![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 124 to 148 of 1085. Go back in thread:
Posted by Mitch on August 9, 2001, at 23:42:46
In reply to Re: Topamax Experiences re: nerve pain, posted by bob on August 9, 2001, at 18:04:43
> > Hi everybody. Nothing too exciting here.
> > I had to back down to 50 mg/day because of
> > urinary stone formation. Wearing a prosthesis
> > in hot weather is a tremendous heat stress and
> > I am awash in sweat all day. Since the stone
> > episode, I have backed down, and drink a minimum
> > of 6 liters a day to make sure I stay hydrated.
> > I also drink cranberry juice to reduce the pH.
> > It was not my idea of a fun time. Incidentally,
> > my level of pain relief at 50 vs 75, does not seem to be significantly different. Again, I
> > I did notice some iritability, but could attribute it to a reaction to the heat stress.
>
> ********************
>
> I attained a 250mg level of Topomax, and got more and more irritable along the way. It was the medecine, without a doubt. At the end, I became aggressive and angry, while at other times despondent. I had to taper down some. Then I had a kidney stone attack. I spent 24 hours at the hospital passing a 4.5mm stone. When I was there, they found 3 more stones in that kidney, and another in the other kidney. They broke up the large stone in the kidney with 3, and luckily, the other two were jostled out with it, although not without significant pain. I am still carrying the other one since it is too small for ultrasound. It causes me pain sometimes. When my p-doc learned about my hospital visit, he ordered me to taper off the Topomax immediately and quickly, and completely. It was a VERY mentally destabilizing odyssey of terror and pain. For some reason, I was extremely sensitive to Topomax, and especially to dose level changes. I guess you could say it wasn't for me.
>
> BobBob, et al,
Tegretol and Trileptal have carbonic anyhydrase inhibitor activity which can also result in kidney stones as well. If anyone is sensitive to this problem they should also avoid these two meds as a result from a switch from Topamax.
Mitch
Posted by Mitch on August 9, 2001, at 23:45:17
In reply to Re: Topamax Experiences re: nerve pain, posted by bob on August 9, 2001, at 18:04:43
> > Hi everybody. Nothing too exciting here.
> > I had to back down to 50 mg/day because of
> > urinary stone formation. Wearing a prosthesis
> > in hot weather is a tremendous heat stress and
> > I am awash in sweat all day. Since the stone
> > episode, I have backed down, and drink a minimum
> > of 6 liters a day to make sure I stay hydrated.
> > I also drink cranberry juice to reduce the pH.
> > It was not my idea of a fun time. Incidentally,
> > my level of pain relief at 50 vs 75, does not seem to be significantly different. Again, I
> > I did notice some iritability, but could attribute it to a reaction to the heat stress.
>
> ********************
>
> I attained a 250mg level of Topomax, and got more and more irritable along the way. It was the medecine, without a doubt. At the end, I became aggressive and angry, while at other times despondent. I had to taper down some. Then I had a kidney stone attack. I spent 24 hours at the hospital passing a 4.5mm stone. When I was there, they found 3 more stones in that kidney, and another in the other kidney. They broke up the large stone in the kidney with 3, and luckily, the other two were jostled out with it, although not without significant pain. I am still carrying the other one since it is too small for ultrasound. It causes me pain sometimes. When my p-doc learned about my hospital visit, he ordered me to taper off the Topomax immediately and quickly, and completely. It was a VERY mentally destabilizing odyssey of terror and pain. For some reason, I was extremely sensitive to Topomax, and especially to dose level changes. I guess you could say it wasn't for me.
>
> BobBob, et al,
Tegretol and Trileptal have carbonic anyhydrase inhibitor activity which can also result in kidney stones as well. If anyone is sensitive to this problem they should also avoid these two meds as a result from a switch from Topamax.
Mitch
Posted by bob on August 10, 2001, at 23:28:25
In reply to Re: Topamax Experiences re: nerve pain » bob, posted by Mitch on August 9, 2001, at 23:45:17
> > > Hi everybody. Nothing too exciting here.
> > > I had to back down to 50 mg/day because of
> > > urinary stone formation. Wearing a prosthesis
> > > in hot weather is a tremendous heat stress and
> > > I am awash in sweat all day. Since the stone
> > > episode, I have backed down, and drink a minimum
> > > of 6 liters a day to make sure I stay hydrated.
> > > I also drink cranberry juice to reduce the pH.
> > > It was not my idea of a fun time. Incidentally,
> > > my level of pain relief at 50 vs 75, does not seem to be significantly different. Again, I
> > > I did notice some iritability, but could attribute it to a reaction to the heat stress.
> >
> > ********************
> >
> > I attained a 250mg level of Topomax, and got more and more irritable along the way. It was the medecine, without a doubt. At the end, I became aggressive and angry, while at other times despondent. I had to taper down some. Then I had a kidney stone attack. I spent 24 hours at the hospital passing a 4.5mm stone. When I was there, they found 3 more stones in that kidney, and another in the other kidney. They broke up the large stone in the kidney with 3, and luckily, the other two were jostled out with it, although not without significant pain. I am still carrying the other one since it is too small for ultrasound. It causes me pain sometimes. When my p-doc learned about my hospital visit, he ordered me to taper off the Topomax immediately and quickly, and completely. It was a VERY mentally destabilizing odyssey of terror and pain. For some reason, I was extremely sensitive to Topomax, and especially to dose level changes. I guess you could say it wasn't for me.
