Can Triptans and Anti-Depressants tog... - National Migraine...

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Can Triptans and Anti-Depressants together cause bad reaction?

sozzy42
sozzy42
28 Replies

Just a quick question please.

I am a chronic 15 year migraine sufferer and have tried everything their is to try but no luck. The only thing that gives me relief is Zolmitriptan a nasal Sprays which I take about 10 a month.

Recently I have been going through the menopause and suffer terribly with Anxiety. I have been prescribed Anti-depressants twice the latest being Fluoxetine and on both occasions I have had the worst migraines ever and the triptans don’t even touch the sides. I have been in so much pain, can’t sleep, can’t eat and my face feels funny. My doctor said that this is not possible and that they don’t cause any reactions but I disagree. Can anyone clarify if this is a thing? If so, any suggestions on what I can do as an alternative?

28 Replies
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Juliapester3

I’m not a doctor but didn’t think you could take anti depressants and triptans together as this can cause seratonin syndrome , please check interactions on your meds. Hope you feel better soon

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sozzy42

Hi

Thank you for reply.

That’s exactly what I thought and read but two different doctors at my surgery said it’s absolutely fine!

Think I need to go and speak to them again!!

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Juliapester3

Yes I would , you can check interactions online as well ....

1 like
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jwilliamsb
jwilliamsb
in reply to sozzy42

Speak to a pharmacist - they're much better informed regarding drug interactions than doctors.

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Onthemove1971

Just curious, there are at least 7 ( or 8) different Triptans... some short acting and some long acting. Also what dose are you taking? With Imitrix, I can only take 100mg ( normally they start at 50mg)

I was like you I though I had tried it all and then I started to really learn something,.just curious... have you listened to the "Heads Up" Podcast? They are headace Specialist that have a number of great Podcast about Headaces. They recently had one on Triptans. Learning from them has changed my life.

Here are a few other ideas: Ice on the back of your neck as soon as you feel it.

Have you used a Neurmodulator?

What about roll on Peppermint? Or hot mint tea? Feverfew?

What type of Magnesium are you using? I just changed to glycinate and it helped a lot.

Do you have back or neck pain? This is often where the migraines start at.

Just curious...

One last resource, have you gone to migraine summitt, online?

Hope some of these help you.

Take care..

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blinc

Hi, I take SUMATRIPTAN when needed (a total life saver apart from v rare occasions) & been on SERTRALINE since July 2018 (not sleeping, tearful about everything, tight chest etc - 50 year old perimenopausal!).... No problems whatsoever, so it may be a case of which antidepressants with which triptans, as others have said. Good luck x

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blinc

Ps thinking back, my migraines seemed to get v slightly worse in first 2 weeks of taking, but I remember speaking to pharmacist & he said it was v unlikely & probably a coincidence, it's certainly been fine for a v long time since 👍

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sozzy42
sozzy42
in reply to blinc

Thank you for your reply. I really like my Pharmacist more than my doctors anyway, so I will go and have a chat. I’m happy to keep pushing through if it will sort itself out in the end but feel they are slightly different to my normal migraine pain. Worth having a conversation though rather than just stop.

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blinc
blinc
in reply to sozzy42

Definitely... Same, I have a lot of time for pharmacists & they generally seem to be v keen to help. All the best x

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Cat00

Anecdotally I was on Fluoxcetine and nasal zolmitripan for years and no trouble, but obviously everyone is different. However I still would have thought it would be more likely your hormones are causing the problem as hormonal migraines are particularly resistant to triptans, where as Anti-depressants are commonly prescribed as migraine preventatives and therefore are commonly prescribed together with triptans.

After both my children when my periods returned after stopping breastfeeding my migraines went into overdrive, nothing touched them. Botox didn't work either and like you I'm a chronic migraineur so I was the end of the road treatment wise (and thus very upset when the CGRP drugs were turned down by NICE ) there was nothing anyone could do, my mother-in-law had to come and live with us for a while to help with the children. The same thing happened to my mother with her menopause and didn't stop until she was put on HRT.

There are so many drugs out there that are prescribed for epilepsy that are also prescribed as anti-depressants and migraine preventatives. They probably make up the most common combination of treatment for migraine so I'm not surprised the doctors are dismissive of your worries as they will have a lot of data on the drugs working well together. However this does not mean that your unique body doesn't do something uncommon to them!

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sozzy42
sozzy42
in reply to Cat00

Thank you for your reply. Sounds all very similar to myself. I was promised a Hospital DHE IV in-patients appointment in June and the plan was then to start me on the CGRP drugs but this has now been put on hold because of the kind people of NICE and I’m devastated. No guarantee it was going to work but was my last option. I have literally tried all preventatives, all the anti-depressant drugs and Epilepsy drugs. All the gadgets and hots and colds and all the dietary changes and many lifestyle change.

