Breaking through the darkness

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.

Reality check

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.

Prevention strategy

Positive thinking

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.

 

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. Blumenthal, James A., PhD, Smith, Patrick J., PhD, Hoffman, Benson M., PhD, (2012). Is exercise a viable treatment for depression?, American College of Sports Medicine: Health & Fitness Journal, 2012 July/August, 16(4): 14-21. Retrieved 4/29/15 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674785/.
  2. DeRubeis, Robert J., Siegle, Greg J., and Hollon, Steven D. (10/9/2008). Cognitive therapy vs. medications for depression: Treatment outcomes and neural mechanisms, Nature Reviews Neuroscience. 2008 October ; 9(10): 788–796. doi:10.1038/nrn2345 Retrieved 4/29/15 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748674/pdf/nihms102348.pdf.
  3. Dunner, David L., M.D. (2007). Preventing Recurrent Depression: Long-term treatment for Major Depressive Disorder, The Primary Care 'Companion to the Journal of Clinical Psychiatry, 9(3): 214–223. Retrieved 4/29/15 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911177/.

Comments

View Comments (15)
  • smilysuz
    2 years ago

    Is there an online support group also?

  • Joanna Bodner moderator
    2 years ago

    Hi there again smilysuz,
    Are you by chance on Facebook? If so, we also have a Facebook page where you can connect with many others for support & to share information. Thank you as well for the update. I was wondering how things were going since your original reply. I very relieved to hear that today has brought you a bit of hope! Don’t lose it!! :)Know we are all behind you! Let us know how things go these next few weeks & how you are doing once you spoken to your doctor on Monday. Have good night. -Joanna (Migraine.com Team)

  • smilysuz
    2 years ago

    I was on the verg of suicide 2 weeks ago, I did not want to talk to anyone!! I just wanted to end my life as I know it as being in bed 85% of the time. I also have had Anxiety, Depression and Chronic Intractable Daily Migraines. Hitting an all time low bc no longer were any treatments working or giving me any relief!! I ended up in the ER 2 days ago and it finally broke my cycle so my pain level decreased but I also had such a drug hangover that caused the deep depression stay. Today is the first day I have had a sliver of hope again!! I am so blessed for this!! I am on anti depressants and my Physc Dr had taken my Wellbutrin dose down from 450mg to 300mg and I feel that has helped a lot!! It has been a little less than 2 weeks ago. He wants me to take Lexapro 10mg but I am afraid to, so I am going to call him on Monday for his suggestion. As far as any preventive medications, I take Trazadone and Lamictial to try to help since all other preventives have not. By the way I was on Lexapro before, and it did not work as a preventive either. I was taking phytenol (sp?) at one time and tore that patch off, I told my Neurologist that it did not work and I only slept more. Then he gave me Dilated to keep me out of the ER, 15 per month!! Those did not help either!! In the ER given by IV knocked me out. So when I went the other day they gave me Torodal, Raglan, Benadryl and something else ( no narcotics ) and it worked IV. Best I have had at the ER!! Now I was also taking Perco 10/325 up to four per day!! Told them I wanted to reduce the mg so now I take a total of two 5/325 and the lower seems better. I cannot seem to go below this dosage bc right now it only works sometimes but NEVER takes them away completely. I also take Klonapin and Phenagran for nausea which I end up sleeping on. That is where I am today!! Thanks for allowing me to post all this, it was very therapeutic for me to know I am not alone it this Migraine World GOD BLESS!!

  • officechik
    2 years ago

    Hi smilysuz….

    I also take those 2 antidepressants/antianxiety meds. Welbutrin 300 and Lexapro 10. If that is what the doctor recommends, try it. Lexipro is NOT a preventative, but it will help you with depression, anxiety and suicidal thoughts. They go along with chronic migraine or chronic pain unfortunately, as many people with these conditions (such as myself) understand.

    What works for me as a preventative (not for everyone of course) is Verapamil, Topomax, and Konopin taken daily. At least it used to work…lol.. I think I’m under too much stress now and I’m getting more migraines than I should. Certainly more than before 5 years ago (start of a bunch of issues), Then I have Maxalt as a rescue for when I get a migraine. But I also have allergies also, terrible, so I have to constantly be on allergy meds or I get sinus headache. UGH !

    Best wishes too you…keep the spirt…the migraine support group is here. They really understand it all and have been through it all.

    Michelle

  • laurahildebrand
    2 years ago

    I would be really interested in the online support group. I suffer from chronic migraine, depression, and anxiety. Laura

  • Sandy Parker
    4 years ago

    Can you tell me the online support group for migraineurs. I would like to join in. I’m in the middle of hard time in my life. My depressions and migraines have both gotten worse.

  • Tammy Rome author
    4 years ago

    Sandy – I sent you a private message.

  • maxgordon
    4 years ago

    Like you, I have battled both chronic migraine and chronic depression since I was a child. Along the way (somewhere in my thirties), I added idiopathic chronic pain most likely due to some still unspecified autoimmune issue (doctor-speak for “we think it’s this but it might be that, just wait until it gets worse and we’ll put you through more tests…”). Still, I managed. To deal with the former, I had a great therapist and decent meds. To deal with the latter, I had a lake, Exedrin migraine, and a revolving roster of migraine meds that didn’t quite work but gave me hope that something would. I had a gf I was quite serious about, a house I adored and planned to grow old in, and–best of all–my son, who means the world to me.

