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Hello I believe I can help you with your concern over the side effects that you have experiencing
I am very sorry that you have been experiencing headaches with the use of antidepressants. It is a common side effect in the beginning, but usually goes away as your body gets adjusted to the medication, but it appears that did not happen with you.
Now I would like to clarify what you wrote, just to make sure that I have the right information. You have been having vertigo for the last 3 months and occipital headaches for the last 3 weeks, when was the last time you used an antidepressant that you believe caused these symptoms?
Also you mention that you had a trial of Buspar 2 weeks ago, does that mean you stopped the Buspar 2 weeks ago? And what dosage was the Buspar?
And you are right about having a slow metabolism with the deficient p450, d6, c19. The cytochromes have a chief function of metabolising drugs in your body and when it is deficient, the medications you were taking may not metabolize appropriately and leave you with these side effects, which is unfortunate. Did you go to endrocrinoligist that told you about this deficiency?
Okay, now how long were you on the Remeron for? And when was the last dose?
Okay, well the remeron can cause postural hypo-tension and dizziness, which are similar symptoms to vertigo. Because you were on it for 10 months, and your body may be slower in metabolizing the medicine from your system, it may take another 3 weeks for the "vertigo" symptoms to go away completely.
But now you have headaches from the Buspar use, that should also go away in 2-4 weeks
Well that is interesting because vertigo is not associated as a side effect of Remeron use, but it is associated as a withdrawal symptom, so that may be why you feel like the vertigo may be getting worse
Well you have tried a lot of medicines and I do not want to recommend a SSRI or an SNRI because of the side effects you are having. You mentioned that you are taking the Rivotril .25mg, have you been experiencing any side effects with that medication?
Well the Rivotril can be increased gradually so that your body can get used to it and not "knock you out." Rivotril and other benzodiazepines are considered the best medications for anxiety, but individuals do develop a physical dependence to them. Another option would be trying a beta blocker that may help with anxiety
Yes that makes sense, I would not recommend a beta blocker then with those symptoms. I am sorry you are so discouraged. Now you mention this anxiety started since the birth of your last child, did you see a endrocrinoligist to test your hormone levels and metabolism?
That is unfortunate because I was thinking it may have been a hormone imbalance because it happened right after the birth of your child.
Have you also considered non-medication treatments like therapy for anxiety?
I understand, CBT is very effective in helping with anxiety, but sometimes the symptoms are too severe and require medication to lessen the symptoms for therapy to be effective.
I think right now, the best medication advice is to see how your body responds to a slow and gradual increase in the Rivotril. That will help with your anxiety and the "knocked out" feeling that you have should hopefully be temporary as your body gets used to the medication.
I know you have used CBT and hypnotherapy, but would you like a link to some relaxations strategies that I give to my patients for anxiety and stress?
So these are usually very effective and they help within minutes too
Can I ask, did your cytochrome levels decrease after your pregnancy?
I understand and I wish there was more I could to help you. I did want to mention that Pregnancy can alter the drug metabolism in P45o cytochrome, researchers think it has something to do with the increase levels of progesterone and estrogen, so that may be contributing to your deficiency levels in this area and most likely is what is causing you to have bad reaction to the medications (because you are not metabolizing them as efficiently).
An endocrine specialist in this area can give you a more definitive answer with blood tests, but I wanted to point it out
Is there anything else I can do to assist you tonight?
Well if you ever have any other questions or concerns, you are more than welcome to contact me at anytime
I wish you the best of luck and I hope you feel better as soon as possible.