I think you are very right about us all being Unique and I’m just going through my battle like you are going through yours. Nice to have a forum like this so we don’t feel so alone.

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Cat00
Cat00
in reply to sozzy42

I usually have about 15 a month and I'm allowed 6 triptan days a month, so I have about half of them without painkillers. When my periods went nuts I was having about 25 days a month and none of my triptans worked. The GP told me to go to A&E the neurologist agreed that would have been pointless. After 6 months of this i was loosing my marbles and then suddenly my periods returned to normal, so did my migraines so they were pants obviously but a pants I was used too.

I'm still hoping NICE sort things out as it was hope at least and like you I've been on too many combinations of drugs with crappy side effects. Even if you find something that works it never works for long.

I hope your migraines settle. Until I came on this forum I'd never met anyone with chronic migraines, even if it is a virtual 'met' it's allowed me to stop thinking I'm crazy and has help me argue with conviction to doctors especially that my experience is real!

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BlueSkies

I was prescribed sertaline a year ago and my GP refused to prescribe any triptans due to the risk of seratonin shock syndrome i.e. too much seratonin can potentially be life threatening. However many years ago I was prescribed a different type of SSRI anti depressant. The leaflet warned not to take with triptans. When I queried this with my GP he said it would be fine. So I think opinions may vary on whether it is OK or not. Probably best to check with your pharamcist or GP.

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Cat00
Cat00
in reply to BlueSkies

I was on sertraline and triptans too for a year or more, no one was concerned. It didn't seem to do me any harm although I am a chronic migraineur so technically I'm never ok.....

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natoneill

I’ve been a migraineur since my early teens, am now 45 and my migraines are defo connected to my hormones as well as other triggers, for the past two years I’ve taken sertraline for anxiety and been using sumatriptan for at least 20 years and it all seems to work ok. I know the dr said I couldn’t take citalopram with Sumatriptan, which I had taken previously as it flagged up as a no in his little book. I am definitely in a peri menopausal phase in my life and the migraines are getting more frequent but the sumatriptan help keep the pain at bay. I use the injections, maybe try another antidepressant? I hope you feel better soon

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troy04

Hi sozzy42,

Doctors prescribe Antidepressant along with Triptans quite often as the chances of serotonin syndrome is rare. Rare does not mean it never happens, and in your case if Fluoxetine (SSRI) and Zolmitriptan are causing issues doctors should be sympathetic and try different medicines.

However, if your headache has increased (intensity and frequency) taking these two medicines does not necessarily mean it is due to Serotonin syndrome.

Also, Fluoxetine itself can cause Serotonin syndrome, but it is very rare. Fluoxetine is thought to be a better Antidepressant than other alternatives - but for migraine prophylaxis, no one can be sure as it becomes complex to measure efficacy.

Tricyclic antidepressants such as Amitriptyline is more common for doctors to use along with Triptans - you may request it. However Amitriptyline also (it is believed) increases level of serotonin but some scientists believe it increases norepinephrine more than serotonin although it has been contested.

Bottom line is - you can stop Fluoxetine gradually (by decreasing doses) - such as taking half of the tablets and/or quarter - and see if this consistently makes any difference.

We all are different, so trial and error needs to be followed, but almost all the doctors want to finish everything in 2 minutes rather than 20 minutes while treating patients - they don't have time !!

/ Troy

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sozzy42
sozzy42
in reply to troy04

Thank you for your reply

I tried Amitriptyline quite a while back but I didn’t get on with it and made no difference to my migraines anyway.

True no one seems to have time to listen and when I see the consultant once a year I always seem to have problems just after the appointment and trying to get in contact with him again is impossible.

Thanks again for taking the time to reply x

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troy04
troy04
in reply to sozzy42

I don't know if you can, but in case you are able to exercise (makeing heart beat fast) for just 15 min/day for 3 times a week it will reduce headache (intensity & frequency).

A fast walk (if jogging is not an option) of 20 min still will do the trick.

Also in case you are not - wine/alcohol, red meat cannot be eaten. Dairy such as cheese or creamy food needs to be avoided.

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tieaknot

I was on a low dose of venlafaxine XR (SNRI antidepressant/antianxiety) and also as a migraine preventative (according to a few headache center sites). Might get 2 birds with one stone?

I’m actually starting again to see if it helps again.

