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Old 07-13-2008, 09:22 AM   #1
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For Scotsman/Howie - SSRI's/MAV

Hey guys,

As I've said, I am only handling the migraine aspect of things right now, by taking Topamax, as I recognized the symptoms of migraine fairly easily...flashing lights, dizziness, tunnel vision, motion intolerance, brain fog, but of course i recognize the need to treat the anxiety portion of things as well. Those symptoms are easy to spot as well,..stress, fear, worry, panic, BUT,...one question is, is the anxiety actually directly causing dizziness itself as well?? One article you posted on another site Scott suggests it can, although I have never experienced dizziness with anxiety before, even before MAV. Of course, it could just be that the anxiety is just feeding the MAV and not causing any direct symptoms itself, like an open window in your house while you have the air conditioner on in the middle of the summer. That open window (anxiety) counteracts any good that the air conditioner (topamax in my case) is doing.

Also, according to this article, there are 3 types of dizzines one can have. Otogenic, which is a neuroto-logical illness like migraine, then there is pyschogenic, which is prmarily anxiety-based, then there is interactive, which seems more like the situation with you and me Scott (let me know if you disagree)....a primary anxiety disorder that we had BEFORE the MAV, but when the MAV hit, the anxiety went through the roof. Now, according to the article, only the otogenic and psychogenic dizziness had complete remission of symptoms, and the interactive group only saw a partial reduction in their symptoms. I'm no doctor, so i really don't know where I fit in here, but i am assuming from my history, and from my symptoms, that i fall into the interactive group, since i had anxiety before, and the anxiety/labrynthitis triggered the MAV. Do you think that makes sense Scott/Howie? Would you say that's the group you both feel you belong to?

See, i'm trying to make sense of why SSRI's seem to help SOME people with MAV, but seem to do nothing for others, and sure, it could just be the old "some people respond to meds and some don't but i'm hoping it's more than that. Apparently, SSRI's do nothing for migraine, and I'm convinced of that from several medical articles i've read, and several doctors I have spoken to. Dr. Hain was VERY particular about this, and said quite emphatically that ONLY Effexor works on migraine. But it's apparent that the SSRI's DO help, SOMEHOW, and i'm seeing a pattern of the SSRI's seemingly helping more MEN with MAV than women, and perhaps it's becoming more clear why.....anxiety!!! Also, according to that article, the exact SSRI used didn't seem to matter. Simply getting more serotonin to the brain was the most important factor, so I'd be more inclined to use Zoloft or Prozac because withdrawl is a heck of a lot easier. But if Effexor actually works on migraine, perhaps I could kill 2 birds with one stone, the anxiety AND the migraine, but tolerance could be an issue for me there.

I don't know exactly where I am going on this lol, sort of just working this out out loud lol, but i am really nervous to take the SSRI in the event that it doesn't work, and since reading the article and deciding that I am most likely in the "interactive" group, i am most likely one of these people who will be needing MULTIPLE interventions, meaning that I will need to kill the migraine from possibly multiple angles (anticonvulsant, possibly CCB), and then hit the anxiety/depression aspect possibly from multiple angles (SSRI/Benzo). At that point, there really isn't much else I can do lol!!! I'm just trying to do everything I can for the migraine first I guess, so that all of that is in place, and then kill it with the SSRI or SSRI/benzo combo if that is what is needed. I really just don't know. Effexor seems like such a risk for me, that I almost feel like trying a less-likely-to-cause-withdrawl-hell-SSRI like prozac or Zoloft first, and if I don't get results or get partial results, at least i know the effexor might have a chance then. I guess what I am saying is, i am afraid that the effexor (or any SSRI) may not work because of the group I fall into, and that if i get on the effexor, and it doesn't work, i may not be able to get off it because of the STRONG withdrawl effect, and effexor is the worst of them all. I found paxil VERY difficult to get off 10 years ago, and i don't feel like going through that again. Dizziness is one of the debilitating symptoms of withdrawl, and since i am already SO dizzy, if I had to deal with that on TOP of my already current dizzy state, I would be bed-ridden for the duration. What would you guys do in that situation?? I mean, you HAD to take the plunge to get on the SSRI's to begin with so you MUST not have been thinking about the drug not working and having withdrawl coming off it?? I just can't go through that. I need to get better obviously but I also can't be stupid, and do something that is going to worsen me at the same time. I am barely hanging on right now, and I feel like I am constantly on the verge of "spinning" type vertigo, but somehow I seem to barely fight it off. I feel like one more stimuli in the wrong direction, and it will put me over the edge. Not sure what to do. thanks guys!

