Which SSRI?

Hi All,
I just wondered if there is a particular ssri that has worked well for you?
I’m going to my Dr on Thursday to discuss me discontinuing Topamax and starting an ssri - I’m just not getting any benefit from being on it after 3 months and think the ssri might be the next thing to try. I want to get my life back!
Thanks and best wishes

Just FYI, SSRIs are pretty much ruled out as a MAV treatment - they appear comparable to placebo in a lot of studies. Having that said, if you still want to try one (for anxiety, depression or whatever) my favorite is prozac - thanks to the long half life. I had a living HELL tapering off lexapro (from 15 mg to 10 mg and I was bedridden, couldn’t eat at all, had a pouding migraine all the time, felt like throwing up… AWFUL few days until I went back on full dosage). Switched it to 40 mg prozac and quit that cold turkey a few months later without a noticeable symptom!
Paxil/paroxetine, zoloft/sertraline, celexa/lexapro ((es)citalopram) all have pretty short half lives, at least when you compare it to prozac (which has an effective half life of over A WEEK, compared to 10-40 hours for most others).
The half life has downsides too, though - it takes longer to get rid of if you can’t tolerate it, and it takes longer to build up to an effective dose.

My friend is doing really well on cipralex.

Hey thank you both. I think Scott was on cipramil before and Scott and I have always had a very similar time - similar symptoms and triggers. I can’t decide if prozac is better because of the long half life - does that mean it has a smoother effect? Tranquility - what have you found works for you? They won’t give me propanolol because I have a history of asthma.
Best wishes

Dr. Hain suggests low dose (37.5mg - 75mg) Effexor (I guess it is a SNRI technically) and its cousin, Pristiq. Some here have had success with these, although I didnt. Someone else (I think it was Howie) did well with Zoloft. Next I will try Nortriptyline, an older school one. Good luck.


SSRIs are pretty much ruled out as a MAV treatment

If you read the paper titled “Migraine–anxiety related dizziness (MARD): a new disorder?” you’ll see that they recommend the use of SSRIs particularly if anxiety is a prominent problem with the MAV. And let’s face it, most of us have had anxiety problems with this.

Second, while SSRIs do not appear to be efficacious in migraine studies per se, they do have an effect in people with MAV – no question. For me Cipramil took me to nearly 100% although it did not eliminate headache (and might have made them worse). Over the last 5 years, I’ve seen a number of people improve massively using everything from Zoloft (Howie), Paxil and Prozac (Molly), Prozac (Gloria and Violet), and lexapro (a few on the healthboards). They definitely work but not for everyone and must be considered.

SSRIs modulate brain serotonin levels and stop fluxuations. Some theorise that sudden drops of serotonin precede a migraine attack and might explain why SSRIs work.

Effexor, of course, is an SNRI but has SSRI properties at a low dose. It is effective in 80% of cases according to Prof Hain. Jenny is currently feeling the best she has in a very long time on Effexor. Pristiq, the metabolite of Effexor, cured Julie after years of misery. For Adam and Roberto Effexor had no effect.

Tesss – go straight for the jugular and start on Effexor XR at 1/3 of 37.5 mg as Hain suggests. If you find it is too much, lower it to start. I have a feeling this one will work for you. I’m not sure if 37.5 mg caps are available in the UK though … Hbep said she couldn’t find them which is odd.

Best … Scott 8)

edit: have you tried Verapamil? Maybe worth a look given Nance’s great success.

OK, I’m not going to bother to answer in this thread anymore, methinks.
So they (SSRIs) are proven not-very-useful for most in scientific studies, but you still think they’re a great find? (Effexor excluded.)
Other things that are proven useful you disapprove of in one way or another, and yet others that aren’t tested at all you also disapprove.
Then you go recommending a drug based on ONE person’s experience - anecdotal evidence?
Sigh, I don’t want to go in to a fight here so I’ll just stop.

[size=85]Also, Julie’s cure came way after the Pristiq has leveled out, and the Topa/klonopin too. Not that she’s still on Topa or neurontin, but still.[/size]

I don’t want to go in to a fight here so I’ll just stop.

Why do you interpret evidence that does not support your suggestion as a possible “fight” Tranquilty? We’re here to discuss REAL and effective treatments for MAV and give helpful advice to Tesss. My interest is in helping Tesss so that she might feel well. As I already explained above, SSRIs have been an effective treatment for many people with this condition on this forum and others. Your comment is a non sequitur.

