תת-לחץ-דם כאשר אני ללא פרוזק

שלום רב, אני בת 36. למשך 6 שנים נטלתי פרוזק עקב דיכאון כרוני. אח"כ הפסקתי למשך שנה לקחת את הפרוזק. במהלך שנה זו התחלתי לסבול מלחץ דם נמוך ( 80/50) כאשר כל חיי קודם, היה לחץ דם של 110/70 ואף יותר. כל אותה תקופה שהפסקתי הרופאים לא ידעו מה גורם ללחץ דם הנמוך. ואני סבלתי מזה. לפני שבועיים החלטתי לחזור לקחת פרוזק. ואז קרה דבר שהדהים אותי. לחץ הדם שלי עלה חזרה ל 110/70. וכך זה נמשך עד עכשיו, לשמחתי. וזאת, כאמור, אחרי שנה של תת-לחץ-דם עיקש. הבעיה היא שאני מתכננת להפסיק לקחת את הפרוזק בעוד כמה חודשים, ואז אני מניחה ששוב תחזור בעיית תת-לחץ הדם. עכשיו ברור שיש קשר לפרוזק. אודה מאד אם תוכל להעלות רעיונות להסבר לתופעה. גם אם זה רק ספקולציות , שעוד אין להם הסבר מבוסס. למשל, רעיון אחד שמצאתי בעקבות קריאה בנושא (יש לי רקע בביולוגיה), הוא אולי ששנות הנטילה הממושכות של הפרוזק, גרמו שבלעדיו יש איזשהו חוסר, ושרק הלקיחה-המחודשת שלו, מחזירה את המצב. או למשל קראתי שסרוטונין עושה וזו-קונסטריקציה (לכן נותנים טריפטאנים לטיפול בכאב-ראש). אולי ללא פרוזר רמות הסרוטונין שלי נעשו נמוכות מאד ויש לי וזו-דילציה אז, שוב, אודה מאד אם תוכלו "לזרוק רעיונות", על קשירם אפשריים. מודה מראש סיגל

לסיגל אמנם הדברים שכתבת משכנעים ובדקת אותם היטב, אולם לפי ידיעתי הפרוזק אינו משפיע על לחץ הדם כלל, לא מעלה ולא מוריד. אודה לך אם תעבירי אלי את המאמר או המקום שבו מצאת את כיווץ כלי הדם-וזוקונסטריקציה, כי יש כאן בחורה ששאלה על תופעת רנו הקשורה לכיווץ כלי הדם. יתכן שזה יכול לעזור לה. בתודה הידש

הן תרופות למיגרנה, שנגרמה מהתרחבות כלי דם במוח. והן פועלות ע"י העלאת רמות הסרוטונין ברצפטורים 1B, 1D. וכך גורמות לכיווץ לכי דם. איני מוצאת כרגע את המאמר על סרוטונין ווזוקונסטריקציה. אבל הנה מאמר מכיוון קצתר אחר שגם קשור. http://www.blackwell-synergy.com/doi/abs/10.1111/j.1526-4610.2006.00470.x Tonight, I Have a Headache? Timothy T. Houle, PhD; Lara K. Dhingra, PhD; Thomas A. Remble, MA; Lori A. Rokicki, PhD; Donald B. Penzien, PhD Objective.—The present study examined the relationship between the diagnosis of migraine AND self-reported sexual desire. Background.—There is evidence for a complex relationship between sexual activity AND headache, particularly migraine. The current headache diagnostic criteria even distinguish between several types of primary headaches associated with sexual activity. Methods.—Members of the community OR students at the Illinois Institute of Technology (N = 68) were administered the Brief Headache Diagnostic Interview AND the Sexual Desire Inventory (SDI). Based on the revised diagnostic criteria established by the International Headache Society (ICHD-II), participants were placed in 1 of the 2 headache diagnostic groups: migraine (n = 23) OR tension-type (n = 36). Results.—Migraine subjects reported higher SDI scores, AND rated their own perceived level of desire higher than those suffering from tension-type headache. The presence of the symptom "headache aggravated by routine physical activity" significantly predicted an elevated SDI score. Conclusions.—Migraine headaches AND sexual desire both appear to be at least partially modulated by serotonin (5-HT). The metabolism of 5-HT has been shown to covary with the onset of a migraine attack, AND migraineurs appear to have chronically low systemic 5-HT. As sexual desire also has been linked to serotonin levels, the results are consistent with the hypothesis that migraine AND sexual desire both may be modulated by similar serotonergic phenomena. (Headache 2006;46:983-990) "Not tonight, honey, I have a headache…" is a humorous clich&eacute; that is associated with a person's desire to avoid sexual activity. Stereotypically, in our society this excuse is linked to women, AND its humor is perhaps derived from socially assumed gender differences in sex drive AND the perceived role of women acting as the gatekeepers for sex. Indeed, the incompatibility of sex while suffering from a headache is intuitively valid. Yet, there is growing evidence for a complex relationship between sexual activity AND headache, particularly migraine, which may greatly complicate the entire notion behind the clich&eacute;. Sexual arousal AND intercourse have been thought to cause headaches. Headaches associated with sexual activity have long been recognized,14 AND the current headache diagnostic criteria even distinguish between several types of primary headaches associated with sexual activity.5 Pre-orgasmic headaches (IHS 4.4.1) are described