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Any experience with Remeron/Mirtazapine or an SSRI??


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#41 findacureformyson

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Posted 16 September 2011 - 01:53 AM

My son has Hppd and his DR has put him on Prozac....she seems to know nothing about Hppd and Im scared it may make his worse... anyone taken Prozac, and had positive or negative effects???? He has been on 10m for two months and was raised to 20m but freaked out so now he is back on the 10m. Along with .5 kolonipin.

#42 findacureformyson

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Posted 16 September 2011 - 02:00 AM

My son has Hppd and his DR has put him on Prozac....she seems to know nothing about Hppd and Im scared it may make his worse... anyone taken Prozac, and had positive or negative effects???? He has been on 10m for two months and was raised to 20m but freaked out so now he is back on the 10m. Along with .5 kolonipin.

He is also taking Gabbapinten

#43 rollingregret

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Posted 18 November 2012 - 01:37 AM

The real trick is understanding what has gone wrong for an individual – let alone a whole community.


So now that I've started on Gapabentin to deal with the muscle tension and heightened physical anxiety (combination of benzo wd and my original HPPD constellation), I've found it to have promise (still at a low dose - 600 TID). Nevertheless, I am both skeptical about whether it can cause a total return to my pre-klonopin cutting experiment state (i.e. effective "curing" of my symptoms) as well as leery of the weight gain side effect. It's too soon to really assess the latter, but I've been working out and dieting like a mad man for the three weeks I've been on it and whereas this would have resulted in a significant body fat reduction previously, I have either stayed the same or gained a bit. I can only imagine what would happen if I hadn't been rabid about my habits. I know some people will say "what do a few lbs matter", but klonopin didn't cause me any weight gain and so I'm used to a solution where I'm comfortable "being me" both mentally and physically.

Anyway, to the point: I'm debating alternatives already (even though I'll give this at least 6 weeks).

There's an SSRI and Keppra. My clinic doc says that SSRIs, specifically Zoloft is the top choice for anxiety and has the least weight gain potential. Why is anxiety important? Cuz my symptoms are muscle tension and a hyper-excited CNS. I'm pretty used to my visuals, don't really care at this point, although for the record, klonopin vastly reduced them.

I then read online (maybe not the best way to get definitive stats) that many people gain weight on Zoloft -- more than I would expect based on my doctor's claims. For example, if you saw that people were gaining 40 lbs on Keppra, you'd be surprised that a large % of people on boards were reporting that given it's just not know for weight gain (perhaps the opposite). Ok, so now I'm doubting both the efficacy, appropriateness and side effects aspects of Zoloft.

Keppra -- Lot of positives on the boards lately about it. Like gabapentin, may work, may not, I have no idea what the stats are there, although many people get at least decent relief from gabapentin (anecdotally).

Back to Zoloft. Why is an SSRI bad for HPPD (as stated in this thread)? I'm guessing because it causes more serotonergic activity and HPPD is related to a class of these receptors. My impression was that there is LESS serotonergic firing amongst a group of inhibitory neurons causing the "noise" blocking mechanism to diminish. Anyway, I'm well aware that there are different types of the same receptor, in different parts of the brain, doing different things, so it's complex. Thus, the rationale for why SSRIs are bad must be experiential, right?

Also, to Visual's point, we're all dealing with overlapping issues. I think the majority here have visuals without physical symptoms (the DSM IV definition of HPPD). Some though have anxiety (psychologica), DP/DR and a mixed bag. So different meds are going to work/not work as they're treating different things. Overall klonopin seems to work best because it's the best storm calmer out there. I figure GABA's inhibitory effects > inhibiting whatever channels Keppra and Gabapentin inhibit.

Yes, but it is more of an indirect help. Instead of reducing afterimages, trails, and what not, I just feel a reduced need to fixate on them. I seem to be able to shit my attention easier. In turn then things have gotten better.


I think Gill has a similar situation to me in that the biggest thing klonopin did for me was to immediately eliminate all the ancillary symptoms (I would classify them as physical, post-hoc). This removes the association of discomfort with visuals and they become, as the people who naturally adapt to HPPD suggest, part of your reality. I can't say that my attention has been shit more easily though ;) .