Other things that are proven useful you disapprove of in one way or another

If you are not able to understand and grasp the difference between a snake oil product (such as an expensive rice powder and seaweed) versus real pharmacological treatments such as the SSRIs for MAV, then we’re wasting our time even trying to have a logical discussion about this. If you believe that PXP cured someone’s MAV (and let’s not forget multiple sclerosis, heart murmers, and metabolic syndrome to boot) then we may as well discuss alchemy and the unicorn you saw in your backyard Sunday afternoon.

Finally, a large part of Effexor’s action is in serotonin reuptake inhibition. There is a mechanism, it is plausible and this particular med comes out on top in clinical trials. To argue that other meds with identical action except for the noradrenalin effect should be “ruled out as a possible MAV treatment” makes no sense given the results seen by numerous people with MAV.

Also, Julie’s cure came way after the Pristiq had leveled out …

Not true.

Posted 22 Sept 08: [Hain] gave me a slightly increased dose of Pristiq. I’ve been on it for a week and I will admit to some improvement. And any improvement is good, no matter how little.

Julie started Pristiq on 15 Sept 08. The “boat landed” on about 10 Dec. That’s a total of approximately 11 weeks on an equivalent Effexor dose of 100 mg. Hain states clearly in a presentation given in May 2008 that migraine meds – including Pristiq - can take “weeks to months to work”. Also at this time she had ended Neurontin and was reducing Topamax. It’s probable that as topamax and neurontin were leaving her system in the weeks before Dec 10, that it allowed Pristiq to work better without these meds in the picture and for her to finally stabilise. As Julie said herself, posted on Dec 10, “He (Hain) believes I have too many meds in my body.”

Scott 8)

— Begin quote from “scott”

Other things that are proven useful you disapprove of in one way or another

— End quote

Actually, I was referring to Topamax there, which you, at least in the past, have made some bad comments about (and I’m not considering posting your experience “bad comments”, because obviously everyone’s allowed to do that!).

I was referring to Topamax there, which you, at least in the past, have made some bad comments about

Topamax was a nightmare for me – and that’s the only bad thing I can say about it from my experience. I also posted information from the FDA about its association with an increased risk for suicide. For others it works great. Rich is doing extremely well on it. As I’ve stated previously, Topamax is a proven migraine treatment which has been subjected to scientific scrutiny in double blinded, placebo controlled trials. It works for many (but not all) who are fortunate enough to not have side effects. Clearly, it’s a migraine med that should be considered by everyone here.

Scott 8)

Let’s all stay friends…

It’s hard not to let it get personal, but remember it’s not the person that’s under “scrutiny”, regardless of “cure”, it’s the therapy.

Maybe Julie was cured by pxp, I hardly doubt it but still… The question really is whether someone who hasn’t tried most of the proven effective meds should start with some expensive promise-everything product OR actually start with something that has a fair chance of working? What would you do tran? =)

Constitutes known effective treatment

Then there’s these things that are effective but aren’t known. Perhaps pxp would be one of those, though again I very much doubt it. However I think it’s pretty much common sense that a person looking for treatment starts with what’s known, and then if that fails and one is desperate, maybe try the unkown (at one’s own risk).

Im not personally sure about ssris, perhaps those who are helped by these not really have migraines as a cause of their symptoms. But I dont know how many here have been helped by these meds, maybe it’s not a very plausible suggestion if many have indeed been helped.

Tesss … Here’s my two cents:

I tried Effexor & hated it. Made me feel like a zombie. For depression, I take Prozac. I can take it for two weeks at a time & the anti-anxiety part of it helps me tremendously. I don’t know how it works long-term because I haven’t been on it for more than a month at a time. Effexor had to build up to do anything, then had to be weaned off … I didn’t like that about it either.

Topamax didn’t work for me because of the cognitive side-effects. I couldn’t think clearly & still have a job. Plus, it didn’t seem to help my dizziness at all. I wasn’t on a very high dose when I decided I had to stop it - 50 mg.

Verapamil helped my dizziness tremendously but caused me to have a headache. It also didn’t mix well with my Zocor so I had to stop it.

Nortriptyline caused me to have ‘the jitters’.

Adenolol didn’t do anything for me.

