Nortriptyline & Topamax

Hi…

Has anyone taken these two meds together? I am currently on 25 mg of Nortriptyline and having moderate success…still suffer from some dizziness and off-balance, but it’s less extreme than before. The problem is I can’t go up any higher…the bad symptoms set in, so my doc wants to try to add in Topamax at a small dose to see if that helps eradicate the rest of the symptoms. I’m curious to see if anyone else has taken these two together. He said he also may try me on Effexor if I can’t find anymore success with the Nort and Topa.

thanks,
Kim

That is the combination I am currently taking. Topamax 50 mg, nortrip. 20 mg (but to gradually increase the latter). If I’m going to be a nortrip. success story, it doesn’t look like it’ll be at 20 mg – though I’ve only been at that amount for two weeks.

I had almost no problems on Topamax, even when at 100 mg.

Thank you George! So, you said you’ve had no side effects from Topomax, but what kind of relief did you get from it?

Thanks,
Kim

Relief? Well, they say it’s associated with weight loss, and I did lose a few pounds – about £6 per refill, to be precise. At 100 mg, it also helped get rid of that irritating habit of speaking like a normal person.

But seriously, it didn’t seem to do any good, at least as a standalone drug. When I was on 100 (which you probably won’t do, since you said your doctor wants to do a small dose), I began having a little bit of speech hesitancy – I was thinking clearly but speaking with odd pauses here and there.

Dr Hain thought the Topamax/nortrip. combo would have better chances against my exceedingly stubborn migraine, because “now we’re hitting it on two different axes.”

Hi George,
Nice to see you on here. Anything getting better? How’s the Xanax situ? I wonder why hain says not to mix effexor with topamax but you can do nort with it? On his flowchart he says they are same somehow. It doesn’t make sense to me.
Kelley

Xanax is in a holding pattern. I reduced slightly (by 10%) and then decided to hold off on the reduction. Yes, if I was at zero, I’d know my “real” baseline (i.e, how much of my vertigo-like stuff was really the migraine, and how much was due to Xanax problems) – but then again, I’d also probably be going through the really nasty withdrawal ON TOP of MAV. So I figure I’ll try to get the migraine under control first, THEN deal with getting off Xanax.

I don’t “get” Hain sometimes. He’s head over heels for Effexor, which helps nobody, and calls the tricyclics “messy agents.” Yet if you look at “Success Stories,” there are nearly a half-dozen amitriptyline/nortriptyline success stories, and none for Effexor. I suspect the TCA’s are more effective and better-tolerated than many newer-generation antidepressants.

Hain says he’s “encountered a few patients who became severely depressed on topiramate – they were also on Effexor, so this may be a drug-drug interaction.” Lisa (MAVNY) pointed out that both drugs work directly on the CNS, making other combos a better first choice. But since nortrip. also affects the CNS, I guess Hain hasn’t had problems when combining that with Topamax.

(The odd thing about Effexor is that, if you ask me, it doesn’t really deserve to be classified as an SNRI, like Cymbalta et al. As I recall, you have to be on 75 mg of Effexor before it affects norepinephrine, while both nortrip. and Cymbalta, among others, affect both serotonin and norepinephrine “right off the bat,” so to speak. I suspect norepinephrine has more of a role in migraine than most of us think…)

— Begin quote from ____

I don’t “get” Hain sometimes. He’s head over heels for Effexor, which helps nobody, and calls the tricyclics “messy agents.” Yet if you look at “Success Stories,” there are nearly a half-dozen amitriptyline/nortriptyline success stories, and none for Effexor. I suspect the TCA’s are more effective and better-tolerated than many newer-generation antidepressants.

— End quote

I’ve often wondered the same thing George. I’ve never seen a hell of a lot of evidence (anecdotal reports) for Effexor whereas there’s been loads for the tricyclics. Yet Hain reports an “80%” success rate. Where? Mars? Perhaps in a small group of natives in the rainforests of PNG?

— Begin quote from "georgekoch"

I’ve often wondered the same thing George. I’ve never seen a hell of a lot of evidence (anecdotal reports) for Effexor whereas there’s been loads for the tricyclics. Yet Hain reports an “80%” success rate. Where? Mars? Perhaps in a small group of natives in the rainforests of PNG?

— End quote

I think he has some fallacious reasoning:
(1) This quote of his: “This antidepressant medication, of the SNRI group, is very effective and has relatively few side effects. (Diamond, Pepper et al. 1998; Nascimento 1998; Adelman, Adelman et al. 2000; Bulut, Berilgen et al. 2004; Ozyalcin, Talu et al. 2005; Tarlaci 2009).” In other words, he likes it because that’s what the research says. He also adds, “The other SNRI, Cymbalta (duloxetine) is minimally effective (Taylor et al, 2007).”

(2) The LINK to the migraine-prevention-drugs page is titled “Migraine Associated Vertigo,” but the actual PAGE is titled “Migraine Headache: Prevention.” He gives very little focus to these drugs’ effect on actual dizziness-like or vertiginous symptoms, instead focusing more on migraine preventatives in terms of their effectiveness in reducing headache frequency, visual dependence (sensory integration problems), and sensory amplification (e.g., photophobia).

In other words, I think he’s reporting results based on (1) what published research studies say – which we can be pretty sure only studied the drug’s efficacy on migraine headaches – and (2) success he has had with patients, but only within the context of a few certain symptoms – NOT whether or not the medicine was effective in the most significant areas, such as vertigo.

(Did that make any sense?)

Thanks George – I think you’re probably correct. Makes sense to me. S