Anti-depressants and Triptans

Hello all,

I just started taking the anti-depressant Cipralex (10mg) a couple days ago.

My pharmacist says I shouldn't combine this medication with Relpax (Triptan) due to the rare seratonin syndrome.

I called my specialist and he said it's not a problem (especially with me only being on 10 mg) but I will be going up to 20 mg in 10 days.

Any thoughts on the combination of these two medications?

-Christina

I'm on the same med as you - 10 mg Cipralex - started 2 weeks ago. Both my pharmacist and doctor said that the 10mg is too low a dose for seratonin syndrome. I was on Cymbalta for 2 months before this and had to stop due to the side effects - they told me too that with the Cymbalta the liklihood was miniscule. I did take the Relpax on two occasions while on the Cymbalta and I was ok. The Relpax didnt do a thing for me to be honest so I'm not going to bother with it anymore. Headache isnt a huge component to my migraines - more of the freaky aura stuff. I honestly don't know what to tell you. Such conflicting opinions about this - hard to make an informative decision. Sometimes it's wise though to err on the side of caution.

I am not sure either. I haven't taken triptans for a looonngg time and was never once told about serotonin syndrome when I did. At that time I was also taking various anti-depressants, just to try and get some relief from something. I never encountered a problem. However, my advice to you is to do your research. If you are uncomfortable with any sort of prescription or combination you don't have to take it. Different medications affect all of us in different ways. Some people are more sensitive to some things than others.

In my several years dealing with this migraine crap, I have learned to be pro-active in my care. I research things on my own, and discuss them with the DR. I also trust my gut. If something doesn't feel right to me, I am reluctant. Often I have asked for another plan. You are your best advocate for your care!

Sometimes I feel like DR's can prescribe, and prescribe. Many times they have never even taken the meds they give us. A lot of times they have no idea what side effects we have. Sometimes they don't really care either. You know yourself best. It is hard to treat someone when they only see you for a ten minute visit and send you out the door for three months to try something. Good Luck!

Hi there

I just did some research on this for Batman55. I've ripped the info out of the thread I posted it in. You need to make your decisions based on real information. A pharmacist telling a migraineur 'you might get a rare serotonin syndrome that might kill you' is so unfair when it's related to a drug that might offer blessed relief from crushing pain and disability. Jeebus. How can anyone be expected to make an informed decision based on that. There is a risk. As far as I can work out here it is (I'm quoting myself by the way):

"... the incidence rate of getting serotonin syndrome from taking a triptan with an SSRI is low. Less than .03% annually of the millions of people taking these combinations get SS and less than .002% are life threatening. To put that in perspective, the annual incidence of car accident in the US is 1.68%. The annual rate of breast cancer in US women is .133% so if you were a woman, you would be 4.5 times more likely to get breast cancer than get SS from taking triptans and an SSRI as prescribed."

The number of serotonin containing products a person takes and the dose may be factors, but then maybe genetics plays a part. If you are unsure, perhaps you could go back to your specialist again and ask him to outline the factors which have been empirically shown to be important in serotonin syndrome.

Best of luck!
Living

EDIT: By the way, according to the place I got this data, SSRIs have the highest risk of interacting with other serotonin agonists so these rates should be the highest. Tricyclics should be lower. This is all assuming the data I based this on was correct. And assuming I did my sums correctly.

Living, thanks for putting it in perspective! Everything we take has some risks to it, so it pays to pay attention to possible side effects. But we shouldn't allow the fear of the remote but possible keep us from trying possible remedies. After all we know just how debilitating doing nothing is.

I've been through some awful side effects, but that wont keep me from trying new possibilities. Quiting is not an option.

Wow! This is some great information / feedback!

I definitely need to do more research on this - I'm also seeing my GP tomorrow so I will ask his opinion while I'm there.

I want to make sure I'm 'prepared' when my next attack comes along.

Thank you for your reponses!

Just wanted to add an update:

I saw my GP a week ago and he switched me over to Bupropion SR (good 'ol wellbutrin) 100mg twice a day. Since I was only on my fifth day of 10mg cipralex he suggested trying this as alternative first to see if it helps, and if not, look into other options.

This anti-depressant does not interact with triptans or when I have to repeatedly take my 3 advil/3 T1 combination for my cervicogenic headaches that can last up to a week.

My side effects from Cipralex for the first 5 days: dizzy, tired, shaky, headaches, increased anxiety/paranoia.

Side effects from Bupropion during the last week: loss of appetite -no hunger or cravings for food at all (only eat cause I know I should), constant increased energy (almost stimulant like-never get tired) this feels great after being down "low" for so long BUT it comes along with insomnia. Then when I do sleep, I have VERY vivid/intense/weird dreams that actually scare me a little.

So we'll see how this continues....

Hi Christina

Wow....your definately having a bad run with the side effects. See how you go but maybe suggest to your Doctor about Cipramil. I know everyone reacts differently but after the first couple of weeks of side effects, I've been doing quite well on it. I use Maxalt for my migraines and that seems to be working a little more effectively at stopping the migraines.

Best of luck.
Lissy

Thanks Lissy,

I'll keep on this for awhile and see how it evens out, but will certainly keep that in mind for an alternative. At least the side effects from the Bupropion SR are more manageable then what I felt from the Cipralex.

I have lost 7 lbs in the six days. I now need to be careful that I don't loose anymore as I was not overweight to begin with. I find that I can avoid the insomnia by making sure that I relax a couple hours before going to bed - make sure my brain is working as minimal as possible. Dreams are still weirding me out - energy is still high.

One fantastic change I must mention is for is that for the last week, I do not wake up with extreme head/upper back/shoulder/neck nerve/muscle/joint pain anymore. I have been waking up for years feeling every morning like I have been hit by a truck, plus that feeling like I never even slept, and it was progressively getting worse. This last week of 'pain-free' mornings bring tears to my eyes just thinking about it. I never would have thought I could ever feel this good getting out of bed in the morning!

I am really surprised by how fast from the start of the medication that this happened! Is this typical with anti-depressants?

I really hope this lasts... and hope for more improvement(s) as weeks pass.

Hi Christina

I'm so glad your doing a little better. To be honest, it may be too soon to actually notice a difference with the anti-depressants, they usually take around 4 weeks before you notice anything. Strange thing is I had a very similar reaction. I really think this is where our mental state plays such a huge role. For me, it was like a relief that maybe something was going to change, some desperate hope. I have certainly noticed a positive change in my mental stability now that I've been on them for a couple of months and even going a little bit longer in between treatments (I've lasted 6 days this week although I am on the brink of a migraine now :-( Anything is worth a try so I hope this continues to work for you.

Lissy