Post Clinic Notes - Dr. Baloh

I have my post clinic notes from my most recent visit with Dr. Baloh.

I have scanned the file to create a PDF.

I wanted to share the info with everyone to see if it may help them.


How are you feeling on the Celexa increase?

No changes…I have been on Celexa at 40mg for about 2 1/2 weeks.

Don’t really know the timeframe of when I would start to notice changes?


I think you have been on Celexa, in some amount, for over 4 weeks…usually 4-6 weeks is a good time to judge, although people will say it has to be 4-6 weeks at the right dosage…
No improvement?
Have you had any side effects?
Personally, Celexa didn’t do much for me, and my doctor (the latest of many) says that if you hit the right neurotransmitter med, you will feel it quite fast…which has been true with me. Even though Baloh knows his stufff, he can’t look in your brain and see what YOU need vs. the whole lot of us…so I wouldn’t be remiss to change paths if you don’t get any relief at all…just sayin… :slight_smile:

I wonder if it makes a difference if you consider the condition it’s prescribed for - I’m aware that when taken for depression or anxiety you can expect to see results when you’ve been on a therapeutic dose of Celexa for 4-6 weeks. I know that when I started Topamax I was told not to expect results for about 3 months. That’s a different medication entirely, but maybe when Celexa is given for our condition, perhaps the results may not be seen as soon? Just wanted to toss out that thought.

Todd –

Thanks a million for doing this. It’ll be VERY helpful for lots of people. Send me the PDF and I’ll upload it to the mvertigo “vault” and then give you the link or I’ll just add it to your first post. Just let me know how you’d like to post it.

Scott 8)


Thanks so much for sharing your clinic notes. I found them very interesting to read. So disappointing that you were previously diagnosed and surgically treated for Meniere’s. For something so rare it seems like a lot of doctors are over diagnosing it instead of migraine, which is extremely common and does not require any surgical intervention. Grrr.

Proud of you for being so well nourished and well dressed. You’re a credit to yourself and the migraine community :smiley: .


I’ll chime in and say thank you very much as well - your notes were a good help for me in thinking about making my notes for my appointment in a few weeks

Todd –

Yes, it sucks that you were injected with gent BUT as Baloh notes, you have compensated as anyone would expect following a vestibular lesion. Just think of it as a doctor-induced labyrinthitis for which you have now gotten over. The only thing holding you back now is the migraine activity and you’re onto it.

Here’s the gold nuggets I liked reading:

– there is a longstanding history of motion sensitivity (would include car sickness as a child no doubt).
– a family history of migraine exists.
– acute and chronic anxiety (common for us lot).
– this type of continuous dizziness IS A COMMON MIGRAINE VARIANT along with longstanding motion sesnitivity.
– anxiety disorders run together with chronic dizziness in an autosomal dominant (genetic) fashion.
– in some men, headaches DO NOT meet the criteria for migraine, but motion sensitivity is prominent.

That last point really hits home for me. We deal with headaches and “neck migraine” but most don’t recognise this as migraine.

Again, great info amigo.

Scott :slight_smile:

I liked the "well nourished’ comment from Dr. Baloh’s notes as well.

In other words, he is saying…“Mr. Seiger has enjoyed multiple burgers, fries, and shakes during the winter months to help insulate him against another very chilly winter” :smiley:

LOL. Yeah, that gave me a chuckle. :lol:

Does anyone know what Dr. Baloh means by:

**1) Other selective serotonin reuptake inhibitors?

  1. Tricyclic amines?**

Specifically, what medications is he referencing? What dosages do these tend to be at for effective control?



Hi Todd,

Scott or Dr Kelley (mvertigo’s resident pharmacologist) will be way more help here but this is what I know (with substantial Wikipedia help).

SSRIs are anti depressants. Wikipedia says:

*SSRIs are believed to increase the extracellular level of the neurotransmitter serotonin by inhibiting its reuptake into the presynaptic cell, increasing the level of serotonin in the synaptic cleft available to bind to the postsynaptic receptor. They have varying degrees of selectivity for the other monoamine transporters, with pure SSRIs having only weak affinity for the noradrenaline and dopamine transporter.

