antidepressants

25 May 2020

What’s Up? – I’m Just Not Sleeping Well!

Most of us know that poor sleep can trigger migraine attacks, or make migraine symptoms worse or more frequent.

What we may not realize, however, is that there are many, many reasons why we may not be sleeping well.

So today we’re going to look briefly at a few of those reasons – and think about some basic information that we can give to a doctor or specialist to start looking for causes and treatments.

A few [surprisingly common] reasons why people don’t sleep well:

Depression: A case where one can make the other worse, and vice versa.
Sleep apnea (sleep apnoea): …of various types.
Hot flashes
Your pet: It’s moving around, getting up onto your bed… ? It’s a common problem!
Migraine: Of course, had to mention that one. Another case where one can make the other worse.
Caffeine
Some antidepressants: And other common medications too!
Worrying about not sleeping: Yup
Sleeping pills: Yes, not using sleeping pills properly can lead to major problems.
Overactive thyroid
Acid reflux
Restless Legs Syndrome
An uncomfortable bed: Just how old is that pillow?
Poor bedtime routine: For example, too much screen time in the last two hours of the day.
Temperature: In the room/bed
Alcohol: (in spite of common myths)
Heart failure
Obstructive Lung Disease
Someone else in the room who can’t sleep

…and those are only a few examples. As you can see, some are serious in themselves, some not. Some are obvious, some are not. Some are easy to fix, some are not. But it helps to open up your mind and think about all the possibilities, instead of just assuming it’s one or two of the more commonly mentioned things.

It’s critical that we think about sleep when we’re trying to get good treatment for migraine, and other headache conditions as well. So where do we start?

Easy Sleep Evaluation

It helps to evaluate your own sleep, and then bring the information to your doctor. This doesn’t mean using an app with complicated charts, although that might be useful. And actually, you want to avoid obsessing too much about your sleep on a daily basis, which can easily make things worse.

Harvard Medical School has published a very useful “sleep diary” to fill out. There are simple questions for before bed, and after you wake up. They recommend using this diary every day for a week before talking to your doctor or specialist.

Before bed:

Medications during the day
Caffeinated beverages during the day
Alcohol during the day; list amount and time
Exercise during the day
Sleepiness during the day
Naps during the day
Food consumed within three hours of bedtime
Activities within two hours of bedtime

In the morning:

Bedtime last night
Approximate time it took to fall asleep
Approximate number of awakenings during the night
Reasons for awakening, if known
Time of awakening for the day
Level of energy and alertness after waking up in the morning (feeling refreshed?)

If you sleep with someone else in the room, also ask them what they’ve noticed about your sleep.

For more useful information, check out the full article here: Insomnia: Restoring restful sleep

23 May 2018

Female Sexual Dysfunction and Migraine and Headache Medications

James Uncategorized 0

Just how common is female sexual dysfunction? It’s a complicated question. Although it’s extremely common for women to report some kind of problem sometime, it’s a whole different question when you start asking about actual dysfunction and what that is.

Man and Woman But statistics aside, the problem is real, and in many cases it could be caused by your migraine or headache medication.

Migraine patients, and patients with various headache conditions, often have many symptoms to think about. And, of course, there can be many causes of sexual problems. It’s hard to know what to mention to your doctor, and with sexual activity that may be new or not regular, sexual dysfunction from medication may not be something easily recognized.

Medications can especially interfere with both desire and pleasure during sex. Common culprits include:

Antidepressants: Antidepressants are often prescribed for migraine prevention, even when the patient is not depressed. Common examples of these medications are amitriptyline (Elavil, Entrip, Triptaz, etc), nortriptyline (Pamelor, Allegron, etc), desipramine (Norpramin, Pertofrane, etc), doxepin (Sinequan, Sinepin, etc).
Beta-blockers: Another migraine preventative, beta blockers can cause problems with desire and orgasm, as well as vaginal dryness. Examples include propranolol (Inderal) and metoprolol (Lopressor, Toprol XL).
Calcium channel blockers: As with beta-blockers. Common examples are verapamil (Calaptin, Veramil etc) and nimodipine (Nymalize, Nimotop)
Anticonvulsants: Another migraine preventative. Anti epileptic drugs are commonly prescribed for migraine, and some may be worse than others when it comes to sexual dysfunction. Examples include valproate, topiramate, and divalproex sodium.

Although these are some common categories, there are a number of other drugs that may affect sexual function.

It’s worthwhile noting that many of these drugs will also cause problems for men, though often for different reasons.

If you’re concerned, talk to your doctor. There may be another similar medication that will control your migraine attacks but won’t interfere with sex.

11 September 2017

Serotonin Syndrome: Are Triptan Users Really at Risk?

James Discoveries & Stats, Medications, News 0

Back in 2006, the FDA in the USA issued a warning about using triptan medications along with certain antidepressants because of the risk of serotonin syndrome. But how high is the risk? New studies suggest that the risk is extremely low, and that thousands have been mixing the medications with no problem.

What is the concern?

Serotonin syndrome can be serious, even fatal. It is caused by excessive accumulation of serotonin, and important neurotransmitter, in the body. Some medications and herbs have been associated with the problem, the idea being that they work to cause runaway levels.

This includes triptans, commonly used for migraine, and certain antidepressants – selective serotonin reuptake inhibitors (SSRIs) and selective serotonin/norepinephrine reuptake inhibitors (SNRIs).

There has been some suggestion that triptans alone could lead, in rare cases, to serotonin syndrome.

This is an important question, because many migraine patients also suffer from depression. And to be clear, for most migraine doctors, this was a “use with caution” warning, not a prohibition.

Re-evaluating the Research

Just because there is a “risk” doesn’t mean you should avoid something. Just because you have a “risk” of falling down the stairs, doesn’t mean you avoid stairs.

