"My doctor prescribed sertraline (Zoloft) for my migraines. Is this an appropriate migraine treatment? I don't have depression."- Lori / New Mexico
This is the answer given by Mayo Clinic neurologist Dr. Jerry Swanson a renowned authority in migraines:
"There's no good evidence that sertraline (Zoloft), a selective serotonin reuptake inhibitor (SSRI), can prevent migraines. Certain antidepressants can help prevent migraines. Most effective are tricyclic antidepressants, such as amitriptyline, nortriptyline (Pamelor) and protriptyline (Vivactil). In fact, these medications are considered among first-line treatment agents and may reduce migraines by affecting the level of serotonin and other chemicals in your brain. Also, you don't have to have depression to benefit from these drugs. However, newer antidepressants — such as Zoloft and other SSRIs — generally aren't effective for migraine prevention.”
Since Dr. Swanson is one of the most renowned neurologists on the subject of migraines, why are doctors not listening to him and taking his advice?
When interviewing migraineurs, we find that the majority have been prescribed one or more of the SSRI drugs for their migraines. However, our research at Tuliv indicates that the majority of migraineurs are actually “upbeat” type of people. Rarely do we visit with someone who tells me he or she has been clinically diagnosed as suffering from depression or bi-poplar syndrome.
That begs the question, why are doctor’s prescribing SSRIs when there is no evidence they work to prevent migraines and why do they think the migraine patient is suffering from depression?
There may be three separate reasons why this happens.
First, in regard to prescribing SSRIs we must ask the question, “If there is no evidence of success, then who is hyping the idea that these drugs should be prescribed for migraines?”
Doctors are “detailed” by drug company marketing representatives to describe the various things for which the doctor should prescribe the drug. These may not be the same things for which the drug was approved by the FDA. There are no rules that prohibit drug representatives from making suggestions about “other” uses for the drug product, i.e. migraine prevention.
The second reason, and one that we hear from many of my migraine clients, is that “anti-depression” drugs are being prescribed to counter the side-effects of the other drug(s), namely the anti-seizure meds such as Topamax that were prescribed to the patient as “migraine preventives”.
Let’s take a quick look at what every doctor who prescribes TOPAMAX® (for example) should know from the Full Prescribing Information.
“Adverse events most often associated with the use of TOPAMAX® were related to the central nervous system and were observed in both the epilepsy and migraine populations. In adults, the most frequent of these can be classified into three general categories: 1) Cognitive-related dysfunction (e.g., confusion, psychomotor slowing, difficulty with concentration/attention, difficulty with memory, speech or language problems, particularly word-finding difficulties); 2) Psychiatric/behavioral disturbances (e.g. depression or mood problems); and 3) Somnolence or fatigue.”
Rather than recognizing, or admitting, the side effects of the “migraine preventive” drugs do exist and may be causing the depression, many doctors dismiss the reality of the true cause and simply prescribe an SSRI drug for the depression. One drug begets another drug which begets another drug.
The third reason is that doctors often confuse a patient’s frustration with depression. When a doctor refuses to listen, can’t answer migraine questions, and repeatedly write prescriptions for drugs that have already failed, the migraine patient may show signs of disappointment, frustration, resentment, and even say things like “I wish I were dead.”
Making any statement that is negative will likely get labeled as a sign of depression, which in turn causes the prescription pad to come out and the doctor to prescribe whatever antidepressant drug that he or she can recall.
Having interviewed thousands of migraineurs, we have found less that 5% who thought they were depressed in life. Most have a well adjusted outlook on life, but desire to live migraine-free.