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What side effects?

I have some weird memory things going on: my short term memory sometimes can only hold 2 bits of info at a time. Sometimes I forget the words for common objects, like refrigerator. And once I even forgot how to get home from the supermarket.

A friend suggested this might be due to medication side-effects. I take fluoxetine and amitryptaline for fibromyalgia, and mobic for an as yet undiagnosed auto-immune process that affects my connective tissues, and provigil for the fatigue. Does any of this affect memory?

My rheumy wants to replace the fluoxetine with Cymbalta or Effexor -- is one or the other more likely to cause side effects in the cognitive area, or in muscle weakness?

Thanks for your input.
==Shari

Using a drug checker...

I found these interactions between Prozac and Elavil.

Quote:

2 potential interactions were found for the drugs you selected.

You searched for interactions between the following drugs:

* Elavil
* Prozac

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(Note: Not all drug interactions are known or reported in the literature, and new drug interactions are continually being reported. This information is provided only for your education and for you to discuss with your personal healthcare provider. )

FLUOXETINE (in Prozac) may interact with AMITRIPTYLINE (in Elavil)

Both fluoxetine and amitriptyline have an effect on serotonin, a chemical that is found in the brain. Excess levels of serotonin in the brain may cause serious or potentially life-threatening side effects. Early signs of this problem include increased confusion and restlessness. Other possible symptoms may include weakness, fever, nausea, and anxiety. In rare cases, high levels of serotonin in the brain may cause severe complications like seizures, stroke, and even death. If these drugs are used together, your doctor may want to monitor you closely when therapy with fluoxetine is started or stopped. If you are experiencing problems, it may be necessary to adjust the dose of amitriptyline or to stop therapy with either drug. Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.

This interaction is well-documented and is considered moderate in severity.

Last Updated: December 2003

FOOD may interact with AMITRIPTYLINE (in Elavil)

Foods that have a high fiber content may interfere with the absorption of amitriptyline from the stomach. As a result, less amitriptyline would be available for the body to use and blood levels could become too low. This could make the drug less effective. High fiber foods include fruits, vegetables, and grains (bread, cereal, rice, and pasta). Let your doctor know if you have recently changed your diet to include more high fiber foods while you are taking amitriptyline. If the amitriptyline does not seem to be working properly, it may be helpful to adjust your diet. You may want to ask your healthcare provider about this potential interaction if you think you are having problems.

This interaction is poorly documented and is considered moderate in severity.

Last Updated: December 2003

from http://www.drugdigest.org/DD/Interac...22+&CheckFDA=1

Also, fluoxetine impairs the clearance and metabolism of amitriptyline.
If the dose of amitriptyline is low, say 10 or 25mg, the effect is not startling.
But if your amitrip. is 50mg or 75mg or 100, this then become significant.
Increasing tricyclic doses, may have an effect on QT times for the heartbeat.
And some people are very sensitive to this.

Quote:

Steady-state kinetics of fluoxetine and amitriptyline in patients treated with a combination of these drugs as compared with those treated with amitriptyline alone
A el-Yazigi, K Chaleby, A Gad, and DA Raines

The steady-state kinetics of amitriptyline (AMI), fluoxetine (FLU), and their active metabolites nortriptyline (NTRIP) and norfluoxetine (NFLU) were studied in 15 patients treated once daily for long durations with 50 mg of AMI and 20 mg of FLU. These compounds were analyzed simultaneously in plasma by liquid chromatography. The means and (SEM) of the steady-state concentrations (Css) of AMI, NTRIP, FLU, and NFLU were 80.6 (14.2), 52.6 (10.3), 85.3 (16.1), and 90 (13.6) ng/mL, respectively, and the apparent oral clearances (CLor) of AMI and FLU were 42.4 (8.6) and 14.9 (2.5) L/hr, respectively. The metabolite/drug steady-state concentration ratio (Css(m)/Css) for NTRIP/AMI was 0.75 (0.14) and for NFLU/FLU was 1.27 (0.17). There was a significant correlation (P < 0.05) between Css of FLU and that of AMI or NTRIP. The Css and Css(m)/Css values obtained for AMI were higher (P < 0.056 and P < 0.0034, respectively) than those we observed in 10 patients treated solely with the same dose of AMI. The twofold increase in Css of AMI and ninefold increase in Css of NTRIP seem to be the result of inhibition of the metabolism of these compounds by FLU, particularly the ring hydroxylation. Norfluoxetine may have a small inhibitory influence on the metabolism of NTRIP but lacks this effect on the metabolism of AMI.

from http://jcp.sagepub.com/cgi/content/abstract/35/1/17

Are you taking other drugs? Neurontin, Lyrica, Topamax all have side effects, like you describe.

The process of Fibro also creates a type of brain fog, itself. Since studies have shown patients with Fibro have low spinal fluid content of B12, use of
B12 orally may help.
http://www.immunesupport.com/healthw...8/98sum003.cfm

To lower homocysteine, the vitamins B6 and folic acid are needed too.
Please visit our Vitamin forum here for more information.

Brain fog is a common symptom also for B12 deficiency. You can have a serum B12 run, by the doctor as well. (they do not normally do spinal taps except in research studies).

((((((((((((((Shari))))))))))))))

Quote:

Originally Posted by shari (Post 54454)

Hi Shari,

Gosh, when I read what you'd written I had to write to you. I had such similar problems, and I found them so scary.

One of the things that I've observed is that many medications, especially antidepressants, affect memory.

My feeling is that they lower our B12 levels and it's really the low B12 that is affecting our memory.

Are you taking Methylcobalamin at all? It can sometimes help. It will always help if you are low on B12, but if you don't know if you are low on B12 then it might or might not help, depending on your underlying B12 levels.

Sorry, that was pretty convoluted. It's just that B12 is so important and is so often overlooked.

At the same time, it isn't a problem for everyone.

You might want to take a look at a page I've been working on that shows how fingernails reflect low B12:
http://health-boundaries-bite.com/Fingernail-Lines.html

If you have those kinds of ridges or are losing the moons on your fingernails, then look at the whole list of symptoms of low B12... if they fit you, if they are what you are experiencing, then you should get Methylcobalamin and keep notes as to what you experience when you are taking it.

((((((((((Shari)))))))))))

Don't worry, but do take these steps.

Symptoms and signs of B12 deficiency

No one symptom (or combination) is always present. It pays to pay attention to your fingernails for general health clues, but presence of lack of ridges or moons cannot determine your B12 status.

The list of symptoms and signs vary so much from individual to individual that they can appear to be entirely different conditions even within immediate families.

rose

Fibro itself causes "fibro fog" - memory loss, attention and concentration problems, and general brain malfunctioning. I've had it bad enough to have to change careers. Effexor can make memory problems worse, I have found, even though it is an "activating" anti-depressant.
I agree that B12 supplement helps with depression, which is part of having fibro.