So, the fact that Zoloft helped him leads me to the question of whether it is effective against anxiety and anxiety-related pathways. It is, of course, used for this, but the question lies in identifying what exactly is causing my hyper-excited CNS (to the point where I have head pressure, muscle tension, panick-attackish tunnel vision). If I had psychological anxiety, it would be pretty evident, but I don't. This is an unusual case of having the physical without the psychological.

Sorry to make this long-winded, but given the aforementioned doctor's view re: Zoloft -- why is it not discussed here as an effective solution to HPPD-related symptoms since many of us suffer from anxiety-based pathologies?
Is it simply cuz Zoloft sucks at anxiety itself or that most HPPDers just don't have anxiety? If Klonopin works so well and doesn't exacerbate the visuals (at the very least), while affecting serotonin to some degree (as well as dopamine, glutamate through GABA), why aren't SSRIs a popular choice?

Thanks for the info -- seeing my pdoc in 2 days and would love to have some HPPD perspective!

rollin

#44 Visual

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Posted 19 November 2012 - 01:22 PM

As far as weight gain (or loss), in general terms anti-seizures tend to reduce appetite. On the other hand, anxiety burns calories yet leads a person to eat more for emotional comfort. So it is difficult to say how a person will react ... complex, complex, complex.

One of the biggest tricks in keeping appetite down is to eat plenty of protein. It is not just vitamins and supplements ... protein. If one is to pick a diet, then choose Zone although it is difficult. Also, Zone tends to emphasize under-calorie for longevity (life extensionism) - but ditch that for now. Work for 30/30/40. Add starvation if you want later, lol. Again, if protein if low, you will never end cravings. Unfortunatly there is nothing quite as tasty as a big bowl of pasta or pizza.


Stimulant neurotransmitters tend to reduce appitite (dopamine, norepinephrine, epinephrine). Whereas serotonin is relaxing (hence can be good for treating anxiety) is historically a weight gainer.


There is a logic to trying an SSRI since with some HPPDers there is evidence of serotonin receptor changes. Yet it doesn't have much tract record for helping HPPD itself. Dopamine meds don't have a tract record either but they don't even have a history yet ... they have rarely been tried (whereas doctors love to hand out SSRIs). Since on the surface it doesn't make sense to give a stimulant to someone with anxiety ... that is another reason most docs don't think of trying them.

Neurotransmitter "balance" is key for each brain system. Unfortunately how each system is affected with HPPD varies - if a system is even affected at all. So you try to balance one and then get side-effects of imbalance elsewhere. SSRIs would be a problem is you have plenty of serotonin anyway. So people like me, Zoloft gives bad anxiety, and Sinemet cuts anxiety even though it is a stimulant. OCD is often treated with an SSRI, so you care less about fixation.

As far as gabapentin for HPPD, IMO it is an assistant med to be used in combination with others.

It is good you are trying stuff anyway. Chronic anxiety is damaging to the brain and needs to be addressed ahead of HPPD (visuals). The trick is to treat both :P

#45 rollingregret

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Posted 20 November 2012 - 05:14 PM

Great post Visual, very informative as always.

As you said, I have to treat both. The complicating matter is that my HPPD and anxiety are linked in two ways:
1) my visuals and physical symptoms started simultaneously (so it wasn't exactly apparent until recently that I actually had an anxiety-related problem -- just "HPPD")
2) the physical symptoms, which I lump under chronic anxiety have really come about after my attempted benzo reduction so they're at least in part a result of benzo wd (which artificially causes anxiety symptoms if you know what I mean)

Anyway, as I'm trying new meds, just went up to 900mg TID Gabapentin today. You say it's best as an adjunct. Quite right and even though my klonopin dose seemed to have reached a plateau in efficacy (for whatever reason), gabapentin seems to be potentiating it or getting it to work again (so in essence acting as an adjunctive therapy).