Rich

 
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Old 07-13-2008, 10:55 AM   #2
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Re: For Scotsman/Howie - SSRI's/MAV

Hi Rich,

My doc just added in Effexor at the 37.5 (the smallest dose of the ER variety)to my other preventatives. I hope when it is time to go off this, that I don't have any issues!?!?!?!

Pam 3

 
Old 07-13-2008, 11:23 AM   #3
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Re: For Scotsman/Howie - SSRI's/MAV

Sorry I scared you with the post Pam. DON'T let my crap scare you off the med. I'm the guy who is scared to take vitamin C!! Seriously, so don't go by me! I WILL say this, however. I don't know the exact protocol, and I'm not saying it's free of glitches or side-effects 100%, but there IS a method of switching over from ANY SSRI (that includes Effexor) to Prozac, which has the longest half-life of all the SSRI's, which is the easiest SSRI to get off of. So since Effexor has the shortest half-life, it has the worst withdrawl. So the technique is to switch from Effexor to Prozac, and then wean off prozac which is easier. I don't know the protocol, but a psychiatrist, neuro-psychiatrist, or psychopharmachologist would know the way to do it.

My only advice to you would be if at all possible, not to go higher than 150mg but Dr. Hain, who uses Effexor extensively, doesn't like to go higher than 75mg, and also says that fortunately, Effexor seems to work 80% of the time even at 37.5mg so take that for what it is worth.

I could not tolerate Effexor even at the starting dose so the only way for me to get onto the medication is to open up the capsule and take out half the pellets so that I can start on less medication. THAT is how sensitive I am. But I am still not sure what SSRI to start with. It is either going to be Zoloft, Effexor, or Prozac. But it looks like I am going to need one of them.

Rich

 
Old 07-13-2008, 01:17 PM   #4
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Re: For Scotsman/Howie - SSRI's/MAV

Rich,

I have read a handful of posts about Effexor and withdrawl issues and it does make me a bit nervous!! I don't think my doc wants me to go above the 75 mg. I might go the next step or might not. I still seem to cross my threshold quite easily, although my sx are so much less than they were. Good luck with what you choose.

Pam 3

 
Old 07-13-2008, 04:15 PM   #5
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Re: For Scotsman/Howie - SSRI's/MAV

yeah, that's the problem isn't it? We seem to get some help from out meds but we seem to still cross our threshold quite easily. That's a problem for me as well. I'm just on Topamax right now and nothing else. I don't think that is going to last so I need to start thinking about other options. What other meds are you on and how have they helped you?

Rich

 
Old 07-13-2008, 05:33 PM   #6
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Re: For Scotsman/Howie - SSRI's/MAV

Hi Rich,

>>> is the anxiety actually directly causing dizziness itself as well?? One article you posted on another site Scott suggests it can ...

In my situation, I *know* that, apart from the early days of this when I was really pychologically freaked out about what was happening to me, that this is all otogenic anxiety. It's a purely physiological reaction to my screwed up balance system. I can easily demonstrate this to myself by simply lying in bed on my back and then turning my head to the left or right and lying like that for about 10 minutes. If I move my eyes to the far corners of my eye socket, it produces the same effect either to the left or right although it is not nearly as bad as it was years ago. My heart rate begins to increase all on its own as though someone were dripping adrenalin into my bloodstream. There is no fear thinking going on in me whatsoever - in fact, when I first lie on my right or left side, it feels really nice and comfortable for the first minute or two before the inner ear garbage starts. This effect was there for me from day one.

The interesting thing about this for me is that I was never a stressed out sort of guy before this happened. I had NO IDEA that anxiety could be so bad. Sure, I'd have my moments if I had to give a talk in front of a large group or had a blind date lined up, but it was nothing compared to what this inner ear thing created.