I remember fluoxetine gave me a bad headache that felt somewhat different, every time I’ve tried to use it (which is several times over the years). You can even look up “Prozac headache”. It subsided in about 2 weeks. Came back with each increase in dose but went away again within 2 weeks.

Using a triptan with an antidepressant does have the risk of serotonin syndrome but so do many many other medicines.

If your neuro thinks it’s safe, I’d give it a try but just be aware of what the signs of SS are so you can get help if it happens.

The “warning” has to pop up on the computers and books, because even if rare, these days it is a CYA medicine world (cover your a$$).

I hope you feel better soon.

1 like
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sozzy42
sozzy42
in reply to tieaknot

Thank you

I think I’m going to half the dose of the fluoxetine and try and stick with it. It is definitely a different type of migraine and triptans don’t seem to work with this one when they are normally my life saver.

Will go to the pharmacist on Monday anyway to see what they say and then the drs.

Thanks again for replying x

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Chleo11

Hello Sozzy. Yes, you need to tell your doctor exactly what you have told us and ask why he/she thinks that the combination of medic prescribed to you is ok. Ask what are the arguments for and against. Doctors are obliged to answer your concerns.

From experience as a migraineur of almost 40 years, any medication of any kind has always been a trigger for my migraines, as catching a virus is another trigger (yes, I get a very bad migraine and then 1 or 2 days later my throat starts hurting and the migraine disappears within hours!).

I switched to another tricyclic a few weeks ago. Great for the first 3 days and then the mother of all migraines hit me. It took 4 days to go. I went back to the previous medic. The doctor is adamant that it wasn't the new medic. Yeah, right!

Just a quick last word on how medic works differently on different people. The same medic actually works differently on different days. Example: I took a Naratriptan last week. I felt the effect within 5 minutes, worked well, all good. I took Naratriptan this morning, didn't have any effect (for a migraine that was much less severe) but wait... it started working 5 hours later, yes, 5 whole hours. I know that it was the triptan as the migraine disappeared within minutes.

You take care and let us know how things go. :)

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sozzy42
sozzy42
in reply to Chleo11

Thank you so much. The reason this forum is so good is that you sometimes have a eureka moment when someone out their is experiencing the same as yourself. I’m so sorry that we are all suffering but it’s comforting to know your out there.

I don’t seem to be able to tolerate any new medications. No matter what it is it always sets of the worst migraines but the dr and consultant think it’s a coincidence but I know it’s not. I’m suffering quite badly with this menopause and will just have to confront the dr and keep trying new medications but only so many times I can keep going sick from work.

Hope you are still feeling better from this mornings episode x

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LarryDahlka

go on manufacturers website and look for symptoms, if not there report them to manufacture

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Iris1721

Hi Sozzy42 I have suffered with Migraine since I was 12. They went away for a long time. But came back about 12 years ago. And have gotten progressively worse. I have Rheumatoid Disease and have been on Zoloft to help deal with that for quite some time. I started taking Triptans about a year ago. And do not believe I have suffered any ill effects.

2 weeks ago I started taking one of the new

Migraine injections. I am using Ajovy. There are two others on the market. I have had 1 migraine in 2 weeks. I swear it has changed

my life. I highly encourage anyone suffering with migraine to explore these medications with their physician. I wish I would not have waited so long. Good luck!

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sozzy42
sozzy42
in reply to Iris1721

Hi

Thank you for your reply.

I am desperate to try the injections but this has just been turned down for NHS use in England. I am not in a position to pay for it privately. It’s now a waiting game for me.

I’m so glad it’s all working out for you though.

X

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Iris1721
Iris1721
in reply to sozzy42

I am so sorry that it is not available to you. I actually completely forgot when I read your post this am that you were in the UK. I rarely post but when I read your I couldn’t help myself. I don’t know if it would work but you could try reaching out to the company. Remember there are three. Most have co-pay assistance programs. If you have trouble getting the information let me know and I will try and find it for you. Best, Iris

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sozzy42
sozzy42
in reply to Iris1721

Hi

I never thought of that, must be worth trying.

Thank you again and all the best.

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AmySholay

I'm unsure if there are contraindications between taking Triptans and antidepressants. I'm a chronic migraineur too. If you are having problems with your sleep though, taking antidepressants aren't recommended as they fracture and lighten sleep. If sleeps a problem, then taking Pregabalin is much more helpful as it deepens sleep. If you are taking a triptan 10 days a month, I would suggest you talk to your doctor about trying a migraine preventative. As at some point your triptan may not work so well. Nasal sprays are faster acting and if this particular one seems to work for you, then I suggest you keep taking it, whatever a dr says. Everybody who has migraine is different and what works for one, doesn't work for another.

Good luck.

Amy

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