The term SSRI is somewhat of a misnomer, coined by the pharmaceutical companies who developed these drugs. Rationally, they would be referred to as SRIs, as dopamine reuptake inhibitors and norepinephrine reuptake inhibitors are referred to as DRIs and NRIs respectively, regardless of their selectivity.*

And here is a list of common SSRIs:

*List of SSRIs
Drugs in this class include (trade names in parentheses):

citalopram (Celexa, Cipramil, Cipram, Dalsan, Recital, Emocal, Sepram, Seropram, Citox, Cital)
dapoxetine (Priligy)
escitalopram (Lexapro, Cipralex, Seroplex, Esertia)
fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem, Ladose, Motivest, Fluctin (EUR), Fluox (NZ), Depress (UZB), Lovan (AUS))
fluvoxamine (Luvox, Fevarin, Faverin, Dumyrox, Favoxil, Movox)
indalpine (Upstene) (discontinued)
paroxetine (Paxil, Seroxat, Sereupin, Aropax, Deroxat, Divarius, Rexetin, Xetanor, Paroxat, Loxamine)
sertraline (Zoloft, Lustral, Serlain, Asentra)
vilazodone (Viibyrd)
zimelidine (Zelmid, Normud) (discontinued)*

Tricyclics are the older class of anti depressants and are considered not actually that good for depression but quite effective in treating migraine, including as a prophylactic. In Australia Prothiaden/Dothep is what Dr Halmagyi uses. Here, courtesy of Wikipedia is a list of some others.

*[edit] List of TCAs
The TCAs include the following agents which are predominantly serotonin and/or norepinephrine reuptake inhibitors:

Amitriptyline (Elavil, Tryptizol, Laroxyl)
Amitriptylinoxide (Amioxid, Ambivalon, Equilibrin)
Butriptyline (Evadyne)
Clomipramine (Anafranil)
Demexiptiline (Deparon, Tinoran)
Desipramine (Norpramin, Pertofrane)
Dibenzepin (Noveril, Victoril)
Dimetacrine (Istonil, Istonyl, Miroistonil)
Dosulepin/Dothiepin (Prothiaden)
Doxepin (Adapin, Sinequan)
Imipramine (Tofranil, Janimine, Praminil)
Imipraminoxide (Imiprex, Elepsin)
Lofepramine (Lomont, Gamanil)
Melitracen (Deanxit, Dixeran, Melixeran, Trausabun)
Metapramine (Timaxel)
Nitroxazepine (Sintamil)
Nortriptyline (Pamelor, Aventyl)
Noxiptiline (Agedal, Elronon, Nogedal)
Pipofezine (Azafen/Azaphen)
Propizepine (Depressin, Vagran)
Protriptyline (Vivactil)
Quinupramine (Kevopril, Kinupril, Adeprim, Quinuprine)*

The therapeutic dosages is different for all of these meds and for each individual. Additionally the therapeutic dose for migraine may be different to the dosage for depression, anxiety or any other label or off label uses.


Hey Everyone,

I haven’t been on the forum for a while …

I saw the thread and just wanted everyone to know here that I’m currently taking 40 mg of Celexa and feel 50–-60% better most days. However, in the past couple of days it’s been getting worse. I’m experiencing some anxiety at the moment, and I think it’s from feeling off balance. I also drink a glass or two sometimes … maybe not the best idea. How many people here still drink while being on the meds?

By the way, how are you doing Scott? Miss you man… 8)


yep - still drinking (white wine only) and still managing 80-85% most days :smiley:

Me thinks you are trying to strip me of my Title! That was quite the response…way better than I would have done. I guess I’ll have to stick with “RDM”…Resident DRug Mule…oh wait…that’s you!! LOL

I think I might hand Vic the administrator role as well … she blew me out of the water with that one! :lol: