Fair Lady - This is not a weird question at all. I agree with your doc that adding anymore amitriptyline (Elavil) would be counter-productive, as I usually consider 25mg to 30mg to be a maximum dose to treat migraines. With any higher doses I tend to find that there is not much (if any) more migraine relief and then the side effects of the amitriptyline become more prominent.

Are your migraines "classic" in nature. That is, do you get the prodromal symptoms like halos around things and that sorta "it's coming" feeling? Are you getting migraines more often and are they more severe since starting the Lexapro and increasing the amitriptyline dose? Are you getting enough sleep at night?

I doubt that the Lexapro (escitalopram) is adding to the problem (but it is possible). One of the start-up side effects of Lexapro is headaches, but I usually do not consider these to be headaches, by any classical definition. What can be experienced is more of a pressure in the frontal part of the head (esp. forehead or what would equate to the frontal lobe area of the brain) and this side effect usually disappears within the first month of taking the SSRI.

If I had to guess I'd say that the sleepiness is being caused by the increase in amitriptyline dose. TCAs, like amitriptyline, are excellent antidepressants; the problem with them is that, when used at antidepressant they can cause heart problems in those who are suseptible and can be toxic in overdose (compared with the SSRIs). A normal antidepressant dose for amitriptyline is 150mg to 250mg per day.

Drowsiness is, in my opinion, is the most annoying side effect of amitriptyline. At one time it was thought that the tiredness never went away, and people just use to the side effect. Recent studies have shown that the tiredness does eventually fade in most people, but this can take 8 to 12 months in some.

In the meantime, naps are an excellent way to get any energy at all, and I do recommend them to those who are able to take them. You may have to replan your day around naps for a month or two, but this tiredness should resolve itself.

Have you tried Inderal (propranolol) for your migraines? If so, did you have any relief from it?

I hope this helps. I can't stay online too long. I am in Florida, again and am paying $12/hour on a slow machine. Could you pass along a message on General that I will only be checking in intermittently for the next week or so.

Thanks - Cam