Breaking through the darkness
By now many of you have read about my battle with suicidal thoughts. That wasn’t the first time, but it certainly was the scariest. I came closer to dying that summer than I ever have before. It also wasn’t the first time I fought depression.
I was practically born into the Migraine community.
Whenever an attack hits, serotonin takes a nosedive. I am convinced that all that up and down set me up for chronic depression. I believe my serotonin receptors got worn out at a young age. Between the migraine-induced mood swings, the trauma of stigma in early childhood, and the medical opinion of the day that the source of migraine was psychological – how could I not be depressed?
Undiagnosed and untreated
I remember four distinct rounds of depression before age 18. None of them were diagnosed or treated. I was first treated for depression in 1994 when I was diagnosed with Post-partum depression after the birth of our first child. Recovery was complicated by the presence of migraine and my intolerance of the artificial hormones used in birth control. Depression hovered over me at least 5 more times (a total of 10 depressive episodes) before my doctor and I decided that I needed permanent antidepressant therapy. That’s long past the recommended treatment guidelines3.
Depression can be lifelong
By that time, I was in graduate school, practicing all the right skills needed to combat rumination and negative thinking patterns. A small dose of an SSRI gave me the push I needed to keep up the good work. About two years ago, my doctor switched me to an SNRI to address both depressive symptoms and the pain of fibromyalgia.
Therapy plus medication
Based on clinical evidence and my own experience, I strongly endorse the use of medication in combination with Cognitive Behavior therapy to treat depression2. You see, I was already taking an SSRI that dangerous summer when I came so close to dying. The medicine alone could not stop the symptoms. I needed more. Frankly, I had neglected to use the healthy strategies learned during my training as CBT therapist. Just like doctors can be bad patients, therapists can also be really bad at admitting when we need help. Looking back now, I realize that my attitude was foolish and dangerous.
When the suicidal thoughts finally broke, I began to realize I need to make a change in order to heal. My mind was so full of anger, resentment, and expectations of failure. I was going to have to fight back hard to break that negative pattern. Yet I was still so exhausted. Thinking of anything except death still required more energy than I could muster on most days. Two things helped me recover:
I reached out for help.
For me, the best option was an online support group for migraineurs who were struggling with suicidal thoughts. The group was started by a friend shortly after our mutual friend took her own life after a horrific battle with chronic migraine. Losing one of our own is a loss than none of us will ever forget. Just thinking about it feels like an open wound. Realizing that my own death would likely have similar results helped me to keep fighting. Participation in the group also reawakened my helper instincts. Encouraging others to keep fighting was good medicine for my soul. Soon the sting of my own pain eased as I focused on helping others.
I surrounded myself with positivity.
I started searching for motivational and inspirational images. I made a slideshow of all these images that I used as a background for my computer screen and as a screen saver. Even though I could not think positively just yet, I made a point to surround myself with positive things. Whatever I had ever loved was pulled back into my life. I was determined to drown myself in joy until some of it rubbed off.
Ever so slowly, my state of mind improved. I have now been in remission for 18 months. Remission means that I no longer meet the criteria for an active depressive episode. That doesn’t mean that I’m cured (like Migraine, Depression is genetic) or that I’m not at risk for another episode sometime in the future. In addition to staying on antidepressant treatment, I employ several different strategies to stave off that next episode for as long as possible.
I make a point to infuse each day with something uplifting even when I don’t feel like it. Mood dips are a normal part of my prodrome experience, so they no longer alarm me. However, if the low mood lasts past the end of an attack or occurs in the absence of an attack, then I double my efforts.
Exercise & activity
Naturally, I am a sedentary person. I have to put forth a lot of effort to include physical activity in my daily routine. Knowing that activity is an important part of any maintenance and treatment plan for depression, I try even harder1. My mood really does improve when I am moving around. It’s also a great way to discharge built-up energy, release anger and frustration, and increase my natural pain-relieving endorphins. I see it as a healthy part of good Migraine and Depression management. It’s as important as antidepressants, therapy, and preventive medicines.
Why am I telling you all of this?
We’ve all heard that Migraine and Depression are comorbid. I’m betting I’m not the only one who’s dealing with both. Just like we all tell stories of our Migraine experiences, I am now telling my story about Depression. I hope that it gives you some ideas on how to cope with your own Depression. More importantly, I want you to know that you are not alone, that there is at least one other person who gets it.
When was your last migraine check-up?