Dr. Bob's Psychopharmacology Tips

Treatment of antidepressant-induced headaches

Date: 14 Nov 95 10:59:46 EST
From: Raymond Behr <71514.3051@compuserve.com>
Subject: Nortriptyline for antidepressant-induced headaches

Nortriptyline -- low dose of 10 mg -- works wonders when added to SSRIs or Effexor (venlafaxine) for medication induced migraine type headaches.

Date: Tue, 14 Nov 1995 22:49:43 -0800 (PST)
From: "J. Wynn" <jdwynn@u.washington.edu>
Subject: Verapamil for antidepressant-induced headaches

Another thing to try is Verapamil SR 120 mg, cut in half and taken BID. Yes, cut the SR in half and take it BID.

Date: Wed, 15 Nov 1995 03:11:48 EST
From: MWKR59A@prodigy.com (Dr Frederick C Goggans)
Subject: Pindolol for SSRI-induced migraines

Why not try adding Visken (pindolol) to the SSRI since it could potentiate the antidepressant effect as well as help with the migraine since it is a beta blocker? I have had some success with this approach.

Date: Mon, 05 Aug 1996 12:57:29 -0400
From: "Samuel L. Kent" <samkent@eznet.net>
Subject: Imipramine for SSRI-induced migraines

I have had one patient with presistently (after the first week and longer) exacerbated migraine related to SSRIs. She was able to tolerate and benefit from sertraline 150 mg/day when 50 mg of imipramine was added at bedtime.

Date: Mon, 05 Aug 1996 11:38:03 -0700
From: "Jonathan A. Slater, M.D." <jas14@columbia.edu>
Subject: Carbamazepine for SSRI-induced migraines

I might consider treating with carbamazepine for both migraine prophylaxis and mood stabilization and then consider adding back the SSRI. Watch CBZ levels becuase it is metabolized via P450 3A4, which is inhibited by fluoxetine, sertraline and fluovoxamine. I have heard that venlafaxine is less likely to inhibit 3A4.

Date: Mon, 05 Aug 1996 14:48:55 -0400
From: "Samuel L. Kent" <samkent@eznet.net>
Subject: Sumatriptan for antidepressant-induced migraines

Of related interest: Blier P, Bergeron R. The safety of concomitant use of sumatriptan and antidepressant treatments. J Clin Psychopharmacol, 15: 2, 1995 Apr, 106-9.

It is presently contraindicated to use the antimigraine drug sumatriptan with selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, or lithium. Consequently, many patients undergoing these pharmacotherapies for psychiatric disorders may not benefit from the therapeutic effect of sumatriptan in acute migraine attacks. Because sumatriptan does not appear to cross the blood-brain barrier and has a short half-life, it was deemed relatively safe to prescribe sumatriptan with antidepressant treatments.

Fourteen patients receiving fluoxetine, fluvoxamine, sertraline, moclobemide, lithium, or buspirone did not experience significant side effects when they took oral sumatriptan for the relief of migraine on a total of 103 episodes. It is concluded that the combined use of sumatriptan with the above-mentioned antidepressant treatments may be safe.

Date: Mon, 5 Aug 1996 17:28:50 -0700
From: Raymond Behr <raybehr@sprynet.com>
Subject: Sumatriptan for antidepressant-induced migraines

I have a patient currently who uses sumatriptan -- it is extremely helpful in ending her migraines but each time she uses it she has brief hypomanic episodes (lasting no more than 2-4 hours). She has a history of severe depression (with similar brief hypomania prior to being placed on mood stabilizers) and is currently using carbamazepine, lithium and venlafaxine.

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