My questions, which you answered, regarding SSRIs were of course trying to explore alternative treatments so that I can circumvent the weight (fat) gain I've notice even with a super strict diet and lotssss of exercise. As for diet, since I do mostly resistance training (with cardio in the way of hockey, soccer), I already have a protein heavy diet. Since I've been very health conscious and active (off and on...we all slack a little) for a decade (since my adolescent metabolism abandoned me), I know exactly how to lose a certain amount of fat in a certain time frame. The equation has changed now with this altered metabolism so I find even that even eating a low % of carbs, the only solution to curb the cravings or even just keep the fat gain at bay is with thermogenic stimulants, which goes COMPLETELY contrary to my efforts to fix my mental health issue. Catch-22.

I guess you're also suggesting that Zoloft is likely to cause weight gain (and it is mentioned as a possible side effect although for some reason I get the impression it's the least offending of the ADs).

I wonder why MDMA causes a complete if not extreme loss of appetite if it increases (massively) serotonin. Perhaps because it also enhances dopamine release, but I thought that was secondary.

I think my best best is with Keppra IF it works for me. I know your particular set of circumstances prevented a positive outcome. Perhaps I will have Rene's response to the med. Apparently it's not prescribed much in Canada. My new pdoc (who has finally been helping me get my life back) had never prescribed it and wasn't very familiar with it when I mentioned it as an alternative, yesterday. I would have thought that to treat bi-polar, seizures, etc., it would be quite common. Thankfully she's giving it a look see (can't tell you what a relief it is to be seeing a real open-minded professional). I also spoke to a pharmacist and my M.D. friend who's been on rotation for a year (one of my MD friends who I think is deserving of the title...there are some who I worked with in academia who I am frightened to know have a medical degree). They said the same about Keppra -- not often prescribed outpatient as far as they were aware/hadn't heard much about it.

It also might not be available as leviteracetam, only branded, which could suck big time. Anyway, that all depends on how my gabapentin treatment progresses and whether my new psychiatrist is in favour of it. It would be sweet to be on a drug that treats the anxiety, reduces visuals AND suppresses appetite.

#46 -mg

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Posted 20 November 2012 - 10:15 PM

It seem to me that it would be easier/better to fine-tune your meds if you were to use a DNRI (bupropion) and a SSRI (celexa, lexapro) than a SNRI (effexor).
Kind of off the topic but, I would sort of put Zoloft (even though it is just an SSRI) in the same category of Prozac (SSRI), Zoloft & Effexor, etc. [in terms of effectiveness].
It seems that 1 out of 10 Paxil/Zoloft works. While Celexa and Lexapro seem to be 3-6 out of 10 effective.
Prozac is virtually first-in-class-SSRI so in some ways you could say that many strides have been made since its first appearance on the market.

#47 Visual

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Posted 21 November 2012 - 02:04 PM

I wonder why MDMA causes a complete if not extreme loss of appetite if it increases (massively) serotonin. Perhaps because it also enhances dopamine release, but I thought that was secondary.

MDMA affects many neurotransmitters. Perhaps serotonin reputation for weight gain is mainly that it has a sedentary/relax effect (pre-sleep - which is the time it is naturally most dominant)

You may find tricyclics interesting to work with. Myself, I don't tolerate Zoloft (gives anxiety) and Lexapro mainly just increased my need for dopamine (doubled Sinemet). But tricyclics are often better tolerated by "Parkinsons type people" than SSRI (though there is no hard, fast rule).

Brief antidepressant history: MAOIs are an early class of antidepressants. They are most effective ... but there can be bad reactions when eating certain types of food. Then came Tricyclics. No reaction but more side-effects. Then Prozac (SSRIs) which have less side effects. However they are the least effective of the lot - but you know how it is when the "new boy comes to town".

I find Imipramine (tricyclic ... the predecessor to amitriptaline) to be decent. Only used it a little, but its antidepressant effect works within hours (not 2 months) so can PRN it. Of course this is about antidepressants ... which isn't what your are after.

Perhaps the "mix" of increasing several transmitters is key (which is what you did with MDMA). At this points I'm starting to babble too much ... :o

Best of success!

#48 415_STYLEE

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Posted 27 November 2012 - 05:55 PM

Well, you never know until you work with a doc and try things. Have you tried Keppra? What else besides Zoloft and Reboxetine have you tried?