So given the above, I believe that in my case and probably yours and Howie's, that we all have a similar anxiety aspect to this condition - it's part of the triad of symptoms outlined in the MARD article. In that paper they explain clearly the physiological mechanisms responsible.

What makes this all so hard to see clearly is that our own real pychological fear and anxiety blurs into the MARD stuff. And if you do feel freaked out it definitely is like pouring gasoline on the fire. By doing that, we further sensitise the sympathetic nervous system and it's just so much easier to have the anxiety take hold. Once that happens then everything else goes mental as well - migraine and vestibular. I think whether or not you were a previously anxious person has no bearing on the actual condition apart from the anxiety you are throwing on top of the physiological stuff created by MARD. It just means that you'll likely have to work harder at understanding and sorting out your own personal anxieties about life in general, whatever they may be.

So the trick is to DESENSITISE the brain to this anxiety response. Apparently it all goes down in the amygdala – a section of the brain that governs the fight or flight response. I would imagine that right now, your threshold for anxiety is rock bottom and it takes nothing to set it off given your extreme symptoms and your own fears over the whole thing right now.

There's two options Rich: either some sort of intensive cognitive behavioural therapy (CBT) or drugs to give you a head start. And of course that means either a benzo or an SSRI.

I know Hain and others say that only Effexor works for migraine but I don't think we're just treating a typical migraine. This is migrainous-anxiety related dizziness and so I believe that ANY SSRI will work for most. This is mentioned in the article on MARD and we have seen it work this way in many people on this board with Zoloft, Cipramil, Effexor and Prozac.

If I were you I'd get back on an SSRI. I'm about to start Lexapro this week I think given the lousy response on prothiaden. The tricyclics seem to be messy drugs to me and even Rauch agrees. I'm thinking a low dose Lex will keep me on an even keel. Just hope the SEs don't drive me crazy. Why not consider Lexapro as a possibilty? It's a very clean version of Cipramil (they've removed the stereo isomer) and seems to get the thumbs up with few complaining about withdrawal hell. The thing is Rich, I think I'm always going to need one of these drugs. I have yet to see any other drug type work for me in this way.

Scott

 
Old 07-13-2008, 05:40 PM   #7
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Re: For Scotsman/Howie - SSRI's/MAV

Thanks Scott. My local GP offered me Zoloft or Lexapro. I look the Zoloft lol. But I could always call him back and ask for a go on the Lexapro. So out of those 3 categories, otogenic, psychogenic, or interactive, where do you think you and I fall into? I think you and I have very similar histories, you with the VN, me with the Labs, but I was DEFINITELY set off by a period of anxiety FIRST. It seems that the VN directly set you off, and then the anxiety kicked up full force. For me though, the anxiety set me off, even though I had prior labs. Think that changes the picture for me?? Because that interactive group, the group that was primiarily anxiety first, and illness second, didn't fair so well on the SSRI's as much as the otogenic/psychogenic group for some reason.

Rich

 
Old 07-13-2008, 05:56 PM   #8
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Re: For Scotsman/Howie - SSRI's/MAV

Hi Rich,

I'm 99% certain mine is strictly otogenic. Maybe in your case your anxiety levels helped to kick off migraine (anxiety and stress seem to be at the root of all sorts of human illnesses), which kicked off the vestibular stuff which then kicked off otogenic anxiety if you know what I mean causing the whole thing to snowball. Do you feel as though your levels of anxiety are far beyond what would seem a normal response to being ill? I think otogenic anxiety has no limits. I had it so bad sometimes, it was like I had a gun at my head and I was preparing to die – it was that extreme. Just out of control stuff.

Whatever the cause Rich, it's the same endpoint: we feel anxious as hell; it revs up migraine and vestibular problems. You need to clearly identify the sources of anxiety. If you think there is a good deal of psychological input, then I'd get some counselling of some sort to learn about this and have the tools to undo it as best you can. In the meantime, because you're feeling so diabled and lousy at the moment, I think it warrants an SSRI to give you a chance to regroup. I don't think any therapy will be useful when you can't even sit still and feel relaxed to actually get through the therapy. I had all of that in spades. I was walking around Sydney in a total state (that happened on Zoloft) wishing a bus would take me out - nightmare. Once treated though, and when I FINALLY understood my own negative reactions to the illness, it all went away and I was well again.