as having a bilateral location, building in intensity with the increase of sexual arousal. Orgasmic headaches (IHS 4.4.2) are described as "explosive" headaches which occur post-orgasm. Both headache types have characteristics that are related to exertional headaches AND are perhaps variants of migraine.1,6 Conversely, sexual activity also has been thought to relieve headaches. In an unpublished study, Couch AND Bearss described that of the 70% of women in their sample (n = 82) who reported having had sexual intercourse during at least 1 migraine attack, approximately one-half (47%) experienced at least some relief from the headache following sexual intercourse (17.5% reported complete relief from the headache).6,7 These results support the authors' previous findings from a smaller sample (n = 34) in which 21% of patients reported some relief after intercourse.8 Perhaps migraine AND sexual desire are 2 distinct phenomena that may be related as a result of their mutual association with serotonin (5-HT). In an extensive review, Ferrari AND Saxena9 described the role that 5-HT plays in the onset, course, AND termination of a migraine attack. The authors utilized many experimental studies to demonstrate that 5-HT is closely AND complexly linked with the pathophysiology of migraine. It has been reported that migraineurs have chronically low systemic 5-HT9,10 and, perhaps, this deficit is related to susceptibility to migraine.9 Specifically, 5-HT has been implicated as having a vasotropic effect on the cardiovascular system,11,12 AND migraine headaches are commonly thought to have a strong vascular component.9 Sexual desire also has been linked with 5-HT. An excess of 5-HT at the hypothesized "mating center" in the midbrain has been reported to antagonize testosterone in men, decreasing libido.13 Further, the side effects of selective serotonin reuptake inhibitors (SSRIs), such as decreased desire AND anorgasmia in both men AND women, have also been well documented.14,15 While gender differences in self-reported sexual desire have also been reported with males reporting higher levels of desire than do females,16 the relationship of sexual desire AND gender to 5-HT is less clear. The specific effects of 5-HT may depend on 5-HT receptor subtypes and/or central versus peripheral effects 5-HT.17,18 The extent to which gender differences of 5-HT levels AND 5-HT receptor subtypes (and the influence of associated neuroendocrine factors) account for differences in sexual desire is unknown. Considering this circumstantial evidence linking both migraine AND sexual desire to serotonin, are the 2 phenomena actually related? Only a single study by Del Bene et al19 could be identified examining the potential relationship between headache diagnosis AND sexual desire. This study found that those suffering from headache differed from controls on several aspects of sexuality. Even though those suffering from headache reported the same frequency of dyadic sexual activity, they reported engaging in masturbation less frequently than controls. However, females suffering from headache reported more sexual fantasies than controls, while the same difference was not observed in males. Although preliminary, the Del Bene study provides important information about the relationship between headache AND sexual desire. Nevertheless, the generalizability of its results may be greatly limited by its small sample size (only 8 migraineurs of each gender were assessed AND compared to an equal number of controls). Further, it did not employ standardized measures to assess sexual behavior AND cognitions which are difficult constructs to measure. Finally, this solitary study was conducted on an Italian population presenting unknown cultural confounds. The present study was conducted to further examine the relationship between headache diagnosis AND sexual desire. It was hypothesized that the abnormalities in the serotonergic system of migraineurs influence their sexual desire even at baseline. Based on findings that an excess of 5-HT in the midbrain is primarily inhibitory in terms of sexual desire, as well as research observing chronically low levels of systemic 5-HT in migraineurs,1 it was predicted that migraineurs would report higher levels of sex drive than those suffering from tension-type headache (TTH). Further, based on previous research on gender differences,16 it was also hypothesized that gender effects would be observed, with males reporting higher levels of sexual desire than females. Finally, given the findings reported by Del Bene et al,19 we hypothesized that gender AND headache diagnosis would interact such that female migraineurs' level of sexual desire will be more similar to male migraineurs than females suffering from TTH are to males suffering from TTH. METHODS Go to: ChooseTop of pageMETHODS <<RESULTSCOMMENTSREFERENCESAbbreviations: Participants.