It was a long time since I wrote in this thread, hardly remember it..
I´ll get Keppra soon. I´m currently on 300 mg Wellbutrin, an NDRI, mainly to combat my ADHD. It isn´t working now though. Why I bashed all Dopaminergic substances I can´t remember. Wellbutrin has not affected my HPPD at all, save for the setting in period where visuals flared up to corresponding 25% of an acid trip (melting walls and stuff).

Since you seem very well versed in the subject, do you think if Keppra could keep down the visual increase which Concerta (Methylphenidate) is known to cause? I´m seriously thinking of quitting Wellbutrin which doesn´t make me focused or lowers my ADHD caused aggression anymore. Concerta is known to be a lot more effective.. And I have a green light for it in my diagnose papers "perscribe with special consideration and monitoring regarding increases in HPPD and signs of mood shifts (bipolarity)".
Think Keppra and Concerta would make a good combo for me?

#49 rollingregret

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Posted 28 November 2012 - 08:06 AM

Seems like a bunch of people starting/recently started Keppra with mixed success so far. I'm seeing my pdoc tomorrow, might be starting it as well although all this uncertainty has given me pause. I'm not sure if there's any conclusive anecdotal evidence on this board that Keppra helps visuals significantly or even to some degree in everyone. I guess it's one of those trial and error things. Personally I think if there are fewer drugs that could help you overall, it's the best route. Ocham's razor and all. That said, if you need Concerta, the only meds that I have heard (experienced one) reduce visuals are klonopin (reduced them for me) and Keppra.

#50 Visual

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Posted 28 November 2012 - 03:31 PM

Seems like a bunch of people starting/recently started Keppra with mixed success so far

This is great because we learn more about our disorder. And for the few that it helps ... fantastic!

I´m currently on 300 mg Wellbutrin, an NDRI, mainly to combat my ADHD. It isn´t working now though.

Did it used to work? And if so, what benefits did you have.

...do you think if Keppra could keep down the visual increase which Concerta (Methylphenidate) is known to cause?

First, are you on Cencerta/Ritalin or have taken it in the past?

Second, haven't read experiences about how this med affects HPPD ... and would appreciate any info on this.

Since it works mainly with DAT and NET, it might not be directly helpful for HPPD since HPPD is considered more a problem in the cerebral cortex (which isn't as much affected by DAT). Any med that inhibits a neurotransmitter reuptake (such as Ritalin with DAT) will cause the brain to counter-react by reducing the amount of the neurotransmitter it produces (dopamine and NE in this case). Even though the brain does this, there will still be a net gain in the activity of the neurotransmitter.

Now with this in mind, it could be possible that when the brain reduces dopamine because of reuptake inhibition, the cerebral cortex suffers further disinhibition making symptoms worse - since it is a system needing dopamine but not using DAT very much.


As for Keppra, it is of a class of drugs called Racetams. Racetams work primarily at the junction of glutamate receptors and cholinergic receptors. http://en.wikipedia.org/wiki/Racetams So one of the relevant effects for HPPDers is its effect on acetylcholine. As mentioned before, there is a balance between acetylcholine and dopamine in many neural systems.

For me, Keppra will briefly improve DR (and muscle spams) ... then brain compensates ... then need more ... then brain compensates more ... then when I stop, it takes about a week to 'recover'. It trashes my memory, but some have reported the opposite.

In the end it is something to try. Hope this was helpful even thought it was rather non-commital, :D

#51 415_STYLEE

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Posted 30 November 2012 - 11:04 AM

Wellbutrin worked for a few months in the beginning. My fits of rage became almost non-existent, sense of time got normalized, had better focus and concentration. Sleep was a bit better too.
Not to mention the blocking of the nicotine receptors, which literally erased my addiction to nicotine. After those months all began to creep back. Craving for nicotine, loss of focus & concentration, rage, all got back to what it was before I started Wellbutrin. Like it stopped to latch on to my receptors at all.

