Which SSRI part II?

Hi All,

I came across this study today on the use of paroxetine (Paxil in the US, Aropax in Australia) for migraine prevention. The study is not strong and it was open-label (everyone knew they were being treated with Paxil) which brings in all kinds of potential for placebo effect but thought it was worth a look nonetheless in light of someone else posting that their neurologist uses this SSRI for migraine. I know Molly experienced pretty good migraine control from this med too.

I may give this a shot next if the side effects from Effexor don’t clear … they’re back with a vengeance.

http://www.glycemicindex.com/sd/paxil_study.png

Full paper here:
http://www.glycemicindex.com/sd/paroxetine_migraine.pdf

Interestingly they say that Paxil treated migraine independently of its anti-anxiety effect (anxiolytic). Check this out:

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“[Paroxetine] is 22 times more potent than fluoxetine (Prozac), 7 times more than sertraline (Zoloft), and 80-100 times more than amitriptyline or imipramine, respectively … the reduction in anxiety level was not correlated with the reduction in the headache frequency. Accordingly, it is likely that at least two mechanisms contribute independently to the migraine-prophylactic and anti-anxiety effects of paroxetine.”

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Scott 8)

Scott, another good find! I was on paxil years about 11 years ago for unrelated anxiety (related to a horrible salmonella food poisoning event). I was only on it for a few months but during that time I did not have any migraines. I never really thought about a possible link until now. This was well before my current MAV issues but it is interesting. I am still hoping that Effexor works for you…Ben

Scott:

Dr Newman uses Paxil after Zoloft…I tried Paxil and after 3 days my anxiety was so high I went to the ER… everyone is different. For me Zoloft worked.

There used to be a guy on the health boards from NY that played squash not sure of the name but he was 100% on Paxil.

Very interesting. Thanks for the info. I look forward to asking Dr. Hain about SSRIs, as well as Effexor. I am beginning to think my most recent doctor, Dr. Buchholtz, author of heal your headache, was wrong that SSRIs cause increased migraines. I just looked and he wrote the book 2002. Perhaps, it is outdated and he is not changing with the times. Maybe the use of SSRIs is more cutting edge. I wonder…

— Begin quote from "MAVLisa"

I am beginning to think my most recent doctor, Dr. Buchholtz, author of heal your headache, was wrong that SSRIs cause increased migraines.

— End quote

Hi Lisa,

I don’t think he’s completely wrong here because my headaches etc did get worse while I was on Cipramil. While it killed everything else, it never really stopped the pain cycles I was getting and seemed as though they got worse over time. I’m hoping that was a phenomenon related to Cip more than SSRIs in general. There are also some case studies in the science literature reporting increased migraine with SSRI use in a subset of people. However, I think it’s a rare side effect and for the most part they don’t increase migraine activity. I haven’t come across anyone else on various forums who reported a worsening of migraine on them. They usually help MAV sufferers immensely. It sounds like Buccholtz threw the baby out with the bath water on this one … but then he probably wasn’t as aware of migraine vertigo as an entity in its own right when he wrote the book. Not sure.

Scott 8)

Scott -I’m not sure either. It’s so confusing. The way Dr. B explains it is a migraine is a migraine. So, my matter what symptoms you have (head pain, dizziness, etc) it is treated with the same meds. I don’t know if he’s right, though.

— Begin quote from "MAVLisa"

Scott -I’m not sure either. It’s so confusing. The way Dr. B explains it is a migraine is a migraine. So, my matter what symptoms you have (head pain, dizziness, etc) it is treated with the same meds. I don’t know if he’s right, though.

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Yet another question to bring up with Hain perhaps?

Hi there! Just wanted to add that yes, Dr. Tusa at Emory in Atlanta uses Paxil as the first choice for MAV. I believe Tusa collaborates in some ways with Hain and the CA dr (can’t remember his name…!! It’s late…). I still think SSRIs are a wonderful treatment option; not sure why more docs don’t agree. It sounds like they by and large just haven’t tried them in a large group of patients. (My headaches increased at first on Prozac and then decreased substantially.)