> >
> > Bob
>
> Bob, et al,
>
> Tegretol and Trileptal have carbonic anyhydrase inhibitor activity which can also result in kidney stones as well. If anyone is sensitive to this problem they should also avoid these two meds as a result from a switch from Topamax.
>
> MitchThank you for the info Mitch!
Bob
Posted by mcmud on August 14, 2001, at 11:36:07
In reply to Re:has anyone been really helped by topamax?, posted by teddy bishop on August 11, 2001, at 13:36:35
Yes, it did get rid of one type of nerve pain
I experienced. It is a partial solution, and
one I monitor closely. I take it in combination
with several other drugs. Amitriptyline seems to
have the most effect, and I have taken it, in
combination with a narcotic for a decade, now.
Topamax is a recent addition, and while it got
rid of one complaint, I certainly am leery about
trying to increase the dose again in the future.
Posted by Sammy on September 25, 2001, at 20:02:12
In reply to Topamax Experiences?, posted by Kingfish on January 4, 2001, at 7:29:48
>Hi Kelly!
I'm on 100 mg a day of Topamax and 40 Celexa. The combination is great. I started September 10 and have lost 6 lbs. Seems like now at least every other day another lb comes off. I gained 35 lbs on paxil but was way underweight so only needed to lose 15 of it. So, I have 9 to go. I'm a lifetime member of Weight Watchers but with the Topamax, don't stay on the program. No need to. I just go weigh in to stay on their books.
The only side effect I've had besides the weight loss is a little bit of an elevated mood. Which, of course, is also a plus. (My husband loves it!)
Keep me posted on how you're doing. Some great person by the name of Tiff posted this message board address on another board so this is the first time I've posted.
Later!
Sammy
Posted by Krazy Kat on September 26, 2001, at 9:45:36
In reply to Re: Topamax Experiences?, posted by Sammy on September 25, 2001, at 20:02:12
Sammy:
Glad to heaar you are doing well on Topamax. It worked well for me. I have ended up adding Depakote because I was rapid cycling and it really helped but the side effects are much stronger. My pdoc wants to try to titrate down the Topamax because it's always been sedating, but I'm feeling less stabilized already and am feeling very nauseous (have cut back from 250 mg to 200 in the last three days).
So perhaps I need both.
With all the weight gain on these meds, it's a nice change, isn't it? I gained @10 pounds toot sweet on Zyprexa.
Celexa also worked for me for awhile without any really noticable side effects, so that's great, too.
I used to get upset when I saw the words "for awhile" but that seems to be the case with many people. I take Prozac now, but am not certain I need it, but am too scared to stop it. :)
Good luck.
- K.
---
>
> I'm on 100 mg a day of Topamax and 40 Celexa. The combination is great. I started September 10 and have lost 6 lbs. Seems like now at least every other day another lb comes off. I gained 35 lbs on paxil but was way underweight so only needed to lose 15 of it. So, I have 9 to go. I'm a lifetime member of Weight Watchers but with the Topamax, don't stay on the program. No need to. I just go weigh in to stay on their books.
>
> The only side effect I've had besides the weight loss is a little bit of an elevated mood. Which, of course, is also a plus. (My husband loves it!)
>
> Keep me posted on how you're doing. Some great person by the name of Tiff posted this message board address on another board so this is the first time I've posted.
>
> Later!
>
> Sammy
Posted by Sammy on September 26, 2001, at 19:20:03
In reply to Re: Topamax Experiences? » Sammy, posted by Krazy Kat on September 26, 2001, at 9:45:36
Hey Krazy Kat!
Sounds like your on top of things. What problems did you start having with Celexa? I hope nothing changes with me because everything is going so well right now for the first time in a looooong time.
The Topamax seems to elevate my mood a little but not much. And I'm really happy about the weight loss. My spirits are up - no depression at all. Life is good. It's nice to be able to say that.
Keep me posted on how you do with your meds, changing them around and all!
Sammy
Posted by Krazy Kat on September 27, 2001, at 12:56:24
In reply to Re: Topamax Experiences?, posted by Sammy on September 26, 2001, at 19:20:03
> Sammy -
No prolems with Celexa - it just seemed to "poop out" as folks here say. And when the Prozac kicked in, I could tell quite a difference between the two - the Prozac helped more, but it also had more side effects (that seems to be the way, eh?)
It sounds like the meds are working for you right now - don't question them. And if anything needs to be adjusted in the long haul, it may be a slight dose adjustment for awhile, or an adjunct, or maybe you'll never need to change. :)
- K.