I have not had Concerta/ Ritalin before, since doctors usually perscribe in this order; 1:Wellbutrin or Strattera 2:Concerta/ Ritalin.
Methylphenidate is known to be more effective for ADHD, but it makes HPPD symptoms worse too. There are some similarites between Bupropion and Methylphenidate, both having a NDRI effect. But Methylphenidate also acts as a releasing agent for DA and NE.
I talked with some people in the old forum who had used Ritalin and said it made the HPPD much worse. Though I don´t know if these people had diagnosed ADHD (memory failure..)
A thesis is that people with ADHD have less receptors for DA/NE and also less release of these neurotransmitters. Some doctors estimate this system to be at 40% functionality in a ADHD person, compared to 100% functionality in a healthy person. Which also means that these type of drugs has a different effect in an ADHD brain.
So, maybe it won´t increase visuals for me? For people with ADHD and bipolar they also add a "mood stabilizer" usually a anti-EP drug such as Ergenyl, Carbamazepine, Lamictal and even Keppra. Like speeding up and then limiting the speed to a perfect level.. This could also negate the HPPD increase from Methylphenidate, possibly.
I´ll be the first guinea pig with both conditions diagnosed and both drugs (Concerta & Keppra) in use it seems! So I´ll post data here regarding the combo.

Interesting regarding Keppra. I got spasms, trembles and neurological pains aswell. And massive DP/DR, still in Wonderland but it´s changed to Creepyland.. ;)
I did feel some increase in mental clarity with Lamictal, but I seems I´m a bit allergic to calcium channel anti-EP meds, so I had to quit it.

#52 3rd_tour_of_duty

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Posted 30 November 2012 - 11:07 PM

I've been on Prozac since I developed hppd. 16 years ago! 8 months or so into the disorder. I wish I could have stayed off and not gone onto meds as quickly but I literally couldn't have handled it any longer. (And i had no idea of hppd or even the slightest inkling what i had done). So Prozac possibly saved my life. Allthough by most reports I'm about the only one that its helped much.

I think I've read that Prozac is one of the least 'selective' of the ssris so I think maybe that's why it worked so well for me for years. Throw enough mud and some will stick and all my symptoms lessoned considerably. (Depression lifted which was my more pressing symptom at the time, dp/dr lifted and the visuals even lifted, still had some bad anxiety but i easily dealt with this through a vigorous exercise regime. unfortuneately the birth of my son and the stress/lack of sleep and potentially even just time itself brought on a relapse and its never really been the same since.

Unfortunately it's gave me no direction in which way to go next. Whether it be dopamine or serotonin based meds. (Currently on low dose of keppra, clono and pzac (old habits die hard). (Tried various ssris since with none having the initial effect Prozac did). Would like to try Wellbutrin but its like blood out of a stone with the medical profession here. They see it more a smoking cessation aid and not an anti-d in this country.

#53 Visual

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Posted 01 December 2012 - 12:28 PM

Wellbutrin worked for a few months in the beginning...

Wellbutrin also increases dopamine. If memory serves, it reduces dopamine reuptake and slightly reduces dopamine production. It was the first dopamine med I tried - and was remarkable. But anything more than 75mg / day for a few days causes bad symptoms. Fortunately found Sinemet helpful. While anything that increases dopamine will increase norepinephrine, they all differ in how much NE gets made. IMO, NE can be trouble for HPPDers even though it is known for attention/focus and many of us suffer such symptoms.

It is too bad it stopped working. You are still taking it? Reducing the dose might be 'eventfull' :huh:

Would like to try Wellbutrin but its like blood out of a stone with the medical profession here

Never mind that by design and definition, Wellbutrin IS an anti-depressant. Smoking cessation was an off-label discovery that has proved good enough to make it official.

Wellbutrin was originally with dosing of 450-600mg / day. Then some people got seizures ... drug re-evaluated and dosing dropped to 300-450 mg / day. Because of this bad episode, some docs are terrified of Wellbutrin just as some docs are terrified of benzos. Why aren't they scared of cars which cause 40,000 deaths each year???

Whomever thinks humans are logical and sensible in behaviour (our 'superiority' over animals) has there head stuck in the ground - - - we are REACTIONARY!

