GP starting me on riboflavin, then nortriptyline

Medication 💊 Antidepressants
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My family-practice doctor–who seems still unconvinced that my dizziness is from migraine–wants me to start 400 mg riboflavin for a few days, then if all seems well, start nortriptyline.

We did discuss Effexor after I brought it up, but since I am already on an SNRI (Strattera, for 7 years now), I was heading the discussion toward just adding an SSRI (thanks Kelley :). He looked up migraine preventives in his Kaiser database and we settle on the plan mentioned above.

I am going to start another thread on HOW to get your doctor to believe you can have MAV without (significant) headaches!? They’ve never heard of it…

I am extremely sad this afternoon because at the appointment, the doc told me he is leaving Kaiser (here in Portland), moving back home to Nebraska. I was devastated, even though I knew something like that could happen. I guess he’s moving back for family reasons, but Kaiser is just pushing the docs too hard, making them see too many patients. My folks’ longtime doctor quit Kaiser for that reason, and then their new one quit in short order, too!

This was the first GP I’ve ever had who really listened to me seriously and never got that smug look that says to the middle-aged woman with lots of complaints “yeah, yeah, yeah, anxious hypochondriac, I know all about you, my mind’s made up, don’t confuse me with the facts…” After many years of seeing doctors for dizziness and weird neuro symptoms, being dismissed or left hanging with no interest, I felt horribly depressed and conflicted, knowing that something was wrong but knowing that if I tried to talk to the doctors about it, I’d (sooner or later) get dismissed and incorrectly labeled. For years it felt like I had rocks in my stomach even thinking about trying to talk to a doctor. This guy was totally different from day one and never “went bad” on me. I will miss him terribly, and will miss that feeling of “security” knowing that I have a doctor I can ask questions of without fear. I doubt there are more than a handful of doctors out there like him.

Of course I made an idiot of myself and started crying in the exam room; couldn’t help it, I was so shocked and disappointed. I honestly think I have PNSD (post-neurologist stress disorder; I made that up :)–just thinking about those psychologically devastating years, and how “unburdened” I felt when I got a doc who was different, can cause a terribly emotional reaction in me. I’m OK tonight, just very sad.

Sorry for the somewhat OT rant…

Nancy

Such is life; sigh.

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Hey Nancy,
Here is the irony…Effexor only hits serotonin at the level that is the target point for MAV…37.5mg (basically making it an SSRI at that dose. Nortriptyline hits norephinephrine right away, which you are already getting with STrattera…so the doctor may not really understand that. A GP has to know a lot about a lot of things, but a psychiatrist, a good one anyway, will know most everything about psychotropic meds…
I would suggest seeing a neurologist if possible, who specializes in migraine…doesn’t have to be MAV per se…
sorry you are losing some of your support system with that doctor…but maybe it will work out better in the long run…
best to you…
Kelley

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Uh-oh… thanks for the info, Kelley. I did not realize nortriptyline had an SNRI effect. I spent the hours before my appt. reading up on Celexa, as you’d suggested, but that wasn’t even on his med list, and I thought nortrip. was just serotonin so I thought I’ll try that, since he seemed amenable to it.

Well, I will give it a try and if it doesn’t work out I will ask about Celexa. Maybe I just need to get more aggressive in “educating” him and bring him some excerpts from Hain (although Hain seems to say little or nothing about Celexa). I tried such “education” a little bit when I asked him for a trial of atenolol two years ago–well, his computer says two years, I was sure it was last year…

Also I expressed to him my concern about the “multitude” of small lesions on my brain MRI, last one performed in January. Hain seems to think this can be a justification for preventive treatment. My GP didn’t seem to know that migraine can be associated with these spots. And I seriously would like to prevent further lesions in my brain. If migraine is the cause, let’s treat it.

Thanks for the info, Kelley. :slight_smile:

Nancy