Posted by Sammy on September 27, 2001, at 15:34:07
In reply to Celexa » Sammy, posted by Krazy Kat on September 27, 2001, at 12:56:24
> > Krazy Kat-
I'm having a REALLY hard time getting a message to you. I've sent you two but don't see either one posted on the board. I had tried to send them a different way. Did you get either one or maybe both? I'm kind of new at this. Please let me know.
Thanks!
Sammy
Posted by Krazy Kat on September 27, 2001, at 15:56:02
In reply to Re: Celexa, posted by Sammy on September 27, 2001, at 15:34:07
Sammy:
I didn't get a message. How are you sending it?
- K.
Posted by Sammy on October 8, 2001, at 19:06:22
In reply to Re: Celexa » Sammy, posted by Krazy Kat on September 27, 2001, at 15:56:02
> Krazy Kat
If this gets through, will you please send me your email address so I can get a message through to you? Mine is adssay@aol.com
Thanks!
Sammy
Posted by inky on November 7, 2001, at 14:38:52
In reply to Re: Topamax Experiences?, posted by Janice1 on January 4, 2001, at 18:52:01
Hi,
I just started (last night first dose) on Topomax as a migraine prophylaxis.
I don't have a history of any psychological disorders. just found this site through a Google search and you guys sound really knowledgeable.
I've had migraines for most of my adult life and in the last few months they've become daily occurences. I've been taking Zomig and Ibuprofen to combat attacks -- have tried lots of other meds, too, both preventive and "abortive."
My doctor, a headache specialist, recommended Topomax based on some very favorable results in his other patients.
I'm a bit worried about side effects. They started me on 15 mg/day to increase by 15 mg each week until either the daily migraines go away or I reach 90 mg/day.
I'm not taking any other neurological drugs.
I'm a bit worried about the side effects. I do feel a bit groggy today but I don't know if it's from the Topomax. Is this commmon? Does it go away?
My doctor mentioned tingling fingers, loss of mental acuity, depression, weight loss (not a negative in my opinion!) and dehydration.
Has anyone experienced any of these? I'm particularly worried about the loss of mental acuity and grogginess since I need my brain power! I'm also worried about depression because I've seen what a horrible disease that can be.
And I'd like to know if the side effects tend to go away with time. If so, how long does it take?
If anyone has any advice, comments, experiences, etc. on taking Topomax for migraines, I'd appreciate it.
Thanks!
Posted by Mitch on November 7, 2001, at 23:12:02
In reply to Starting on Topomax for Migraines. Advice anyone?, posted by inky on November 7, 2001, at 14:38:52
> Hi,
>
> I just started (last night first dose) on Topomax as a migraine prophylaxis.
>
> I don't have a history of any psychological disorders. just found this site through a Google search and you guys sound really knowledgeable.
>
> I've had migraines for most of my adult life and in the last few months they've become daily occurences. I've been taking Zomig and Ibuprofen to combat attacks -- have tried lots of other meds, too, both preventive and "abortive."
>
> My doctor, a headache specialist, recommended Topomax based on some very favorable results in his other patients.
>
> I'm a bit worried about side effects. They started me on 15 mg/day to increase by 15 mg each week until either the daily migraines go away or I reach 90 mg/day.
>
> I'm not taking any other neurological drugs.
>
> I'm a bit worried about the side effects. I do feel a bit groggy today but I don't know if it's from the Topomax. Is this commmon? Does it go away?
>
> My doctor mentioned tingling fingers, loss of mental acuity, depression, weight loss (not a negative in my opinion!) and dehydration.
>
> Has anyone experienced any of these? I'm particularly worried about the loss of mental acuity and grogginess since I need my brain power! I'm also worried about depression because I've seen what a horrible disease that can be.
>
> And I'd like to know if the side effects tend to go away with time. If so, how long does it take?
>
> If anyone has any advice, comments, experiences, etc. on taking Topomax for migraines, I'd appreciate it.
>
> Thanks!
Hi Inky,It seems that more anti-epielpsy meds are starting to be used for migraine prophylaxis. I know Depakote has been used for that and has an approvable indication for that purpose.
I have tried Topamax for my bipolar. Lots of others here have tried it as well for various things (mostly bipolar disorder). All I can say is that it *can* cause some fairly bad cognitive dulling effects. I wouldn't say that it is all that "depressogenic". As with many meds nowadays you have to start low and go slow with dose increases. I made it up to 50mg/day for a while with other meds added on and I was pretty foggy-headed. Many people here have had little trouble with that if you hang with a dose long enough before you increase it. 15mg to start was where I started. I would continue taking the 15mg/day dose until the "tiredness" or whatever seems to abate *before* you go up a notch in the dosage FWIW,
Mitch
Posted by mcmud on November 9, 2001, at 11:54:30
In reply to Re: Starting on Topomax for Migraines. Advice anyone? » inky, posted by Mitch on November 7, 2001, at 23:12:02
Hi Inky. I have been taking Topamax for > 6 mos. for phantom pain, in combination w/ amitrip. and hydrocodone. The adage start low, go slow is probably the best advice. I found that 50 mg/day is what I can tolerate without experiencing unacceptable side effects. Tingling of the extremities is common. It is very important to stay well hydrated when taking this drug.