I think I've read that Prozac is one of the least 'selective' of the ssris so I think maybe that's why it worked so well for me for years

Very intersting observation. PD people often tollerate tricyclic antidepressants more than SSRIs ... and tricyclics are 'dirty' (affect lots of neurotransmitters)

Have long wanted to try an MAO but doctors are even more terrified by them. Had excellent experience with a MAO-B, which doesn't have the food reactions, but then neuro moved and noone wants to prescribe it anymore ... besides it does severly limit other meds that can be tried.

#54 3rd_tour_of_duty

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Posted 01 December 2012 - 10:05 PM

I'm pretty sure the dopamine part of the Prozac is what made my eyesight sharper and unblurred my vision back then. Can't say for sure though obviously. Maybe if I could get on a 75mg or 150mg dose of Wellbutrin I'd know for sure. Does keppra have any effect on domaminergic neurons?

#55 Visual

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Posted 02 December 2012 - 03:10 PM

Does keppra have any effect on domaminergic neurons?

Yes, sort of ... unsure. The documentation says it affect SV2 proteins (Synaptic Vessel #2) ... but can't find out what that is about (other than SVs contain neurotransmitters for release).

Since it does affect DR for me (and even more symptoms for some other members), I thought it did. And it has been tested for dopamine-knockout-mice to improve their condition (seizures). It is also used to extend Sinemet effect for RLS. And there is a drug trial to see if it helps PD people with Dyskinesia. With this in mind, it must have some effect on dopaminergic systems.

But it is in a class of drugs known primarily to affect acetylcholine. My brief DR experience with it, and another med that affects DR a tiny bit, Imipramine (which is anticholergic), and also an experience with Kodie in Australia (DPSelfHelp.com) who got DR from Pimozide (anti-psychotic) taken to treat his Torrettes but fixes the side-effect by taking Benztropine (anticholergic) - - - all this leads me to focus on the acetylcholine aspect of Keppra, not so much any dopamine affect. [ Is there an award for a run-on sentence? ... sorry, you'll have to read carefully ]

So in summary, Keppra affects dopamine directly to some degree and/or indirectly via the balance between dopamine and acetylcholine. [ pant :o ]

#56 3rd_tour_of_duty

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Posted 02 December 2012 - 10:57 PM

Lol. Yeah I got 99% of that there visual. (I think lol). Cheers :) I'm certainly noticing some aspects getting better just over a week into my small dosage of keppra. Visuals are still there but I think about them less. DP/DR is better. And it hasn't cleared my blurred vision much but there's been a couple of eureka moments where I've seen through the brain fog as it were which has been nice but weird after having it so long and so intense. Only on 250mg twice a day so far though and it's effected my depression a bit too in a negative sense so I'm scared to up it too fast. It's certainly making me self realise and feel emotions that weren't there before so its worth persevering with at the moment.

#57 Visual

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Posted 03 December 2012 - 01:18 PM

This really sounds great ... so, yea, don't up the dose anytime soon. Frankly, I really believe that even if a med isn't a perfect fit, just 'rattling' the symptoms around (such as you describe) is useful. This may sound strange, but whenever you get something positive (eureka moments) try to calmly focus on the feeling (sort of meditation) and see how long you can make it last. By 'exercising' these moments, you can train your brain to get better. I've used this and, in some cases its been remarkable, others just mild.

Glad you understand some of my gibberish. Some stuff is hard to explain ... either it requires more technical knowledge or its just an intuitive feel - - - very difficult to communicate either way.

#58 3rd_tour_of_duty

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Posted 03 December 2012 - 11:39 PM

Hmm. It was going up and down but tonight's been the worst. I've had a severe migraine and head pressure, probably worse than I've had for years. Feel nauseous. Think I'm going to have to stop the keppra cos I'm constantly thinking negative thoughts. Which weren't nearly as bad 10 days ago before I started keppra. It can't be a coincidence lol.

#59 Visual

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Posted 04 December 2012 - 12:39 PM

Do you have some B6 (or P5P) to add?

While it helped me, it wasn't enough. The longer on Keppra, the more unstable emotionally I get. Its a bummer

#60 Visual

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Posted 04 December 2012 - 01:15 PM

If this is true, than anyone who is low in dopamine would tend to have problems with Keppra: "Acetylcholine agonist" http://www.axonmedch...etiracetam.html