    Fast-forward to financial distress leading to me being forced to sell my house and move out of the countryside into an apartment in a town. To treat the inevitable situational depression that compounded the chronic depression, my doctor upped my bupropion (antidepressant) and duloxetine (SNRI that helped with the neuropathic pain). Thus began my first summer in 22 years without access to a lake to cool off in (body temp is a huge trigger for me) and what felt like the hottest summer of my life. Unbeknownst to me, and apparently to my doctors, my blood pressure became dangerously high, as in hovering between 150 and 200. From June to August, I had only a few migraine-free days. Then, while my son was away for a week, my gf of 13 months broke things off. I could have dealt with any one of these things, but…

    Now, I have thought of suicide off and on all my life, but I am a logical, empathic person, and I was easily able to dissuade myself from acting on it. After my son was born, I also had that to stop me, as I know how it feels to have a parent die by suicide. But on that day five years ago, coming off a three-day migraine, I snapped. But somehow this time, the safety switch had been turned off. I went into automatic mode, and slit my wrists. Although I am not trying to absolve myself completely for the responsibility–I picked up and used the blade–I blame the meds for removing my natural self-preservation mechanisms and my logic.

    Obviously, I survived. I won’t bore you with all the details of the drawn-out medical, legal, and family backlash, except to say that I no longer speak to my siblings, and 2.5 years ago my son ran away to live with my ex (despised by me and, he had said, by him).

    If I thought I had a chance to win, I would sue the pharmacy companies, as I am convinced that while antidepressants help in low doses (indeed, I am now on a very low dose of duloxetine only, for the pain), in higher doses, they kill; people with chronic pain and chronic depression are easily pushed over that fatal edge. When you can’t support yourself without help, it’s demoralizing and demonizing, and your reasons for living become very, very blurry.

  • BethBlue
    4 years ago

    Once again, you have hit the nail squarely on the head (are you sure you’re not my twin?), and it’s fascinating! My diagnoses were the opposite of yours. Although I’ve been experiencing migraines in some form since age 10, I wasn’t properly diagnosed until I was 47. On the other hand, I was diagnosed with clinical depression when I was 36. I began therapy immediately and I’ve been on anti-depressants ever since. Although I no longer attend therapy (I really can’t afford it), my neuro continues to prescribe my anti-depressant medication, as he recognizes the importance of treating my comorbid condition. Keep up the good work, Tammy — you absolutely rock!

  • Sarah
    4 years ago

    How does one know if you are depressed or just down? Is it a constant state? How do you bring this question up to the doctor? I never know how to respond to those generic questions… on a scale of 1-5, how do you feel and so on.

  • Tammy Rome author
    4 years ago

    Sarah,

    One of the most reliable ways to determine if you are facing Depression is the Beck Depression Inventory. You can search for it and see the actual questions. Therapists use and a clinical interview to determine if a client meets the criteria for a diagnosis. It’s more than just feeling sad.

    When I was working, I would use the BDI and then have a conversation with clients. I looked for changes in energy level, activity, sleep, eating, changes in weight, loss of interest, difficulty thinking & concentrating, feelings of sadness, worthlessness, and helplessness. I always screened for suicidal ideation and did a risk assessment. In order to meet the criteria for depression, I looked for at least 5 out of 10 symptoms occurring non-stop for at least 2 weeks.

    The similarity between depression symptoms and migraine confuses the issue. With migraine, these symptoms come and go with each attack. Unless, of course, you have chronic migraine. Then the stop/start of each attack isn’t so clear. It’s a judgment call on the part of the clinician that is based largely on client complaint.

    I should probably write another article on what to look for. Thanks for the inspiration!

  • Beth
    4 years ago

    I’m dealing with depression right now. Between my migraines and realizing that I’m going to need open heart surgery in a few weeks I can seem to see the light at the end of the tunnel. I’ve got an appointment on Friday with the neurologist and I’m going to finally ask for help. I really hope he will!!

  • Alison
    4 years ago

    Thanks Tammy,
    For me too they go side by side. Periodic migraine turned to chronic, along with post partum depression in my 39’s, and depression comes and goes. My saviour in the summer is an hour in my garden, pottering around with the little gardening I can do and just listening to bird song. In the winter a log fire and good movie, with the volume down low of course. I am on a low dose of antidepressant at all times now and don’t really have the possibility of counselling. I did ask for it once but was told the waiting list was about a year. I live in the U.K and our health system is good with some things, not good with others. I know this is a U.S website but I have joined up and hope you don’t mind as I find it a Godsend. When a suicidal day arrives the first thing I do is log on and I want you to know that this site helps so, so much. Just knowing you are not alone is invaluable. Knowing that your feelings are shared is invaluable. So thank you everyone who set up this website and thanks to all who contribute. You help me to cope.

  • Anne
    4 years ago

    I’ve got both migraines and depression. My serotonin does the same thing too – right before an attack it falls noticeably. Being in acceptance of migraines and the limitations that come with them are the hardest thing. I think it’s normal to have suicidal thoughts when you have depression – it goes with the illness – I don’t give them much weight when they come up. I’ve also been fortunate enough to find the right medication for depression. Once you discover the correct medication, it’s so clear that it’s all chemical.

  • britt
    4 years ago

    Depression is often overlooked by doctors when treating migraine or the patient feels at fault for their depression and doesn’t seek help. I know I’ve felt guilty for having it and was loathe to admit I was depressed, which made it hard to seek help. Your story makes it alright to have depression. Not a good state, but an acceptable one for someone with migraine. Thank you.

  • Poll