Mental Health Awareness month: Depression and migraines

There is no such thing as pain without emotion. Pain comes with an emotional reaction. Often with chronic pain depression and anxiety. (2)

With migraines, we are three times more likely to develop depression.

This is notthe lifestyleI ordered

And we have a higher risk of suicide as well, even factoring in the depression.

This week is mental health awareness week and I think depression is an important topic with chronic migraines specifically. With chronic pain, we tend to have this belief that the pain would make anyone have troubles coping. That anyone would be down. Frustrated. Have dark moods. And depression, if we acknowledge to ourselves it is even that. We say everyone must feel like that sometimes… because of the pain. Indeed, pain itself is a suicide risk factor all on its own and it is a risk factor with migraines aside from depression… because suicide is what happens when we exceed our coping strategies and have no hope in resolving that problem. And that situation is something chronic migraineurs find themselves in often. But we also blame the depression on the pain, feeling it is normal to be like that with pain. In fact, depression associated with a medical condition like chronic pain… is a type of depression. But it is depression. And it can be dangerous if it is not treated along with pain management. If the pain is out of control the depression will respond to that. So both need to be effectively managed at the same time. It is my belief the depression treatment will not be very effective if it is therapy based if the pain isn’t being managed at all. When it is depression associated with chronic pain that is. You have to show there is some Hope in pain management. I am all for therapy though. Very valuable for this type of depression because a therapist that

In fact, depression associated with a medical condition like chronic pain… is a type of depression. But it is depression. And it can be dangerous if it is not treated along with pain management. If the pain is out of control the depression will respond to that. So both need to be effectively managed at the same time. It is my belief the depression treatment will not be very effective if it is therapy based if the pain isn’t being managed at all. When it is depression associated with chronic pain that is. You have to show there is some Hope in pain management. I am all for therapy though. Very valuable for this type of depression because a therapist that specializes in chronic pain can help with the depression and with coping with the pain, and how they work together and tangle together. And oh, how they tangle together.

Sometimes depression isn’t depression related to a condition, sometimes it is Major Depressive Disorder and ignoring it can be dangerous. It can lead to suicidal thoughts and actions even without the risk factors of the pain and migraines. This is the type of depression I was diagnosed with. Actually did exactly what I said, ignored it for years because I thought it was the pain. Just the pain causing it and I could deal with it. But it wears on a person. Gets the best of them. And going to the pain clinic, seeing the pain psychologist and ultimately being put on Abilify (I have severe adverse reactions to antidepressants) was the best thing that ever happened to me. Trying to cope with pain while fighting your brain is a difficult battle every day. Makes it twice as hard to cope. It is a heavy burden to bear. Having it lifted enough to deal with it effectively makes me able to use all the strategies I need to cope with the pain. Depression doesn’t just make you fight yourself mentally and emotionally. It saps your energy and motivation. You have strategies and habits you want to maintain… but then just can’t find the will to do them. Or even why. Why bother? What ever changes? What is even the point? All those thoughts happen. But every bit counts in a routine with pain, as we all know. Ice helps. Magnesium helps. Vitamins help. Meditation helps. Medication helps. You add all the things that help and you get something that helps you manage your pain.

Management of our comorbid mental health conditions is vital. There is no shame in it. There shouldn’t be anyway. There is the stigma. There is even doctor stigma. There is so much stigma it is insulting to me and to society as a whole. I have been pretty insulted by the stigma myself. But that is on them, which is why we need awareness. But don’t you feel shame just because of that stigma. 1 in 5 people will have mental health problems in their life. That is a lot of shame if people expect us to feel that. And we have no reason to. Our neurtransmitters are a little out of sorts is all.

We ticked off Fluffafur

fluffafur

Time to focus on my mood again. I need some mood boosting days. Some self-care mood boosting. It has been a difficult time on the pain front. Very difficult time stress wise and depression wise. It has been worse this week for sure. But since January it took a dip and I have been sort of wallowing, I suppose. Sleeping too much. Fatigue. Lack of motivation. Then I got some bad news and it dropped significantly lower. Yay.

So time to do some self-management instead of wallowing. Depression sort of encourages wallowing, though. It saps motivation, you have fatigue and it makes it hard to make decisions.

But I think if I start making firm decisions and carry them out step by step it will help in the long run. That I will start Monday.

This weekend time for some self-care. I will focus on my writing and do some reading. Avoid negative interactions. Get in some meditation.

And above all focus on my humor. I need it. Fluffafur needs it. We all need it.

The Migraine Manual.png

helpful-migraine-tip_number-1-2

I am depressed

Add subtitle text(12).jpg

I actually knew I was depressed. It isn’t a surprise or anything. However I have been looking through my files for ‘evidence’ to give my insurance company for my migraines and came across my psychologists letters to my doctor.

