First off, I’m going to agree that switching up meds if something is working is a risky strategy at best. That being said, I am the kind of person who doesn’t believe in settling either, so I think there are options. I believe you should be able to try out topamax without actually changing your current medications.
You can most definitely take topamax concurrently with nortriptyline. I am actually doing it. I am in the process of weening myself of nortriptyline at the moment. Tonight in fact is my last night at 50mg. I go down to 25mg for another few days and then I’ll be off it entirely. I was at 100mg 10 days ago. I’ve been on it at varying doses between my starting dose of 10mg and my max dose of 150mg since about last Octorber. I thought it might be helping, but ever since the Topamax kicked in, I think any help it was giving me was either minimal, or was just from me learning my triggers and avoiding them. I’ve noticed 0 increase in symptoms as I’ve backed the dosage down from 100 to 50. Hopefully I’ll continue to notice no change from 50 to 0.
I don’t know if you can also take topamax with verapamil but I suspect you can. They do entirely different things. Probably paxil too, though I know less about paxil.
So the way it would work would be you would add topamax to your existing cocktail. Hopefully what you would see is that your existing symptoms would either stay the same or improve (other than the expected dizziness that seems to occur for 5 days or so with almost everyone who starts up or changes dosages of topamax) but the topamax might help to counteract some of the weight gaining properties of the nortriptyline and paxil.
Here’s where you could then choose to be brave. If your symptoms seemed to be ok, you could then see if you could back off of some of the other medication and see if the topamax was keeping the symptoms in check. Obviously you wouldn’t know if this was working or not until it wasn’t, so that’s a big risk. That’s kind of what I’m doing right now, except that since my symptoms didn’t go away until after I was ON the topamax, all I’m proving is that it isn’t the combo of the topamax and nortriptyline that is fixing me. And since there hasn’t really been anything to suggest that there is some magic combo of topamax and nortriptyline helping tons of people out there, I’m not expecting to find that to be true with me.
So I guess you could go into it just trying it out to see if it helps with the weight gain, and then decide down the line if you want to drop other medications. If it makes you feel BETTER, then I think dropping other medications becomes an easier decision. For example, at one point I thought the nortriptyline might be making me 30% better. Now that I am on the topamax, I realize that it was more like 10%. It was almost negligable improvement compared to what I have received from the topamax. But that is just me–everyone responds to different medications in different ways, and I think topamax has more serious side effects than anything you are currently on.
I’d be interested to hear what your doctor has to say, given that I’m pretty much just pulling all of this out of my *** based on my very limited personal knowledge from my last year of dealing with this crap.