two thirds of the capsule and swallowed the capsule with the remaining third in it.

I’m feeling a bit nauseated and more dizzy, but I expected that. I’ll give it a good run for a few weeks.

Before the possible fistula issue came up, Dr. Hain did mention that the next step in my treatment----should I fail on verapamil—was indeed low doses of Effexor.

One of the interesting things about Effexor is that it was recently deemed to be a very inadequate treatment for depression, which is it’s “on label” use. It will be interesting to see if the “off label” use----for migraine—now becomes the dominant/most common use in prescriptions.

I think there have been FDA concerns about effexor with overdose, high blood pressure and withdrawal syndromes too. An interesting note: a patient with neurocardiogenic syncope failed her tilt table test, and the cardiologist sent back a note to start her on paxil. So I called him and asked why, and he said they weren’t sure why it worked, but somehow through the autonomic nervous system and neurotransmitters, but they were finding the SSRI’s helpful for patients who pass out when they stand up.

I read a NE Journal review article that said that the effectiveness of SSRI’s for depression was 50% with any given drug.

So, maybe their off label uses are going to be increasingly important.

I’ve been doing some internet searches again, and I knew that Furman (a psychiatrist from U of Pittsburgh who calls MAV=MARD, migraine assoicated anxiety and dizziness, when you’re a psychiatrist, everyone has a psychiatric problem) likes zoloft for MAV. So does Larry Newman at the Headache Institute at St Lukes-Roosevelt in NYC. In a google search I found a link to a pdf article on SSRI’s for MARD, and they found them effective, but said to start low, go slow. Very low doses with slow titration.

archotol.ama-assn.org/cgi/conten … /128/5/554
Serotonin Reuptake Inhibitors for Dizziness With Psychiatric Symptoms
Jeffrey P. Staab, MD, MS; Michael J. Ruckenstein, MD; David Solomon, MD, PhD; Neil T. Shepard, PhD

Arch Otolaryngol Head Neck Surg. 2002;128:554-560.

Objective To investigate the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) for the treatment of patients with dizziness and major or minor psychiatric symptoms, with or without neurotologic illnesses.

. Before being treated with an SSRI, two thirds of the study patients took meclizine hydrochloride and/or benzodiazepines, with minimal benefit.

Conclusions Treatment with SSRIs relieved dizziness in patients with major or minor psychiatric symptoms, including those with peripheral vestibular conditions and migraine headaches. Patients fared far better with SSRI treatment than with treatment with vestibular suppressants or benzodiazepines.

Kira

Adam,

I’m the one who got an email from Hain about what his top choices are. He goes for Topamax first, then Effexor = 80%. The rest is verapamil with occasional Neurontin. He found Lyrica and Keppra of little benefit.

Good luck on your Effexor and please keep us posted on how it works… The nausea will go away and you have to take it with food. My friend who takes it for hot flashes says that it made her racy the first couple of days, then very calm. I did some research - it hits seritonin receptors at low doses; at higher doses it hits norepinephrine; at even higher doses it hits dopamine receptors.

Kira,

GREAT research - thanks. I have a niece who failed her tilt table test. She has fainted so many times, she’s had one concussion already. She also suffers with migraines and dizziness. i’ll pass this info on to her.

Julie

— Begin quote from "kira"

I think there have been FDA concerns about effexor with overdose, high blood pressure and withdrawal syndromes too. An interesting note: a patient with neurocardiogenic syncope failed her tilt table test, and the cardiologist sent back a note to start her on paxil. So I called him and asked why, and he said they weren’t sure why it worked, but somehow through the autonomic nervous system and neurotransmitters, but they were finding the SSRI’s helpful for patients who pass out when they stand up.

I read a NE Journal review article that said that the effectiveness of SSRI’s for depression was 50% with any given drug.

So, maybe their off label uses are going to be increasingly important.

I’ve been doing some internet searches again, and I knew that Furman (a psychiatrist from U of Pittsburgh who calls MAV=MARD, migraine assoicated anxiety and dizziness, when you’re a psychiatrist, everyone has a psychiatric problem) likes zoloft for MAV. So does Larry Newman at the Headache Institute at St Lukes-Roosevelt in NYC. In a google search I found a link to a pdf article on SSRI’s for MARD, and they found them effective, but said to start low, go slow. Very low doses with slow titration.

archotol.ama-assn.org/cgi/conten … /128/5/554
Serotonin Reuptake Inhibitors for Dizziness With Psychiatric Symptoms
Jeffrey P. Staab, MD, MS; Michael J. Ruckenstein, MD; David Solomon, MD, PhD; Neil T. Shepard, PhD

Arch Otolaryngol Head Neck Surg. 2002;128:554-560.

Objective To investigate the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) for the treatment of patients with dizziness and major or minor psychiatric symptoms, with or without neurotologic illnesses.

. Before being treated with an SSRI, two thirds of the study patients took meclizine hydrochloride and/or benzodiazepines, with minimal benefit.

Conclusions Treatment with SSRIs relieved dizziness in patients with major or minor psychiatric symptoms, including those with peripheral vestibular conditions and migraine headaches. Patients fared far better with SSRI treatment than with treatment with vestibular suppressants or benzodiazepines.

Kira

— End quote

It looks like it’s going in that direction. It will be interesting to see how this shakes out in the next 1 to 2 years.

I saw the announcement about Effexor on a news program early one morning in the gym about a 4-6 weeks ago.

I just wanted to thank everyone in this group for all the information and support. Two things: I was reading the sports page (don’t ask me why…) and a golfer was talking about his bouts of nystagmus that are forcing him to stop playing and how no one is able to figure them out or treat them. Sounds familiar.
I finally reached my ENT, and he prescribed zoloft–I’d rather try effexor, but I take a low dose of biaxin for chronic sinusitis, and it has been remarkably effective, and it’s a drug interaction with effexor (could cause heart irregularities). I didn’t pick up the prescription yet, but will.
I’m still really unsteady, but only at work–in the windowless, airless offices. I get through the day by sitting down a lot. I found Dr. Hain’s comments about patients with MAV and how long their symptoms can last validating. It is getting better, so part of me wants to leave things alone, and the other part wants to get better and not be waiting for the next flare to occur.
I work in medicine, and two women I saw yesterday are having seasonal flares of their vertigo. Hmmm. One woman was having Raynaud’s from her atenolol, but because it “cured” her MAV, she doesn’t want to give it up.
Julie, thanks for your information on the zoloft–I had to convince my ENT that it could help, and I’ll see him in a couple of weeks to review the reasons why. I do have an otology appointment next Friday, and despite his lack of support recently, I just want to get information–if he has any beyond what I’ve learned here. I do get some postural symptoms as well, so the zoloft just may be the right med to try. And it is all trial and error.
Adam, I hope the effexor is helpful. Please let us know.
Kira

Kira,

Seasonal flares of vertigo - Ugh! I get a horrible increase in symptoms during allergy season - i really dread seeing those spring fruit trees bloom :frowning:

I’m not sure if i mentioned, my oto-neuro said i wouldn’t see any relief until I hit 75 mg of Zoloft. As always, the proof is in the pudding - i started to feel relief at more like 6 mg.

Good luck - you sure have done your home- and leg-work.

Julie