Initially when she diagnosed me she diagnosed me with mood disorder associated with a medical condition; as in depression associated with my chronic pain. And primary insomnia. I remember this because, yeah, it made sense to me. In pain, also depressed. However, she got to know me and changed that to Major Depressive Disorder. I don’t remember that, but, that being said I was depressed at the time and my memory of such things is hazy at best. I had been returning to work after my first suicide attempt and was seeing her because I was worried work would pretty much cause a second attempt. And I was right, but it would take some time.

Different people are affected in different ways by major depression. Some people have trouble sleeping, they lose weight, and they generally feel agitated and irritable. Others may sleep and eat too much and continuously feel worthless and guilty. Still others can function reasonably well at work and put on a “happy face” in front of others, while deep down they feel quite depressed and disinterested in life. There is no one way that people look and behave when they have major depression. However, most people will either have depressed mood or a general loss of interest in activities they once enjoyed, or a combination of both. In addition they will have other physical and mental symptoms that may include fatigue, difficulty with concentration and memory, feelings of hopelessness and helplessness, headaches, body aches, and thoughts of suicide.All about depression.com

I guess I can see why she changed it. My depression did become its own beast. Initially years ago I do believe it became a problem simply because of the pain. The pain was getting the best of me and I was pushing through the pain to work… and it was really becoming a massive problem so I was depressed about it. But tack on a few years of That and it ingrains itself pretty good. Get some strong habitual depressive thoughts. Some steady suicidal ideation and a couple of attempts in there. A lot of self-worth issues and guilt. But I masked my depression very well, up to the suicide attempt obviously and other than no succeeding I regret that I can no longer mask it. I prefer to pretend it is all well and just deal with it myself. But clearly that is risky when you are suicidal.

After the second attempt my current psychologist sent me to a psychiatrist for medication. Clearly he agreed it is Major Depressive Disorder and at the time needed to be medicated as well. And it really, really did. I would get in a lot of pain and all I would think about is wanting to die. How much better off everyone would be. How much better off I would be not suffering. How I wouldn’t be a burden anymore. And I was useless anyway, no one would miss that. Take me away and there is no one thinking she was necessary for this or that. I was fundamentally useless with pain. Those thoughts and more on repeat. The med, Abilify, stops that. I do get suicidal, from pain alone. But I do not get the plummeting mood that drives me to want to die,  just die that very moment. It evens it out. So I am depressed but it is milder and easier to tolerate. The pain isn’t so I still get the issues with that.

Here is the criteria I found on All about depression.com

Diagnosis of Major Depressive Disorder, Single Episode

From Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition

A. The person experiences a single major depressive episode:

  1. For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest.
    1. Depressed mood. For children and adolescents, this may be irritable mood.
    2. A significantly reduced level of interest or pleasure in most or all activities.
    3. A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight.
    4. Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia).
    5. Behavior that is agitated or slowed down. Others should be able to observe this.
    6. Feeling fatigued, or diminished energy.
    7. Thoughts of worthlessness or extreme guilt (not about being ill).
    8. Ability to think, concentrate, or make decisions is reduced.
    9. Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide.
  2. The persons’ symptoms do not indicate a mixed episode.
  3. The person’s symptoms are a cause of great distress or difficulty in functioning at home, work, or other important areas.
  4. The person’s symptoms are not caused by substance use (e.g., alcohol, drugs, medication), or a medical disorder.
  5. The person’s symptoms are not due to normal grief or bereavement over the death of a loved one, they continue for more than two months, or they include great difficulty in functioning, frequent thoughts of worthlessness, thoughts of suicide, symptoms that are psychotic, or behavior that is slowed down (psychomotor retardation).

B. Another disorder does not better explain the major depressive episode.

C. The person has never had a manic, mixed, or a hypomanic Episode (unless an episode was due to a medical disorder or use of a substance).

It is a pretty serious co-morbid for migraines and chronic pain. We have to have it treated well and see a psychologist to manage it.

Mental illness awareness week

14

I have depression. I have had depression for some time. It should be said I had a depression episode that was diagnosed as chronic depression when I was 18. I felt it was a response to chronic pain, of the fibromyalgia I had not been diagnosed with and was having trouble coping with. It lasted 4 years. Then around when the migraines became chronic I began to have bouts of depression related to the migraines in the prodome that were pretty severe. When the migraines became daily, I developed comorbid depression associated with chronic pain.

Continue reading “Mental illness awareness week”

Selfish

This is a reprint of a post I made for Migraine Checked about suicide. Since this is the anniversary of my second suicide attempt. Unmanaged pain is a very dangerous thing.