Scott

 
Old 07-13-2008, 06:54 PM   #9
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Re: For Scotsman/Howie - SSRI's/MAV

Well, I can tell you straight off how this happened in a nutshell. You seem like a good problem solver......I have ALWAYS had anxiety problems. I have always been a worrier, been fearful, a "what if" person, and had a period in my life about 10 years ago when I started having panic attacks and was treated with Paxil for 2 years. when I came off it, I managed to ignore the anxiety, and was able to keep it at bay by keeping busy, and getting involved in hobbies, but it was always there, underneath, ready to strike, if something were to set me off. For me, anxiety and panic was set off in my early 20's by recreational drug use, and this was really the beginning of the panic and worry. I also got involved in several legal situations (non-violent, just dumb lol) that also traumatized me, and set off anxiety. Each time, I would calm back down, and then gain some sense of normalcy. In March 2007, the labrynthitis hit and I had SEVERE spinning vertigo that lasted 4 straight days, left me severely imbalanced for 2 weeks, and took me 2 months to FULLY compensate. During that time, and since then, the anxiety has been ramped up a bit because I was afraid that I would get another attack. But, I did learn to let it go, and I was fine for almost 8 months. But during December and January, I was under a TREMENDOUS amount of stress. Much more so than I had been in quite a long time, and I'm 32, not 22 lol, so I don't bounce back as quickly, and this time, something different happened. The MAV hit me on January 24th after the stress just reached a peak. So, I guess I sort of answered my own question. I had a pre-existing anxiety disorder that went left untreated, and because of that, it set off the MAV. So I suppose that puts me in the interactive group I had primary anxiety disorder first, then the MAV hit, then the anxiety got ramped up that much more. Regardless, it looks like the SSRI is needed. I'm afraid that if I go with the effexor, being how sensitive I am, I might not be able to get up to meaninful dose to touch the anxiety. I will try one of the SSRI's along with the topamax to see what I get. If I don't get complete relief, I could always add a benzo or add another migraine med, depending on what is still a problem, anxiety or the migraine!

I just find it interesting that those in the otogenic/psychogenic groups had such a positive reaction to the SSRI but those in the interactive group didn't. I mean, the otogenic CLEARLY has a neuro-otological illness and reactive anxiety feeding the problem, so the SSRI must be directly helping the problem itself. And the pychogenic group is clearly all anxiety and the SSIR helped. So why, in the interactive group, where BOTH components are there, would the SSRI be LESS than effective lol? This is a mystery to me!

Just curious,...what dosage of Zoloft zombified you?

Rich

 
Old 07-13-2008, 07:09 PM   #10
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Re: For Scotsman/Howie - SSRI's/MAV

Rich:

No idea why the SSRIs worked for some and not others really. Who knows? All we can do is take a stab in the dark and hope you get lucky really.

Zoloft affected me badly immediately. Anxiety levels and then dizziness went through the roof – off the charts. I stuck it out for about 5 or 6 days hoping I would adapt but no chance. You'll know soon enough if it's right for you. Lex and Cip are known to be very good SSRIs for anxiety. Maybe you should hit Lex before Zoloft? If these don't help then move onto Effexor. You can change SSRIs quite easily without having to totally come off one before starting the other. Sometimes it requires stopping one for a day or two and then introducing the new one. And remember that Hain says withdrawal from Effexor is not a big issue when the dose is no more than 75 mg.

Seems to me like MARD fits you well. The vestibular injury was already there; you were already stressing out massively at the time, and then migraine kicked in. It was a trifecta! And now that the 3 rings are all in place, the hell starts. It could be a really bad version of Lord of Rings! So knock out the anxiety ring and it should weaken the beast sufficiently for you to feel some normalcy again.

Scott

 
Old 07-13-2008, 08:25 PM   #11
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Re: For Scotsman/Howie - SSRI's/MAV

Thanks buddy, I appreciate it! I have nothing to lose but the dizziness I suppose, and I guess a little personality too lol, but I need some life back. I'll call my doc and see if he will change the script to Lexapro, since he offered that first anyway. thanks again i hope you do well with it as well ;-)

Rich

 
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