Posted by JohnX2 on November 12, 2001, at 17:41:21
In reply to Re: Starting on Topomax for Migraines. Advice anyone? » inky, posted by Mitch on November 7, 2001, at 23:12:02
Hi,Topomax is one of the few anti-convulsants I have
not tried. I have chronic tension headache and
bruxism and lately was suggested baclofen. But
my older neurologist thouht Topomax may help.
I never got substantial relief from the other
anti-convulsants, but i am currently taking lamictal
and klonopin is the main releaver of my headaches.
When I looked into topomax I saw it worked very
differently than lamictal and it had action at the
GabaA receptor increasing Cl- conductance which is
also what klonopin does. So I was still thinking it
may be good to try, especially given the latest buzz
regarding it being a good adjunct to lamictal.Any thoughts?
Thanks,
john> > Hi,
> >
> > I just started (last night first dose) on Topomax as a migraine prophylaxis.
> >
> > I don't have a history of any psychological disorders. just found this site through a Google search and you guys sound really knowledgeable.
> >
> > I've had migraines for most of my adult life and in the last few months they've become daily occurences. I've been taking Zomig and Ibuprofen to combat attacks -- have tried lots of other meds, too, both preventive and "abortive."
> >
> > My doctor, a headache specialist, recommended Topomax based on some very favorable results in his other patients.
> >
> > I'm a bit worried about side effects. They started me on 15 mg/day to increase by 15 mg each week until either the daily migraines go away or I reach 90 mg/day.
> >
> > I'm not taking any other neurological drugs.
> >
> > I'm a bit worried about the side effects. I do feel a bit groggy today but I don't know if it's from the Topomax. Is this commmon? Does it go away?
> >
> > My doctor mentioned tingling fingers, loss of mental acuity, depression, weight loss (not a negative in my opinion!) and dehydration.
> >
> > Has anyone experienced any of these? I'm particularly worried about the loss of mental acuity and grogginess since I need my brain power! I'm also worried about depression because I've seen what a horrible disease that can be.
> >
> > And I'd like to know if the side effects tend to go away with time. If so, how long does it take?
> >
> > If anyone has any advice, comments, experiences, etc. on taking Topomax for migraines, I'd appreciate it.
> >
> > Thanks!
>
>
> Hi Inky,
>
> It seems that more anti-epielpsy meds are starting to be used for migraine prophylaxis. I know Depakote has been used for that and has an approvable indication for that purpose.
>
> I have tried Topamax for my bipolar. Lots of others here have tried it as well for various things (mostly bipolar disorder). All I can say is that it *can* cause some fairly bad cognitive dulling effects. I wouldn't say that it is all that "depressogenic". As with many meds nowadays you have to start low and go slow with dose increases. I made it up to 50mg/day for a while with other meds added on and I was pretty foggy-headed. Many people here have had little trouble with that if you hang with a dose long enough before you increase it. 15mg to start was where I started. I would continue taking the 15mg/day dose until the "tiredness" or whatever seems to abate *before* you go up a notch in the dosage FWIW,
>
> Mitch
Posted by Mitch on November 12, 2001, at 22:56:23
In reply to Re: Starting on Topomax for Migraines. Advice anyone?, posted by JohnX2 on November 12, 2001, at 17:41:21
>
> Hi,
>
> Topomax is one of the few anti-convulsants I have
> not tried. I have chronic tension headache and
> bruxism and lately was suggested baclofen. But
> my older neurologist thouht Topomax may help.
> I never got substantial relief from the other
> anti-convulsants, but i am currently taking lamictal
> and klonopin is the main releaver of my headaches.
> When I looked into topomax I saw it worked very
> differently than lamictal and it had action at the
> GabaA receptor increasing Cl- conductance which is
> also what klonopin does. So I was still thinking it
> may be good to try, especially given the latest buzz
> regarding it being a good adjunct to lamictal.
>
> Any thoughts?
>
> Thanks,
> john
>John, tension headaches and migraines are quite opposite from each other with regards to vascular effects. Anything that might be effective for migraines might exacerbate tension headaches and vice versa. Tension headaches that I have experienced often involve excess use of stimulants like caffeine for example, while caffeine tends to help migraine sufferers.
As far as AED's go: Topamax and Gabitril were the worst for cognitive side effects that I have experienced. I felt like someone rubbed my forehead down with lidocaine and then slugged me with a large Masonic Bible!
Mitch
>
> > > Hi,
> > >
> > > I just started (last night first dose) on Topomax as a migraine prophylaxis.
> > >
> > > I don't have a history of any psychological disorders. just found this site through a Google search and you guys sound really knowledgeable.
> > >
> > > I've had migraines for most of my adult life and in the last few months they've become daily occurences. I've been taking Zomig and Ibuprofen to combat attacks -- have tried lots of other meds, too, both preventive and "abortive."
> > >
> > > My doctor, a headache specialist, recommended Topomax based on some very favorable results in his other patients.
> > >
> > > I'm a bit worried about side effects. They started me on 15 mg/day to increase by 15 mg each week until either the daily migraines go away or I reach 90 mg/day.
