jinian | trying topiramate

Started on nortriptyline around May 2004, ramping up to 100mg and staying there for quite a while. (Timeline here.)

I've been reducing the dosage slowly for a couple of years. Succeeded in getting down to 25mg with some difficulty -- rough time for about a month before feeling okay. Still getting light-headed spells, but no longer dangerous feeling on stairs etc. Reducing to 20mg has NOT worked out; no help with the dizziness, but constant feeling of migraine threat and headaches (front left or all over) for at least part of every day.

So I bugged my neurologist, and we agreed to try another med. No other migraine preventive is really approved for general pain treatment the way tricyclics are, but he's of the school that figures if you have migraines then all your headaches can be treated as migraines. I guess we'll see. Topiramate was his first choice because he sees few side effects and good migraine smiting. (He noted that he gets asked to prescribe it for the appetite loss side effect by people who do not have migraine or convulsions. He Doesn't Do That, and he was careful to say that weight loss was a problem for some people.)

Possible side effects per him: small chance of kidney stones, hideously painful but not permanently damaging or stealthy; Feeling Like A Zombie (phrasing apparently shared by all who get this problem); tingling mouth and hands

More side effects I was aware of independently: GI problems, mood effects, menstrual changes

I've been on 25mg topiramate for two days now, and it's... weird. I'm obviously sleepy and a bit stoned, which I hope will wear off; I was not ideal for driving but did all right with it. I definitely notice a tendency to dissociate a bit in a way that's not typical for me. There have been a couple of times that I have a sleepy, stoned layer but also a mentally-sharper-feeling, grumpier layer, and I'm not used to having discrete mental-emotional sets like that. I've also had moments of feeling like only 95% of that body part is really mine. The combination of these could maybe feel zombie-like to someone if it were more severe and ongoing, or maybe I'm just not getting that effect at all.

When I'm (or part of me is) stoned and mellow, I'm more willing to touch people affectionately and more willing to believe that I'm important to them. Contrariwise, I'm more inward-directed than usual and might not talk much. It feels hard to focus and get things done, but playing in the dirt yesterday I got a lot accomplished and felt great because it was in perfect accord with my relaxed mood, even though I was sleepy. I wondered what it would be like to do that all the time, but I noticed that in my daydream I was on sabbatical or something, not like my life goals had changed.

So far, no appetite loss, but I'm still giving myself gold stars for feeling like eating and consuming normal portions after my stomach bug. Hard to tell if any digestive weirdness is from that recovery or the drug.

I woke up yesterday with a headache from sleeping funny, didn't take anything for it, bent over a bunch while gardening, and didn't get dizzy or migrainish. I wish one day weren't a significant datum, but the way things have been lately it really is.

The plan is to go up to 50mg topiramate before reducing the nortriptyline any further, but I'm going to see how I feel. If it continues to be interesting I'll talk about it some more.