—Sixty-eight participants (37 females AND 31 males, mean age = 24.3 years, SD = 7.95; marital status: 87.3% unmarried, 9.9% married, 2.8% divorced) who were either undergraduates from the Illinois Institute of Technology OR members of the surrounding community completed the study. Following the International Classification of Headache Disorders II (ICHD-II) criteria,20 each participant could have more than 1 type of headache, AND each headache type received its own diagnostic code. The 68 participants in the current study reported 83 distinct headache types (with 14 subjects contributing 2 headaches, the rest 1 headache). The diagnoses of the individual headache types are presented in Table 1. The most common diagnoses were frequent episodic TTH (IHS 2.2: 45.8%), migraine (IHS 1.1 AND 1.5: 13.3%), AND probable migraine (IHS 1.6 AND 1.6.5: 15.7%). Two participants could not be included in the analyses due to incomplete data about their headache symptoms. Additionally, 2 participants were excluded from the analysis because of missing data from the self-report of sexual desire. Lastly, because of the infrequent OR unique nature of their headaches, the participants who qualified for only ICHD-II diagnoses of Infrequent TTH (2.1), Probable Infrequent TTH (2.4.1), AND Cluster Headache (3.3) were not used in the analysis (N = 5). Brief Symptom Inventory.—This 53-item questionnaire was designed to assess psychological symptoms that may be indicative of clinically relevant psychopathology.21 Items are rated using a Likert-type scale ranging from 0 to 4, where 0 describes experiencing the symptom "not at all," AND 4 as "extremely." Three items concerning suicide AND the desire to harm others were not assessed. The Brief Symptom Inventory (BSI) has been shown to have good internal consistency, with &#945; = 0.80 AND higher,22 AND predictive validity in both the general community AND chronic pain populations. Structured Diagnostic Interview for Headache-Brief Version.—This structured diagnostic interview assesses headaches in terms of duration, intensity, location, associated secondary symptoms, AND pain quality.23 The data from the interview were then applied to the ICDH-II diagnostic criteria for classification (see diagnostic classification below). Sexual Desire Inventory.—This 14-item, self-administered questionnaire is designed to measure 2 aspects of sexual desire.24 Specifically, 9 items measure dyadic desire AND 5 items measure solitary sexual desire. The items are rated using a Likert-type scale ranging from 0 to 7 (items 1, 2, 10), OR 0 to 8 (remaining items). Higher numbers indicate greater desire. For example, item 3 asks "When you have sexual thoughts, how strong is your desire to engage in sexual behavior with a partner?" A high degree of reliability for both subscales (&#945; = 0.86 for dyadic desire; &#945; = 0.96 for solitary sexual desire) has been reported by its authors. The 14 items are summed to calculate an Sexual Desire Inventory (SDI) total score. Procedure.—All procedures were approved by the Institutional Review Board at the Illinois Institute of Technology. The participants were recruited in 1 of the 2 ways: through local newspaper advertising OR by soliciting undergraduate psychology classes asking for volunteers. All participants were pre-screened on the phone using the BSI. Anyone who reported that they experienced less than 10 headaches per year, had received a Diagnostic AND Statistical Manual of Mental Disorders IV (DSM-IV) Axis-I diagnosis, reported that they were currently taking an SSRI, OR endorsed 30 OR more items on the BSI were excluded to reduce the likelihood that participants may have altered sexual desire from other sources (recreational drug use was not formally