 

I want to talk about the very serious topic of suicidal ideation and suicide. The stigma with suicide though still runs rampant though and while I have seen so many people understand this death and so many others were caused by depression… others feel they can judge those who die in this way. They say they are selfish. That they should have just got help before it got that serious. That they should not have let their families suffer for their pain. I have seen this on twitter and I have seen it on Facebook. I have seen it recently and I have seen it before and I will see it again. “Suicide does not take the pain away, it gives it to someone else.” And people think these things because they do not understand depression. And because they do not understand suicide. And they do not even understand the two do not necessarily have to go together. Physical pain alone is a trigger for suicide.

This is one thing I want people to understand about suicide:

Add subtitle text

 

In my case my suicide attempt in 2010 was not this spontaneous occurrence. With profound pain came suicidal ideation that I fought off every time. Bravo me. I survived more times than you can count. Was that then selfless of me or just survival instincts? We want to live. We love people. But there was a war within me and one I was losing.

10940595_441892489298178_2467716175032968871_n

There is a thought process that we go through during these times. My existence was torture and it seemed Unreasonable that I should have to exist this way. Irrational that I would choose to exist in that pain and in fact choose to make it worse. Why would any sane person do that? And all avenues I had tried to reduce that pain had been used up. Society, my employer and my doctor at the time were all by their lack of caring and disinterest stating they wanted me to suffer. So this was my existence. Forever. And forever is a long time when you are in pain. A very long time. You see how endless and indefinite it is. If you just knew how long it was you had to go on. You begin to think how nice it would be to have a fatal stroke because… that would not be your fault. Then you imagine if you could kill yourself but make it look like an accident then no one would have to suffer with the knowledge that you had killed yourself. Clearly, I knew I was suicidal but these were Bad Days with Bad Thoughts. And my bad pain days were usually status migraine stretches, so I just had to wait them out… until I could get back to normal pain days. Normal hell. Then my work place would give me these ultimatums. If you do not work every day… we will do something unpleasant. And that would cause more pain, more stress, more suffering. Until that last ultimatum in that last status migraine…

Do not ever tell me someone is selfish when they are suicidal until you have been in that mental space. Until you have gone down that slippery slope of thinking and reached that line… and crossed it. You have no idea what goes on in that space. No clue. We do think of the consequences of our actions. It is just that first, we understand that grief will end and our suffering has no end unless we make it end. That is the first misconception our brain convinces us of. Well with physical pain we are very aware there literally is no end. But pain has a way of consuming your capacity to see reason as well, but that is another rant. (I will just say extreme pain warps reality as well) Second, that our families will be better off without us. We are a burden after all. We are holding them back. Imagine how much different and better their lives will be if we removed ourselves? Of course they would not Want that… but if we did it for them, it would in fact be better after they grieved for us. I myself was sure of this. I also knew my insurance company covered suicide so I knew financially some of my expenses would be covered… an added bonus really. Frankly, I assumed my existence was really rather worthless. Just this endless mass of pain that has no real meaning and worth. Except essentially to torment me… and That seemed like the ultimate madness really. You can rationalize suicide. You can slide down that slippery slope until you have essentially made it make Perfect Sense. I even explained it to a therapist after the fact and she could not even argue against me… as in she could not explain to me how my reasoning was not rational. She should have been able to because there should be flaws in the reasoning but we can really have quite an in-depth rational going on.

And so, no point arguing is there? There are finding reasons to live I find. Finding ways to live. Finding what you need to change and figuring out how to do it. Living until living works for you. Seeing a psychologist is something I chose to do to help with pain management because pain management is what I was severely lacking in. And it was damned hard. I was traumatized by the suicide attempt. I think sometimes people think an attempt is just a cry for attention but in fact it is just… didn’t get it right for whatever reason. In my case poor timing on my part. I know I could have had good timing and not be here right now because I had done the rest of it quite well. But I will say… it should be taken very seriously and the cause taken very seriously and the treatment taken very seriously. In my case it wasn’t really. The pain wasn’t treated. The work situation remained. And I became depressed from it. But after that… when I shook free from that I was motivated to change my doctor, see the psychologist, start managing my pain in new ways and took a long leave from work. I suspect I might not be here if I had not made those changes. Pain like that when not treated can really consume a person.

In the end when you survive a suicide attempt you are always at risk for another attempt. There is less of a chance of survival with a second attempt. We have to make that choice to understand the future does not mean endless suffering. The future can bring with it positive changes if we look for the right solutions and get the right sort of help that we need. It is not always easy to find and it is not always an easy solution… sometimes it is a damn hard fight, a constant endless battle to manage our suffering… but better than it would be with no help at all. With no hope at all.