I can’t remember what else I’ve tried - it seems like the list is pretty long but I’m sure there are others who’ve tried lots more. Right now I’m on Amitriptyline. It isn’t helping the dizziness at all, but seems to be helping the headaches become less frequent … unless I eat an obvious trigger food. And admittedly I’m on a very low dose. I take it at night before bed & have been extremely groggy in the mornings - that’s not a good thing, but it seems like this is just ‘groggy’ & not the constant brain fog that I had on Effexor & Topamax.

On April 1 I’m going to try the “expensive promise-everything product” :mrgreen: and see what it does for me. If things go well, I’ll wean myself off the Amitriptyline & see how I feel on nothing but the infamous ‘homeopathic alternative treatment’.

Hi Tesss,

My neuro just started me on Cymbalta (20 mg). I’ve only been taking it for 5 days and so far, so good. The side effects are managable (a little trouble sleeping and some shakiness in my hands), but it doesn’t make me dizzier (yeah!) and it puts a little pep in my step! I take it in the morning and so far I’ve been feeling pretty good…and I seem to be a little less dizzy! Hopefully as I continue to take it, I will see more positive effects.

Good luck!

For what it’s worth (and sorry to Tesss for hijacking the thread) Julie is off all of her preventatives (cold turkey) now and still doing perfect. On Pristiq (last med added) she couldn’t even drive, so that clearly wasn’t anywhere NEAR a cure. SOMETHING happened, that’s all we know, and that something happened loong after all the meds had reached their full effect. Incidentally (and, as always, correlation does not imply causation - but it sure points to it) it happened a week or two after adding PXP, and really took off when taking more of it.

Also, I’m not sure about other docs (or current research, for that matter) but Hain says that Effexor does NOT work for migraine because of the SSRI effect, but because via some unknown mechanism or undiscovered neurotransmitter, and that the same could hold true for i.e. Zoloft and others which apparently works for some. (Or, in the case of Zoloft/Lexapro etc., it could well be the placebo effect, since that applies to pharmaceutical meds too… ;))
Heck, the entire monoamine hypothesis is under pretty heavy scrutiny right now, and lots of folks thinks it’s just bollocks, and that the meds work in a completely different way, such as stimulating neuron production or something along that way. :slight_smile:

Great for her. Why don’t you try it for yourself?

— Begin quote from “MikaelHS”

Great for her. Why don’t you try it for yourself?

— End quote

Because I want to come off my many meds first, and see what that does. After that, probably try pizotifen (since my body doesn’t seem to like high serotonin levels, an antagonist might be the right thing). If that fails, maybe then.

Hi all :smiley:

I’m still taking the “wonder stuff” and still doing well. I’m down to 20 mg prop now.
Just thought now might be a good time to update you, just don’t ask me to tell you WHY it works for me. I don’t honestly know. (Nor do I really care at this point). 8)


I am like 95% or so on Zoloft and Verapamil. It is not a placebo effect. Both times I came off medications Zoloft 6 months later I was in total relapse. I also came off Verapamil as we were trying for another child ns switched to a beta blocker. I am back on Verpamil 2.5 weeks and back up to 95%…The drugs work if you give them a chance…

Hey Joy,

On April 1 I’m going to try the “expensive promise-everything product” and see what it does for me. If things go well, I’ll wean myself off the Amitriptyline & see how I feel on nothing but the infamous ‘homeopathic alternative treatment’.

You made me chuckle with the new words for what is now “the three letter word” :smiley: . Look forward to your report on the Elixir of Life! Just make sure you have an iron-clad agreement that you’ll get your money back if you’re not satisfied Joy – even if you buy the product from a friend (that is a concern to me too – that if people buy this stuff off a known friend, they may be reluctant to report it to that friend as useless for fear of feeling bad … and getting a refund might prove to be difficult because of the awkwardness of it all).

it could well be the placebo effect, since that applies to pharmaceutical meds too…

You’re absolutely right. But why not use something that has a real pharmacological effect AND the placebo effect working together?

An interesting interview here on the placebo effect. It’s an incredibly strong phenomenon.

Dear Tess -

I was on Prozac 15mg for years, and came off of it in November. I noticed at least a 15% worsening of my visual and motion sensitivities. I told Dr. Cherchi and Hain about this and they said that other than Effexor, Prozac was the only other proven SSRI to have a prophylactic effect on migraines. Now it didn’t cure it by any means, but it did soften the symptoms more than I had realized. I think for some people they get even more of a positive effect. I am now trying Paxil, not for Mav, but to better treat the anxiety that comes with it for me. Not sure what I think yet, but I know I’m feeling less catastrophic about my future and that’s a good thing.