So here’s the question – just how high is the risk?

Researchers in Houston in the USA went back to check out the original research that the FDA had in 2006. They found that the evidence should not have been considered sufficient for the FDA warning. The evidence was “Class IV” – the lowest possible level. (See the abstract here: The FDA alert on serotonin syndrome)

Another study, presented at the 59th Annual Scientific Meeting of the American Headache Society, provided even more reason to question the warning. Over 14 years, about 19,000 patients who used both triptans and SSRI or SNRI antidepressants were evaluated – and between 4 and 7 patients developed serotonin syndrome. That’s about a 0.03% risk.

Of those patients, how serious was their condition, and do we even know for sure that it was caused by the medications? Serotonin syndrome, although it can be serious, usually is not fatal.

Of those patients, only two cases were related to triptan medications. And in one of the cases, the symptoms started before the patient took the triptan!

In the end, one of the researchers said simply,“Our data do not suggest a clinically meaningful risk of serotonin syndrome in patients coprescribed triptans with SSRI/SSNI antidepressants.”

Risk?

From these studies, it seems that with regular use of triptans and antidepressants, the risk is almost nil. However, because of the seriousness of serotonin syndrome, patients should be aware and should report new symptoms to their doctor. It is also important to remember that there is concern about “street drugs”, taking more than is prescribed, and certain supplements such as St. John’s wort and ginseng. Your doctor needs to be aware of what other drugs and supplements you’re taking.

For more information on the drugs that have caused concern, see Serotonin Syndrome: Symptoms and causes.

via: Triptans (like Imitrex) mix well with antidepressants

20 May 2017

Headache and Constipation

James Information 0

If you’re suffering from both headache and constipation, could they be connected? Yes, but it’s not that simple.

What is Constipation?

Constipation occurs when your colon absorbs too much water from your food, leading to overly dry and hard stools. You might still feel like your bowels are “full” even after you’ve used the bathroom. And you’re having less than three bowel movements in the course of a week.

There are actually a number of things that can contribute to constipation, and we’ll talk about some of those below. But if you’ve never been constipation, or the symptoms don’t go away, or there are other symptoms such as weight loss, blood in your stools, or stomach pain, you should see your doctor as soon as possible.

Note that laxatives can actually lead to worse constipation (yes, you read right) – check with your doctor first!

Constipation and Headache?

Sometimes headache and constipation go together. It may just be that you have both – no connection at all. But there are situations in which there may be a clear connection.

Headache Medications: Yes, some headache and migraine medications may actually lead to constipation. These include: opioids (such as codeine), antidepressants (such as amitriptyline), calcium channel blockers (such as verapamil), beta blockers (such as propranolol), and NSAIDs (such as acetylsalicylic acid/aspirin or ibuprofen). That’s not an exhaustive list, so be sure to let your doctor know what medication you’re taking.
Diet problems: Problems with your diet can lead to both headache and constipation. For example, not eating enough fruits and vegetables, not getting enough liquids, and even not eating on a regular schedule – a typical migraine trigger.
Comorbid diseases: Some conditions that typically go along with migraine are also related to constipation, such as irritable bowel syndrome, hypothyroidism, fibromyalgia, and stroke. This is another reason to see a doctor so that she can rule out some dangerous causes of constipation.
Hormone imbalance: Hormonal imbalances may also lead to constipation and headache conditions such as migraine.
“Straining” headaches: Not to be too graphic, but there are some headaches specifically triggered by pushing hard! These include cough headaches and headaches from brain abscesses. If straining triggers a headache or makes it worse, see your doctor.

Treating Constipation and Headache

As mentioned before, it may be that both conditions simply need to be treated separately. However, improvement in one may lead to improvement to the other.

First, with any new headache or constipation symptoms, talk to a doctor who knows your medical history and what medication you’re taking.

Second, your body may be telling you that you need to make some simple changes. Go for a walk once a day, drink more water, eat more fruits and vegetables. That alone can help treat both.

When you need to go — go! And take your time.

As a last resort, with your doctor’s supervision, you may want to try a laxative. But be cautious here.

In most cases, especially with an improvement in your diet, constipation will go away on its own. But it is important to take it seriously, because it can be a sign of a serious condition.

For more information, see: Constipation: Causes, Symptoms, and Treatments and When to Get Help for Constipation

16 June 2008

Antidepressant side effects (Q&A)

James Medications 3

Many with migraine take antidepressants for migraine itself, and not for depression. Some take it for both, or for depression alone. Whatever category you are in, it can be a challenge to find your way through all the different types of medication, the differing opinions, the side effects, etc.

I thought a good starting point for conversation may be this question and answer time with Dr. Joseph Glenmullen from Harvard Medical School. The article is over 3 years old now, but many of the points brought up are still very current. The article mostly deals with those who have been diagnosed with depression, but the side effects can be similar no matter why you’re taking them.

Anything in the article that sounds familiar? What problems have you had with antidepressants? Or how have they helped?

An excerpt from the article:

If you tried to stop your antidepressant and couldn’t because of withdrawal symptoms, a good question to ask is: Are you caught in what I call the “antidepressant catch 22”? Antidepressant withdrawal symptoms like anxiety, depression, insomnia, and crying spells can mimic a patient’s original psychiatric condition. Countless patients have tried to lower the dose of their antidepressants and mistook these withdrawal symptoms for depressive relapse. Their doctors make the same mistake if they are not well informed about antidepressant withdrawal. When this happens, patients are needlessly put back on the drugs, often for years and despite severe side effects. In this “antidepressant catch-22,” patients are unaware that they were undergoing withdrawal rather than a return of their original psychiatric condition. The antidepressant catch-22 can be avoided by learning how to distinguish withdrawal symptoms from depressive relapse.