assessed). Eligible participants were invited to attend a 1-hour assessment session, AND ineligible people were referred to community mental health centers, OR to a pain clinic. Upon arrival, participants provided their informed consent. The complete anonymity of survey AND interview results was emphasized before the onset of the experiment. The structured headache diagnostic interview was administered by a trained doctoral-level clinical psychology graduate student. After completion of the diagnostic interview, participants were escorted to a private room to complete the SDI AND several other questionnaires not considered in the current study. Following completion of the SDI, the results of their interview were reviewed with each participant AND they were given a sheet of information about headaches, treatment options, AND referral phone numbers. Diagnostic Classification.—For the purpose of analyses, participants were classified as either migraineurs OR those suffering from TTH based on their headache symptoms AND resulting ICHD-II diagnosis. Other than the standard general rules for classification20 (eg, each headache receives its own diagnosis) 2 other criteria were applied. First, when a headache OR multiple headaches from the same participant qualified for 2 diagnoses OR "probable" diagnoses, AND either was migraine, that patient was classified as a migraineur. Eight participants met criteria for both Probable Migraine (ICHD-II 1.6) AND Probable TTH (ICHD-II 2.4), but were classified as "Migraine" participants for the purpose of analyses. Table 1 displays the ICHD-II diagnoses by headache AND classifications by participant. Statistical Analysis.—To compare reported sexual desire as a function of diagnosis AND gender, as well as the interactions between diagnosis AND gender, a 2 × 2 ANOVA was conducted with gender (male vs. female) AND diagnosis (TTH vs. migraine) as between group factors, AND SDI total score as the dependent variable. The modest sample size of the present study provided adequate statistical power (>0.80) to detect only "large" effects (f> 0.40),25 so a measure of effect size is reported (&#951;2) to allow for better interpretation of the observed differences (for description see Ref. 26). To examine diagnostic group differences on dichotomous demographic variables, such as the presence OR absence of headache symptoms, chi-square analyses were conducted. Group differences in demographic variables which had at least interval properties (eg, pain intensity) were examined using independent t-tests. Point biserial correlations between the presence of headache symptoms (an arbitrary category) AND reported sexual desire (a continuous variable with interval properties) were estimated using Pearson coefficients. RESULTS Go to: ChooseTop of pageMETHODSRESULTS <<COMMENTSREFERENCESAbbreviations: Headache AND Demographic Variables.—Age, gender, AND headache characteristics of the 2 diagnostic groups are displayed in Table 2. As expected, the migraine group, which consisted of a range of different migraine diagnoses, had significantly more pain, greater prevalence of nausea, vomiting, pulsating quality, photophobia, phonophobia, unilateral location, AND headache being aggravated by routine physical activity (all P values <.001). Also as expected, the TTH group had a greater prevalence of pressing pain quality, AND bilateral location of pain (all P values <.001). The TTH group reported a significantly shorter duration of their headaches. Groups differed significantly on age, with the migraine group (28.3 years) being somewhat older than the TTH group (22.6 years). Because of the unexpected age differences, this variable was examined as a potential influence on reported sex drive. Although statistically unrelated to reported SDI scores (which could be a function of statistical power as much as lack of effect), age did have a small relationship with reported sexual desire, with older participants reporting somewhat higher sexual desire, r = 0.21, P> .05. Group Differences in Sexual Desire.