Question: Successes with nortriptyline? Nortriptyline impact on cortisol?
Answer:
Full Question:
I have recently had uncontrollable disabling
migraines. Myself and family have a history of migraines. Most of the triptans
do not work for these new migraines. The neurologist has given me nortriptyline
in a progression from 10 - 40 mg daily as a preventative. I seem to have lowered
the stronger attacks but not the daily strong headaches. Do you know any
successes with nortriptyline? Do you know if nortriptyline has any impact on
cortisol? I have three doctors who are in agreement that these migraines are
being triggered by stress, so I am wondering if my cortisol levels could be too
high and causing this as well. Do you have any understanding of how magnesium
effects the brain or hormones? I have been doing quite a bit of research to
resolve my issue and your website has been so very helpful. Thank you. Brandy
Answer:
Dear Brandy;
Your question are excellent but some are very broad-based topics. Magnesium is a complicated topic in its own right. It often works very well to quell an ongoing migraine, but has to be given intravenously, as oral magnesium is poorly absorbed. The relationship of cortisol derangments to Migraines, like all endocrine disorders, can be associated with headaches. This is something we go looking for, and I often tell my patients that I am evolving into an amateur endocrinologist in trying to look for endocrine abnormalities associated with their Migraines and headaches. We pick up a number of folks a year who have thyroid, sugar, cortisol, pituitary dysfunction and other endocrine issues perhaps associated with their headaches. Seek care with a headache and Migraine specialist. There's a link below to our directory of recommended specialists.
I have looked for the answer to your question. The abstract below is the closest but doesn't answer it either. Actually, high stress can be linked with either low or high cortisol levels. Your magnesium question is overly broad and I don't know where it comes from. There are many thousands of papers of the effects of magnesium on a very large number of brain events. Try going to www.pubmed.gov and this will get you into the National Library of Medicine. "Journal of Clinical Psychopharmacology." 1995 Aug;15(4):250-8.
Amitriptyline metabolism in elderly depressed patients and normal controls in relation to hypothalamic-pituitary-adrenal system function.
Schmider J, Deuschle M, Schweiger U, Korner A,Gotthardt U, Heuser IJ.
Max Planck Institute of Psychiatry, Clinical Institute, Munich, Germany.
The pharmacokinetics of amitriptyline (AMI) have been extensively studied,
and a large interindividual variability between oral dose and concentration
of the drug in plasma has been documented. The aim of this study was
twofold: first, to compare AMI kinetics in depressed patients with those of
healthy controls and, second, to describe the relationship between AMI
levels in plasma and hypothalamic-pituitary-adrenal (HPA) system changes
during depression. Thirty-eight patients with a DSM-III-R diagnosis of major
depression and 13 healthy control persons received 75 mg of AMI daily for 6
weeks. Levels of AMI and nortriptyline in plasma were determined, and
neuroendocrine testing with the combined dexamethasone-suppression/CRH-stimulation
test (DST) was done before AMI administration and after weeks 1, 3, and 6 of
medication. AMI levels in plasma were significantly higher in the patient
group compared with controls during the entire treatment period, whereas
nortriptyline levels did not differ between the two groups. Drug levels
correlated significantly with age, but gender had no effect on the
concentration of the drug in plasma. Twenty-two patients remitted after
treatment. There was no difference in drug levels between responders and
nonresponders. Fifteen patients were DST nonsuppressors before treatment; 23
patients and all controls suppressed cortisol after dexamethasone. DST
suppressors had significantly higher AMI levels in plasma at weeks 3, 5, and
6 compared with DST nonsuppressors. In comparison to patients with high AMI
levels in plasma, those with low drug concentration had higher
postdexamethasone cortisol and adrenocorticotropic hormone levels and an
increased hormone release after additional CRH. (ABSTRACT TRUNCATED AT 250
WORDS)
Good luck,
Teri Robert and John Claude Krusz
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Published January 9, 2006