> > >
> > > I'm not taking any other neurological drugs.
> > >
> > > I'm a bit worried about the side effects. I do feel a bit groggy today but I don't know if it's from the Topomax. Is this commmon? Does it go away?
> > >
> > > My doctor mentioned tingling fingers, loss of mental acuity, depression, weight loss (not a negative in my opinion!) and dehydration.
> > >
> > > Has anyone experienced any of these? I'm particularly worried about the loss of mental acuity and grogginess since I need my brain power! I'm also worried about depression because I've seen what a horrible disease that can be.
> > >
> > > And I'd like to know if the side effects tend to go away with time. If so, how long does it take?
> > >
> > > If anyone has any advice, comments, experiences, etc. on taking Topomax for migraines, I'd appreciate it.
> > >
> > > Thanks!
> >
> >
> > Hi Inky,
> >
> > It seems that more anti-epielpsy meds are starting to be used for migraine prophylaxis. I know Depakote has been used for that and has an approvable indication for that purpose.
> >
> > I have tried Topamax for my bipolar. Lots of others here have tried it as well for various things (mostly bipolar disorder). All I can say is that it *can* cause some fairly bad cognitive dulling effects. I wouldn't say that it is all that "depressogenic". As with many meds nowadays you have to start low and go slow with dose increases. I made it up to 50mg/day for a while with other meds added on and I was pretty foggy-headed. Many people here have had little trouble with that if you hang with a dose long enough before you increase it. 15mg to start was where I started. I would continue taking the 15mg/day dose until the "tiredness" or whatever seems to abate *before* you go up a notch in the dosage FWIW,
> >
> > Mitch
Posted by bob on November 12, 2001, at 23:44:58
In reply to Re: Starting on Topomax for Migraines. Advice anyone? » JohnX2, posted by Mitch on November 12, 2001, at 22:56:23
Mitch:
That quote about the lidocaine and the Masonic Bible was absolutely priceless. I have to admit that the cognitive dysfunction arising out of drugs like Topomax in practically unbearable -- at least with my experience.
Posted by Mitch on November 13, 2001, at 9:15:41
In reply to Re: Starting on Topomax for Migraines. Advice anyone?, posted by bob on November 12, 2001, at 23:44:58
> Mitch:
>
> That quote about the lidocaine and the Masonic Bible was absolutely priceless. I have to admit that the cognitive dysfunction arising out of drugs like Topomax in practically unbearable -- at least with my experience.Bob,
I've got comorbid adult ADHD mixed up with bipolarII problems. For whatever reason, it seems that the AED's that affect GABA in some way appear to be the worst ones. I think one of the mechanisms of Topamax is GABA-ergic in some way as well (I might be wrong here). Gabitril was clearly the worst one (it blocks reuptake of GABA). Even with just a 4mg dose, I could go to work and find myself starting things over and over again. When I was taking 500mg/day of Depakote (for nearly two years), I was trying to train somebody at work and I remember her turning around and looking straight at me and saying, "Do you have attention deficit disorder, or something?". That was before the comorbid ADHD dx. I wonder if a lot of other BP's out there are misdiagnosed or the comorbid condition is missed.
Mitch
Posted by AHP on November 13, 2001, at 9:33:30
In reply to Re: Topamax Experiences?, posted by Janice1 on January 4, 2001, at 18:52:01
I won't tell you how many medications that I am on already, but when I added topamax, my life changed for the better. Now it could be that my illness has just gone into a natural remission and it is a coincidence, but since I was diagnosed six years ago as a mixed states, rapid cyclying bipolar I, my life had not been the same. Then topamax came into the picture last year, and I have had the most incredibly pleasant year you can imagine. I am up to 500 mg now, I may go to 600 mg, but eigther way, I am thrilled. I am not embarrassed to admit that it was the answer to some serious praying that I was doing at the time...and even though Topamax may be a stepping stone to my final health plan, I would recommend it to anyone to at least give it a try if NOTHING else is working. I feel like a normal human being again.
Anna
Posted by JohnX2 on November 13, 2001, at 9:48:15
In reply to Re: Starting on Topomax for Migraines. Advice anyone? » JohnX2, posted by Mitch on November 12, 2001, at 22:56:23
Thanks for your feedback.I was getting mad at the neurologist because
he wanted to throw migraine headache medicines
at my tension headaches, and I had absolutely
no symptoms of migraine. Anyways, I did a bit
of research on tension headaches, which are
less vascular, and more related to muscle
contraction spasms. I found that SSRIs can induce
them in an area of the brain where dopamine
counteracts acetylcholine in the stimulation of
the masseter (jaw) muscles. These dopamine neurons
are unique in that they do not contain self
regulating auto-receptors. Their firing is gated
by serotonin receptors (proportional to 5ht-1a
post synaptictic and inversely proportional to
5ht-2a receptors) at the junction and also by
dopaminergic projections from a pool of dopamine
neurons at the VTA where there are other somotodendric
dopamine neurons gated in a similar manner but by
many afferents (it does have the same serotonin
input). The serotonin input can be exacerbated
by stress. Stress can cause greater serotonin
impulses due to interesting cross talk with
the noradrenergic stress center (the locus
coerulus) and all this indirectly can lead to
bruxism and tension headache because of the
goofed up dopamine modulation. In the hypo-dopaminergic
state a dopaminergic med like Adderall makes the
headache go away, so do 5ht-2a antagonists. This
is in the literature and also my experience.
