Something my prescriber said during our conversation the other day, about what to do next with my meds, really stood out to me and I’ve been mulling it over ever since. She said that in her experience, that folks who tend to react well to the meds I react well to (tricyclic antidepressants) tend to need to keep taking them. She theorized that this class of medications acts in relation to a variety of chemicals in the brain, and so for someone like me, with a little handful of issues (anxiety/depression/ADHD), maybe it was just a good fit.
I’d tapered off of mine, partially because I was curious to see if I still “needed” them. The first thing I learned, once I got down to zero, was that indeed, I do need to keep taking mine (nortriptyline) in order to manage my migraine disorder. Just 10mg a day of my tricyclic and my migraines are completely non-existent. My migraines were particularly intrusive into my life – for the past several years, instead of getting regular ol’ migraine headaches, my migraines have manifested as “vestibular migraines”. Vestibular migraine is a particular flavor of migraine that blesses you with vertigo. So the upside is, no pain from a headache, the downside at least for me was being completely sidelined by vertigo nearly 24 hours a day, and unable to work, for weeks to months if unchecked. The other symptom that had me down for the count was severe cognitive impairment. I’ve been reading up on something called “confusional migraine” recently, apparently a new category of migraine that is being researched and identified. I may fit into this category also.
But of course I also hoped that maybe I just didn’t need to treat my anxiety/depression with medication. I don’t know why, exactly. I think maybe I just wanted to remember what it was like…maybe hoped that with less change in my life that “things” may have settled down (despite my lifelong history with disruptive anxiety and depression symptoms). Maybe I just needed a reminder. I also didn’t like the side-effects of my medication and thought there might be something “better” out there. I suppose there maybe be some other way to mitigate my issues…but when I was not taking the medication, honestly, it was just so hard to even try anything else. The white noise returned, a constantly provoked state where depression and anxiety battled for prominence in my consciousness. It was a battle to complete normal daily things like get up, get bathed, get dressed. Nevermind try to make choices about how to combat how I was feeling. I tried – I would drag myself to exercise my dogs, or to exercise myself in at least some small way, or attempt to redirect my thinking in my positive directions. I tried focusing on making plans, giving myself small things to look forward to. But I didn’t even know what mental state to expect each day. It all came back to me so clearly. Yes, I used to function this way all the time, but my god, what a lot of work it was.
Knowing this, however, didn’t temper my disappointment. I told my prescriber this – that I was just hoping I might be able to function without it. She was very understanding. She said “well you wanted to try it and you hoped it would work, it’s natural to feel disappointed”. I’m trying to decide if I feel like maybe I failed. I’m still processing that idea. I’m not sure that I do. I think I’m just disappointed.
Even in my disappointment though, I appreciate that with such a small change in dosage, I feel so much better. And I agreed that, since the nortriptyline works SO well for my disabling migraine symptoms, I should maybe try fine tuning the dosage on that, instead of starting with something new. Though I haven’t been tested in any way, it’s pretty clear from my reactions to drugs that I must be a very slow metabolizer. Before I tapered off, I was at a whopping 25mg for a drug whose therapeutic dosing levels for adults is generally considered to be between 75 and 100mg. I’d tapered down to zero from 25mg…which brought on a recurrence of the migraine process, so I went back up to 10mg. My prescriber and I talked about bumping me back up to 20mg just to see if the side-effects I was experiencing at 25mg were avoidable at that level…and that if the side-effects popped back up at that levels I could go down to 15mg. Well I went up to 20mg a couple of days ago and the side-effects seem to be mostly non-existent. I mean yes, my thinking does seem a little slower…but not as slow as at 25mg…and what I now realize is that without a little bit of that slowing, I was completely overwhelmed. My god, the static that my mind’s activities create when left to their own devices. I truly understand now why nortriptyline is said to be beneficial for some folks with ADHD. At this dosage, I feel like I’ve got my foot on the breaks very lightly, and I feel more in control, where 25mg just made me feel kinda dumb and unable to react with my usual wit (my prescriber called it cognitive blunting). 10mg clearly wasn’t giving me enough control over the vehicle. This 15mg to 20mg range seems good though. Yes, disappointment…but I feel much better informed having had this experience, and comfortable with how I feel in my brain right now. And it’s funny how what was a side-effect, at this lower dosage, has become a benefit.
Making such small changes makes me wonder how many other folks out there might really benefit from a more subtle approach to using medications. So many prescribers are out there swinging chemical baseball bats around at people’s heads. Lower dosages, smaller changes…I bet a lot of people might feel differently about medications if they had this experience that I just had. Medications aren’t necessarily the approach that everyone might want to take, of course, I get that, I respect that. But how many folks have formed their opinion of medications on an experience where they maybe only tried one or two, and the dosages were too high and made them not feel good? Where their prescribers put them on dosages that were initially too high and then never lowered, to see what might happen, before discontinuing the medication?
I just keep thinking about “people like me” reacting well to certain types of medications…while other people perhaps react better to other medications. I’m excited to see what the future holds in terms of what they may discover about matching individuals up more effectively with the “right” medication for their “type”. Removing some of this guess work could be so helpful to so many.