—Significant gender AND diagnostic differences on the SDI were observed. Males reported higher levels of sexual drive than females, F(1, 55) = 7.04, P< .01; &#951;2 = 0.11. Migraineurs reported higher levels of sexual desire than those suffering from TTH, F(1, 55) = 4.59, P< .05; &#951;2 = .08. However, no interaction between diagnosis AND gender was observed (&#951;2 = .01), such that the relative level of sex drive was maintained across gender AND diagnosis (ie, female migraineurs, though reporting higher levels of sexual drive than females suffering from TTH, had the same relative level of sex drive compared to similarly diagnosed males suffering from TTH). The Figure displays the observed differences in SDI scores as a function of gender AND diagnostic group. Headache Symptoms AND Perceived Sexual Desire.—To examine if the presence of any particular headache symptom was related to SDI total score, correlations between the SDI total score AND headache intensity, average duration, the presence OR absence of photophobia, phonophobia, nausea, vomiting, pulsating pain quality, pressing pain quality, unilateral location, bilateral location, AND headache aggravated by routine physical activities were conducted. The correlations are presented in Table 3. Only the presence of "headache aggravated by routine physical activity" was significantly correlated with SDI total, with the presence of the symptom being associated with higher sex drive, score, r = 0.27, P< .05. Interestingly, when the analysis was restricted to only include those subjects in the migraine group (n = 23), the correlation between headache aggravated by routine physical activity AND SDI total score was quite substantial, r = 0.43, P< .05. Finally, for the SDI item (#9) asking participants to rate their own sexual desire compared to people of their age AND sex, migraineurs reported the highest level of sexual desire. On a 0 ("much less desire") to 8 ("much more desire") scale, the means of the groups on the item were 5.0 for migraine AND 3.7 for TTH. The migraineurs' average score of 5.0 is above the expected median (4.0) on this item, indicating self-perceived greater than average desire. Although the statistical analysis of 1 item is certainly suspect in terms of reliability, AND also redundant because of inclusion of analyses involving the SDI total score, this observed difference in self-perceived sexual desire reached statistical significance, t(57) = 2.57, P< .05. COMMENTS Go to: ChooseTop of pageMETHODSRESULTSCOMMENTS <<REFERENCESAbbreviations: The current study examined self-reported sexual desire among migraineurs AND those suffering from TTH. It was hypothesized that gender AND diagnosis effects would be observed such that males AND migraineurs would report higher levels of sexual desire than females AND those suffering from TTH. Further, the relative sexual desire of female migraineurs as compared to male migraineurs was hypothesized to be greater than in a comparison TTH group. The results partially supported these hypotheses. Migraineurs reported higher levels of sexual desire than those suffering from TTH (accounting for 8% of the total variance in sexual desire). This statistical difference in level of desire may be apparent to the migraineurs themselves, as they also rated their own level of sexual desire to be higher than the level of perceived sexual desire of others. Males reported higher levels of sexual desire than females (accounting for 11% of the total variance in sexual desire). However, no evidence was found to support the hypothesis that diagnosis AND gender interact to influence reported sex drive (the interaction accounted for only an additional 1% of the observed variance in sexual desire). A correlational analysis of headache symptoms revealed that only the presence of headache aggravated by routine physical activities was a significant predictor of higher SDI score. The conclusions drawn from the present study must be tempered by limitations in the sample on which they are based. First, the majority of the subjects in the study were unmarried (87.3%) AND young (74.6% were 25 OR under, the remaining between 26 AND 60 years of age). Most of the subjects were recruited from the student population, yet some were from the community. Thus, the generalizability of these results to married adults of middle age is unknown. Although the study's sample size provided very little power to detect differences in subgroups of subjects, there was a slight (although nonsignificant) relationship with reported sexual desire AND age, with older subjects reporting