Klonopin slows the firing of those serotonin
neurons and so does buspar, which gives them
potential therapeutic advantages. I was hoping
that maybe Topomax could achieve some of the
same goals as klonopin, but the feedback on it
hasn't been overwhelmingly positive in this
regard.Thanks.
-john
> >
> > Hi,
> >
> > Topomax is one of the few anti-convulsants I have
> > not tried. I have chronic tension headache and
> > bruxism and lately was suggested baclofen. But
> > my older neurologist thouht Topomax may help.
> > I never got substantial relief from the other
> > anti-convulsants, but i am currently taking lamictal
> > and klonopin is the main releaver of my headaches.
> > When I looked into topomax I saw it worked very
> > differently than lamictal and it had action at the
> > GabaA receptor increasing Cl- conductance which is
> > also what klonopin does. So I was still thinking it
> > may be good to try, especially given the latest buzz
> > regarding it being a good adjunct to lamictal.
> >
> > Any thoughts?
> >
> > Thanks,
> > john
> >
>
> John, tension headaches and migraines are quite opposite from each other with regards to vascular effects. Anything that might be effective for migraines might exacerbate tension headaches and vice versa. Tension headaches that I have experienced often involve excess use of stimulants like caffeine for example, while caffeine tends to help migraine sufferers.
>
> As far as AED's go: Topamax and Gabitril were the worst for cognitive side effects that I have experienced. I felt like someone rubbed my forehead down with lidocaine and then slugged me with a large Masonic Bible!
>
>
> Mitch
>
>
> >
> > > > Hi,
> > > >
> > > > I just started (last night first dose) on Topomax as a migraine prophylaxis.
> > > >
> > > > I don't have a history of any psychological disorders. just found this site through a Google search and you guys sound really knowledgeable.
> > > >
> > > > I've had migraines for most of my adult life and in the last few months they've become daily occurences. I've been taking Zomig and Ibuprofen to combat attacks -- have tried lots of other meds, too, both preventive and "abortive."
> > > >
> > > > My doctor, a headache specialist, recommended Topomax based on some very favorable results in his other patients.
> > > >
> > > > I'm a bit worried about side effects. They started me on 15 mg/day to increase by 15 mg each week until either the daily migraines go away or I reach 90 mg/day.
> > > >
> > > > I'm not taking any other neurological drugs.
> > > >
> > > > I'm a bit worried about the side effects. I do feel a bit groggy today but I don't know if it's from the Topomax. Is this commmon? Does it go away?
> > > >
> > > > My doctor mentioned tingling fingers, loss of mental acuity, depression, weight loss (not a negative in my opinion!) and dehydration.
> > > >
> > > > Has anyone experienced any of these? I'm particularly worried about the loss of mental acuity and grogginess since I need my brain power! I'm also worried about depression because I've seen what a horrible disease that can be.
> > > >
> > > > And I'd like to know if the side effects tend to go away with time. If so, how long does it take?
> > > >
> > > > If anyone has any advice, comments, experiences, etc. on taking Topomax for migraines, I'd appreciate it.
> > > >
> > > > Thanks!
> > >
> > >
> > > Hi Inky,
> > >
> > > It seems that more anti-epielpsy meds are starting to be used for migraine prophylaxis. I know Depakote has been used for that and has an approvable indication for that purpose.
> > >
> > > I have tried Topamax for my bipolar. Lots of others here have tried it as well for various things (mostly bipolar disorder). All I can say is that it *can* cause some fairly bad cognitive dulling effects. I wouldn't say that it is all that "depressogenic". As with many meds nowadays you have to start low and go slow with dose increases. I made it up to 50mg/day for a while with other meds added on and I was pretty foggy-headed. Many people here have had little trouble with that if you hang with a dose long enough before you increase it. 15mg to start was where I started. I would continue taking the 15mg/day dose until the "tiredness" or whatever seems to abate *before* you go up a notch in the dosage FWIW,
> > >
> > > Mitch
Posted by Mitch on November 13, 2001, at 12:58:51
In reply to Re: Starting on Topomax for Migraines. Advice anyone? » Mitch, posted by JohnX2 on November 13, 2001, at 9:48:15
>Anyways, I did a bit
> of research on tension headaches, which are
> less vascular, and more related to muscle
> contraction spasms. I found that SSRIs can induce
> them in an area of the brain where dopamine
> counteracts acetylcholine in the stimulation of
> the masseter (jaw) muscles. These dopamine neurons
> are unique in that they do not contain self
> regulating auto-receptors. Their firing is gated
> by serotonin receptors (proportional to 5ht-1a
> post synaptictic and inversely proportional to
> 5ht-2a receptors) at the junction and also by
> dopaminergic projections from a pool of dopamine
> neurons at the VTA where there are other somotodendric
> dopamine neurons gated in a similar manner but by
> many afferents (it does have the same serotonin
> input). The serotonin input can be exacerbated
> by stress. Stress can cause greater serotonin
> impulses due to interesting cross talk with
> the noradrenergic stress center (the locus
> coerulus) and all this indirectly can lead to
> bruxism and tension headache because of the
> goofed up dopamine modulation. In the hypo-dopaminergic
> state a dopaminergic med like Adderall makes the
> headache go away, so do 5ht-2a antagonists. This
> is in the literature and also my experience.
