Antidepressants
Clinical studies have found several antidepressants to be useful in migraine prevention. They are thought to prevent migraines by regulating the levels of serotonin, norepinephrine, and other neurotrans-mitters in the brain.
Amitriptyline (Elavil, Endep) is an antidepressant and antianxiety medication that was also one of the earliest and most-studied migraine prophylactics. Amitriptyline is a tricyclic antidepressant, an older class of antidepressant drugs. Other tricyclics have been studied for migraine prevention, but amitriptyline is the only one that has been proven effective in controlled clinical trials. It is considered a first-line drug in migraine prophylaxis.
The other, newer, antidepressant drug that has shown some efficacy in migraine prevention is fluoxetine, or Prozac. Fluoxetine is a selective serotonin reuptake inhibitor drug, so should be used with caution, if at all, in people who are taking triptans because of the risk of serotonin syndrome.
Tricyclic antidepressants cause a number of troublesome side effects, including dry mouth, dizziness, nausea, constipation, weight gain, anxiety, photosensitivity (i.e., sensitivity to sunlight), and fatigue. Orthostatic hypotension, a sudden drop in blood pressure when changing position, may also occur. Less common but potentially more serious side effects can include loss of libido, blurred vision, high blood pressure, and increased heart rate. If taken in too high of a dose, TCAs can cause seizures, stroke, or heart attack.
Fluoxetine can also cause nausea, weight gain, anxiety, insomnia, and fatigue, although these side effects often lessen or disappear over time. In some people, the drug may more rarely cause skin rashes, increased blood pressure, seizures, and vasculitis.
Antidepressants should never be abruptly stopped (i.e., “cold turkey”) because doing so can cause dizziness, headache, muscle aches, nausea, and anxiety.
If you take an MAO inhibitor, you should not take TCAs or fluox-etine because of the risk of a life-threatening drug interaction. Any MAO inhibitor must be stopped two weeks prior to starting these antidepressants.
The antidepressant drug classes serotonin reuptake inhibitors (SSRIs) and selective serotonin/norepinephrine reuptake inhibitors (SNRIs) can cause serotonin syndrome when taking in con-junction with triptan drugs. Symptoms of serotonin syndrome include irregular heartbeat, increased body temperature, hallucinations, and fluctuating blood pressure.
Antidepressants should be prescribed with care and monitored closely in patients with liver, kidney, or heart disease. Certain antidepressants are not recommended for use in people who are recovering from myocardial infarction (heart attack).