slightly higher levels of desire. Unfortunately, because of the distribution of age in our sample AND confounding of age with diagnostic group, a covariance analysis could not be judiciously undertaken. Nevertheless, to eliminate the interpretation that age differences were driving the observed effects, when age was entered as a covariate, it accounted for only a negligible amount of variance AND did not substantially reduce the variance accounted for by headache diagnosis. The present study was correlational in design, so any attempt to explain causal mechanisms for the observed associations is simply speculation. However, it can now be hypothesized that a serotonergic (5-HT) link may be implicated in both migraine headaches AND sexual desire such that migraineurs tend to have higher levels of sexual desire than others. Yet, this observed link may be multifactorial AND difficult to specify. Serotonin has been linked, both directly AND indirectly, to several aspects of migraine pathogenesis. The present study's hypotheses were based on the line of inquiry demonstrating chronically low levels of 5-HT availability in the brain.9,10,27,28 Yet, the actual role of serotonin in migraine is mediated by multiple receptor types. Seven classes of 5-HT receptors have been identified (5-HT1 to 5-HT7),29,30 AND there are subtypes for each class,31 resulting in a broad array of potential mechanisms in which 5-HT may relate to migraine activity. The roles for each of these receptors in migraine are still not well known AND most of the evidence linking them to migraine activity is still circumstantial.31 In sum, any neurochemical mechanism(s) that might link 5-HT AND migraine would likely be sophisticated AND multifactorial. The evidence linking sex drive to 5-HT is equally as complex AND is also circumstantial. In humans much of the evidence is based on the reaction of individuals being treated with various 5-HT-specific agents (eg, SSRIs). It has been reported that activation of 5-HT2 receptors inhibits sexual functioning AND that activation of 5-HT1a facilitates functioning.32 Further complicating a potential link between 5-HT AND sexual functioning is the location of action of 5-HT. Peripheral 5-HT receptors, which account for about 95% of all 5-HT receptors in the body, are involved in several aspects of sexual functioning (eg, vasodilation, smooth muscle activity),32 yet the role that this peripheral activity plays in sexual desire is not known. Lastly, sexual desire is a subjective entity which is affected by a broad range of biopsychosocial variables,32 many of which may themselves be affected by serotonergic phenomena (eg, depression, mood). In accepting the relatedness of migraine AND sex drive, the door is opened to consider the relatedness of other phenomena that have a similar neurochemical basis. The reported high prevalence of depression in migraineurs,33 which is also theorized to be modulated by 5-HT, adds to the current study's contention that an altered serotonergic system may have behavioral correlates. The concept of a "migraine personality" is not a new idea34 AND may be, in part, a consequence of such an altered system, although support for a migraine personality has been mixed.35 One avenue of future research is delineating whether a reliable cluster of migraine characteristics OR symptoms can serve as markers of an altered serotonergic system. Another avenue of research, beyond replication of the present results, involves the examination of behavioral patterns hypothesized to be controlled by a particular neurotransmitter system that may covary with respect to other chronic pain disorders to further our knowledge of those behaviors as well as their underlying neurochemical systems. Although the sample size of the current study was modest, certain demographic characteristics were not well represented (eg, marital status, age range), AND the paper–pencil measure of desire may not adequately reflect any behavioral dimension of sexuality other than cognitive aspects of sexual desire, the results support the hypothesis that migraineurs have elevated levels of sexual desire. The excuse, "Not tonight honey I have a headache," will probably remain a valid option in eluding sexual activity, but those suffering from migraine may be the least likely to use it.