[Guest]

Dr.,

I complained to my GP about the headaches that have been killing me for 10 days now while on only 10mg of Celexa. He explained that (as you had) that all SSRI can cause headaches, so we may have to try something different if they don't go away very soon as they are preventing me from functioning more than the anxiety (at least I can take a Xanax when that gets bad, nothing works for these headaches, although oddly, sometimes a painkiller followed by Xanax every 6 hours provides some relief). He says the headaches are "serotonergic effects", and was unsure what to try next though (Effexor, Serzone, both also high on the headache list). I have three questions today:

1. I understand TCAs are not known for headaches, but act on serotonin, so why don't they cause headaches, or Remeron?

2. If this is a "serotonergic effect" why don't I have any others (nausea, insomnia, sexual dysfunction - not even a smidge of them,but awful headaches)?

3. What would be your suggestion as alternative drugs (or combinations) before benzodiazepines for PD and daily anxiety if the Celexa headaches cause me to have to quit (I haven't been able to get up to a good dose yet, so don't know whether it would help if I could tolerate the headaches). Thanks as always.

[Guest]

No one knows the answer to the first two questions. People are all different and react differently.

Question #3. Nortriptyline, Remeron, Serzone, Effexor. or just a "plain" benzo. These do not share the side effects of Celexa. Nortriptyline may have dry mouth,constipation, urinary retention or blurry vision. Typical doses are 50-75 mg. A blood level after a week can tell you if you are at the right dose. Remeron is a good agent, but may cause weight gain or sedation. Serzone may cause sedation and there is a very rare but very publicized risk of liver failure (1/250,000 pt years). Effexor is a great agent but is a lot like the SSRIs in side effects. There is nothing wrond with a plain ol' benzo if it works.
[quote] Dr. ,

I complained to my GP about the headaches that have been killing me for 10 days now while on only 10mg of Celexa... [/quote]