Thanks for posting this study Scott. My neurologist uses Paroxetine for all the spectrum of migraine - headache, dizziness, nausea etc and also uses it for New Daily Persistent Headache.

Violet - that’s really interesting that your Doc uses Paxil as a first choice for MAV, mine is also very keen on it. He said that the only reason he uses it less now is that patients are reluctant to take it because of the bad press it got a few years ago (even though he feels the bad press was unwarranted).

Becky

Thanks for the info Becky. I’m going there next actually … I can only get the dose up so much on Effexor and SEs kick in. I wonder if I can stay on 5 mg of Effexor and add in Paxil?

Scott

Scott- just wondering what side effects you are currently experiencing on Effexor? Do you think your body might adjust and they could subside?

So Scott,

Bringing this thread back around as all of us are playing musical chairs with various SSRIs, which ones seemed to be held in the highest esteem by all the doctors we’ve heard from? I’d go back through and look but my eyes are being fried by computer light at the moment. Sorry to make you do the work for me :lol: . But I am sure you have it right on the tip of your tongue you with the scientific abilities!

So how is everyone doing? Any one else feeling like a science experiement?

Best, Molly

I’m definitely a science experiment. No question. :frowning:

H

Molly –

It looks to me like it goes something like this with antidepressants:

  1. Effexor
  2. Zoloft or Paxil
  3. All other SSRIs
  4. Nortriptyline (although Rauch would slot this in at #1)

Scott:

At the last support group I went to as this is not limited to Dr. Newman’s Patients… There were a few people who were taking Zymbalta. I dont know much about but some had some positive reviews

Howie,

So they were MAVers getting good results on it? Called Cymbalta. That’s really interesting because I think Hain was uncertain about whether or not it was effective. He tends to stick with what the literature has to say by the looks of it. I wonder if Cymbalta is any less brutal than Effexor for withdrawal etc?

S

— Begin quote from "scott"

Molly –

It looks to me like it goes something like this with antidepressants:

  1. Effexor
  2. Zoloft or Paxil
  3. All other SSRIs
  4. Nortriptyline (although Rauch would slot this in at #1)

— End quote

Hmm, amitriptyline (which is metabolised into nortryptiline) is often used as the first-line med regardless of class, and the same goes for docs who prefer nor- over ami-. When it comes to scientific proof for migraine, they are no doubt #1 on this list (along with Topamax in most studies).

Edit: Re: cymbalta withdrawal, I’ve heard horror stories there too. en.wikipedia.org/wiki/Cymbalta#D … n_syndrome
Half-life: ~12 hours.

Scott:

No research but people who were completely miserable and full of anxiety and depression are now decent or manageable…

Hey Tran -

I made up that AD list based on what was said by the handful of docs we’ve had on here lately etc. But for sure amitriptyline is used as a first-line approach by some neuros. I imagine many years ago it was the standard. One doc I saw years ago wrote a script for it first off. Have you ever used it? One girl I remember from the Healthboards was instantly well on it within a week. Unfortunately, after a month or so, she lost the ability to swallow!

Thanks Howie.

S

— Begin quote from "scott"

Hey Tran -

I made up that AD list based on what was said by the handful of docs we’ve had on here lately etc. But for sure amitriptyline is used as a first-line approach by some neuros. I imagine many years ago it was the standard. One doc I saw years ago wrote a script for it first off. Have you ever used it? One girl I remember from the Healthboards was instantly well on it within a week. Unfortunately, after a month or so, she lost the ability to swallow!

Thanks Howie.

S

— End quote

I’m actually on 12.5 mg right now… and it doesn’t help. (Went up to 20 and stayed there for a month (after 50 days on 10).)
Actually, it probably hurts, but… me and withdrawal. Sigh.