Anxiety / Medications

When the meds stop working: What’s next?

I have read other people’s stories about their psychotropic medications crapping out on them, but until now, I didn’t know that experience first hand.

I started taking nortriptyline almost three years ago, ironically, not for a mental health condition but to treat a disabling vestibular migraine disorder. Instead of getting classic migraine headaches, like I used to, I had started to have nearly constant vertigo, a less common manifestation of migraine. When you see those commercials about people with “chronic migraine”, I’m one of those people – except instead of being in pain, I’m trapped on the couch with severe vertigo, and rendered mentally non-functional by an accompanying brain-fog/cognitive impairment. After a miserable process of having doctors treat me like I was making it all up, the fantastic neurologists at Massachusetts General Hospital were able to identify my problem. They prescribed nortriptyline, a drug known to be effective in preventing migraine of this type, and of course, it is also an old tricyclic antidepressant. They were rather proud of themselves for coming up with an option for me that might also have a beneficial effect for my generalized anxiety disorder.

For most of three years, it’s been fantastic. It keeps me migraine vertigo free about 95% of the time, and indeed, at the small dose required for the migraine treatment it took the edge off of my near constant anxiety.

I worried as winter approached, in October, that seasonal depression might come out to play again (it does that sometimes) but instead, November hit, and a weird thing happened. My anxiety came back. And not a situational, reactive type of anxiety, but the nasty, grinding, white-noise kind that the nortriptyline had shielded me from since 2010. Talked to my doc, he raised my dosage just a tiny bit, but before I could pick up the prescription, the vertigo walked in and crumpled me up again. In the past few years I have learned that the vertigo does have a trigger – stress – and indeed, I had been very stressed out. I started taking the higher dose, but then started having a problem with low blood pressure (which also could have been caused by a Magnesium supplement I was taking), so we discontinued the higher dose and went back to the original dose. Things were fine through December and January…but now that cruddy anxiety is back.

And it’s aggressive. And the primary source of the stress I was having in the Fall is no longer a factor so – what the heck. I think it’s just not working anymore. I don’t know what I’ll do about it yet, other than contact my prescriber and talk it over. I DO know that I can’t continue to have anxiety nightmares, annoying OCD tics and compulsions, and waking up with my entire body exhausted from being clenched from tip to toe every night. Grinding my teeth all day is giving me a wicked headache…and I know from experience that I have never been able to manage this type of anxiety without chemical intervention before.

Sigh.

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