We need to talk about this. We need to reduce the stigma of mental illness. And reduce the stigma of suicide. Check out: Stop calling suicide victims ‘selfish’

 

Suicide Hotlines

#Migraine and #depression

3

I was diagnosed with depression associated with chronic pain, but the fact is migraines play a significant role in this. Migraines can dramatically affect my mood. Significantly when the migraine is a status migraine and lasts for three days to, well, way too long. I have had suicidal ideation. Suicidal attempts. The depression itself can rise and fall like a storm, much like the migraines itself. And powerful. However, due to the chronic nature of my migraines it also became a force in-in-itself. More powerful in times of high pain, but there regardless.

It was ignored for years and I wrote a post about why here. Point is after a second suicide attempt the pain clinic rather thought the depression itself needed to be paid some attention to. When I first when to them they thought it could be managed with just some support from the psychologist who specialized in chronic pain, because the depression was a beast of the chronic pain. In a way, that was true but the intensity of the depression when I was in high amounts of pain and sleep deprived was extremely difficult to get around the excessively dark thoughts. Since I already in the past had a suicide attempt my second one was very spontaneous. I had already crossed that mental barrier and knew how easy it was to cross… so just leap right on by it the second time with little thought or consideration. Pain has a way of influencing thoughts to be deeper and darker. Not, unfortunately, unrealistic… just sharper and more exemplified of reality. Nothing gentle can sneak in there. Therefore they decided I needed to temper the storm with medication. Here is the irony; antidepressants make me suicidal. In fact that was the contributing factor to my suicide attempts, the medications, that made suicidal thoughts aggressive and persistent. Therefore when they looked at my medication choices the pain clinic psychiatrist said I can never be put on that class for pain management again, let alone depression. There were two alternatives and I am on Abilify. It actually works well. I have depression still, especially with a wicked migraine hitting hard. I just don’t really have the extreme lows that I was used to. The freaky scary lows.

Depression is an insidious beast that affects my chronic migraine treatment in so many ways. I was not as involved in my general self-care. I lacked motivation to do anything let alone the exercise I was supposed to do. I didn’t care about my hobbies and the things I used to enjoy anymore. I just wanted to sleep. I’d miss work from the migraines but also because I didn’t want to move, exist, be in pain that day. I am still in what I call a ‘funk’ still trying to encourage my motivation, force myself to engage in self-care. Trying to work on my hobbies hoping to spur my creativity again.

Another thing about depression is the lack of hope. When I feel a bit better I try. I try all the things on my pain management list and I do them every day. Set a routine. But when the depression sinks into me lower. I don’t try. Because why does it even matter? Nothing is going to work. And my routine falls apart. I have yet to find a way to keep my routine through the dips of the depression.

Here is some research to look at for migraines and depression.

Continue reading “#Migraine and #depression”

Bad mood days

Add subtitle text (1)

The pain is getting the best of me today. The migraines have been brutal as the weather shifts from sunny to rainy on a dime. That and knowing I have to work tomorrow with the fake smiles and the game that I have to play brings in the depression I struggle with.

My depression is directly correlated to my pain. I was diagnosed with depression related to pain. But it is more complicated that that. Due to anti-depressants and their suicidal side effects I have two suicide attempts under my belt. That was being on those medications odd-label for migraines and fibromyalgia. So due to that sensitivity I cannot take them. Due to the second attempt, which was very spontaneous and sudden, they put me on Abilify for mood control.

I have not had any suicidal intent since. No active plan. But I have had suicidal ideation. That rises and falls with high pain.

Because I want the pain to end. I want peace. Silence. Darkness. Rest. All the things I cannot have working. All the things refused to me. And I tire of this game of pretending to function. Putting on the facade of wellbeing and the fake smiles.

And my brain knows an answer to that. It craves an end to pain. It tempts me with its story of an end to suffering. It is Compelling.

I don’t listen. Even though it is smart that brain. It makes some very valid points. It knows how to get me going down that slippery slope to suicidal intent.

I can’t listen because the rules say suicide isn’t right. It hurts people. The rules say you have to learn to cope with the pain. You have to function with it. You get no rest. No silence. No darkness. The rules say you have to do things that will cause you more pain because it is the right thing to do.

I don’t really believe those rules at all. I believe I need to find my own reasons to live and stick with them. Hold onto them tightly. Fake it till I make it. And know when the pain lessens slightly I will feel better mood wise.

Nevertheless, I am in a lot of pain. My mood is low. I have to work. And I am damn tired of it all. And i will go to sleep in pain. Have a crappy sleep. And work in a great deal of pain. One more day till the weekend. One more day to make it through to earn some rest, silence and darkness that a migrainuer needs to find a least a little peace to suffer in.

Something to tell my psychologist about I suppose.