Aha! So, that's why I grind my teeth and get headaches from Zoloft. That is interesting about the 5-HT2a antagonists. Maybe you ought to pitch some Serzone in there (if you are not already)? I noticed that when I took Serzone I had greatly reduced *agitation* and restlesslness and didn't experience any headache or stomach upset (at low doses). The trouble with Serzone was mild pruritis and amyblyopia (big time-had difficulty reading).
Maybe a little Serzone with a little Adderall in combination with a mood stabilizer?? Hmm.Mitch
Posted by JohnX2 on November 13, 2001, at 18:31:22
In reply to Re: Starting on Topomax for Migraines. Advice anyone?, posted by Mitch on November 13, 2001, at 12:58:51
Guess what Mitch,The paper discussing this phenomena was
specifically siting cases of Zoloft! I can
send you a print if you send me an email address.It recommended buspar as one anti-dote, another
is a 5ht-2a antagonist. It suggested Serzone (which
worked great for me) or possibly Remeron (not quite
great). Didn't mention atypical anti-psychotics, but
I believe that a dabble of zyprexa et. al may do the
trick to.The future of the serotonin drugs are either stand alone
SSRIs with *clean* 5ht-2 antagonism (not dirty like serzone)
and/or an SSRI with a mixed in clean 5ht-2 antagonist.
Get rid of those potential rls,eps,sexual dysfunction,
tension headache,agitation, side effects...
But what pharmaceutical company will win this horse
race? Tell me and I'll buy the stock!
There are from what I understand clean (selective)
5ht-2a antagonists in the pipeline and with celexa and
prozac going off patent I could see those manufacturers
bundling the clean 5ht-2a meds with the generics in one
pill....-john
> >Anyways, I did a bit
> > of research on tension headaches, which are
> > less vascular, and more related to muscle
> > contraction spasms. I found that SSRIs can induce
> > them in an area of the brain where dopamine
> > counteracts acetylcholine in the stimulation of
> > the masseter (jaw) muscles. These dopamine neurons
> > are unique in that they do not contain self
> > regulating auto-receptors. Their firing is gated
> > by serotonin receptors (proportional to 5ht-1a
> > post synaptictic and inversely proportional to
> > 5ht-2a receptors) at the junction and also by
> > dopaminergic projections from a pool of dopamine
> > neurons at the VTA where there are other somotodendric
> > dopamine neurons gated in a similar manner but by
> > many afferents (it does have the same serotonin
> > input). The serotonin input can be exacerbated
> > by stress. Stress can cause greater serotonin
> > impulses due to interesting cross talk with
> > the noradrenergic stress center (the locus
> > coerulus) and all this indirectly can lead to
> > bruxism and tension headache because of the
> > goofed up dopamine modulation. In the hypo-dopaminergic
> > state a dopaminergic med like Adderall makes the
> > headache go away, so do 5ht-2a antagonists. This
> > is in the literature and also my experience.
>
>
> Aha! So, that's why I grind my teeth and get headaches from Zoloft. That is interesting about the 5-HT2a antagonists. Maybe you ought to pitch some Serzone in there (if you are not already)? I noticed that when I took Serzone I had greatly reduced *agitation* and restlesslness and didn't experience any headache or stomach upset (at low doses). The trouble with Serzone was mild pruritis and amyblyopia (big time-had difficulty reading).
> Maybe a little Serzone with a little Adderall in combination with a mood stabilizer?? Hmm.
>
> Mitch
Posted by Mitch on November 13, 2001, at 23:35:31
In reply to Re: Starting on Topomax for Migraines. Advice anyone? » Mitch, posted by JohnX2 on November 13, 2001, at 18:31:22
>
> Guess what Mitch,
>
> The paper discussing this phenomena was
> specifically siting cases of Zoloft! I can
> send you a print if you send me an email address.John, thanks for the feedback, but I really don't need *that* much detail :)-I am on the computer enough as it is (between the web and my work!-eek, that sounds a little macabre somehow).
>
> It recommended buspar as one anti-dote, another
> is a 5ht-2a antagonist. It suggested Serzone (which
> worked great for me) or possibly Remeron (not quite
> great). Didn't mention atypical anti-psychotics, but
> I believe that a dabble of zyprexa et. al may do the
> trick to.Well, can't do Remeron or Buspar due to the alpha-2 antagonist induced irritability (more "dirty" meds hitting receptors like a pin-ball game). If I went back on Serzone I would have to put up with some itching and difficulties seeing/reading, plus it is not very "liver-friendly", either.
>
> The future of the serotonin drugs are either stand alone
> SSRIs with *clean* 5ht-2 antagonism (not dirty like serzone)
> and/or an SSRI with a mixed in clean 5ht-2 antagonist.
> Get rid of those potential rls,eps,sexual dysfunction,
> tension headache,agitation, side effects...
> But what pharmaceutical company will win this horse
> race? Tell me and I'll buy the stock!
> There are from what I understand clean (selective)
> 5ht-2a antagonists in the pipeline and with celexa and
> prozac going off patent I could see those manufacturers
> bundling the clean 5ht-2a meds with the generics in one
> pill....
>
> -johnProbably what is going on there is just bottom-line economics (not that I disapprove-they are also rolling bucks into the *new* stuff). When we start to see the patents expiring for Zoloft, Paxil, and Celexa-THAT is when we will probably see the meds you are talking about start "coming to the surface". If you can make an SSRI tolerable-wow that's where the money would be.
Mitch
> > >Anyways, I did a bit
> > > of research on tension headaches, which are
> > > less vascular, and more related to muscle
> > > contraction spasms. I found that SSRIs can induce
> > > them in an area of the brain where dopamine
> > > counteracts acetylcholine in the stimulation of
> > > the masseter (jaw) muscles. These dopamine neurons
> > > are unique in that they do not contain self
> > > regulating auto-receptors. Their firing is gated
> > > by serotonin receptors (proportional to 5ht-1a
> > > post synaptictic and inversely proportional to
> > > 5ht-2a receptors) at the junction and also by
> > > dopaminergic projections from a pool of dopamine
> > > neurons at the VTA where there are other somotodendric
> > > dopamine neurons gated in a similar manner but by
> > > many afferents (it does have the same serotonin
> > > input). The serotonin input can be exacerbated
> > > by stress. Stress can cause greater serotonin
> > > impulses due to interesting cross talk with
> > > the noradrenergic stress center (the locus
> > > coerulus) and all this indirectly can lead to
> > > bruxism and tension headache because of the
> > > goofed up dopamine modulation. In the hypo-dopaminergic
> > > state a dopaminergic med like Adderall makes the
> > > headache go away, so do 5ht-2a antagonists. This
> > > is in the literature and also my experience.
> >
> >
> > Aha! So, that's why I grind my teeth and get headaches from Zoloft. That is interesting about the 5-HT2a antagonists. Maybe you ought to pitch some Serzone in there (if you are not already)? I noticed that when I took Serzone I had greatly reduced *agitation* and restlesslness and didn't experience any headache or stomach upset (at low doses). The trouble with Serzone was mild pruritis and amyblyopia (big time-had difficulty reading).
> > Maybe a little Serzone with a little Adderall in combination with a mood stabilizer?? Hmm.
> >
> > Mitch
Posted by JohnX2 on November 14, 2001, at 3:06:46
In reply to Re: Starting on Topomax for Migraines. Advice anyone? » JohnX2, posted by Mitch on November 13, 2001, at 23:35:31
> > It recommended buspar as one anti-dote, another
> > is a 5ht-2a antagonist. It suggested Serzone (which
> > worked great for me) or possibly Remeron (not quite
> > great). Didn't mention atypical anti-psychotics, but
> > I believe that a dabble of zyprexa et. al may do the
> > trick to.
>
> Well, can't do Remeron or Buspar due to the alpha-2 antagonist induced irritability (more "dirty" meds hitting receptors like a pin-ball game). If I went back on Serzone I would have to put up with some itching and difficulties seeing/reading, plus it is not very "liver-friendly", either.
>
I concur about the Remeron and Buspar a2 antagonism.
Neither helped as much as I would have liked.
The a2 antagonism increases the noradrenaline
conductice in that stress center that connects
to the serotonin path. So I think it counteracts
the 5ht-1a agonist in buspar and/or 5ht-2 antagonism
in Remeron.I've always wondered if buspar would have been
a better anxiolytic w/o the alpha-2 side effect.
It incidently probably helped sales as people
discovered at the high dose of 60 mg it had some
antidepressant effect likely due to this.PS. What is your current med cocktail?
Is it mainly Zoloft? I it would be novel to meet
someone on pbabble who was humming along on
1 ssri med. ;)Regards,
John
Posted by JohnX2 on November 14, 2001, at 3:18:21
In reply to Re: Starting on Topomax for Migraines. Advice anyone? » Mitch, posted by JohnX2 on November 14, 2001, at 3:06:46
Whoops Mitch, sorry I forgot about our other threads.
My bad. good luck with your meds. Hard to keep
track of everyone I have been in contact with
lately. I have taken so many meds over the past
3 years and learned so much. I wish these brain
cells were storing memories about traveling,
fun,relationships...but unfortunately they encode
psychopharmacology. Hopefully I can spare a few
of you from wasting brain cells on this with
some answers the pdocs don't readily provide.-john
> PS. What is your current med cocktail?
> Is it mainly Zoloft? I it would be novel to meet
> someone on pbabble who was humming along on
> 1 ssri med. ;)
>
> Regards,
> John
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