This is another topic I wanted to specifically raise for migraine awareness month because comorbid mental illness complicates migraine treatment immensely in quality of life.
I am treated for depression with Abilify. It turns out the antidepressant treatment we often get for a preventative, in me, worsens depression significantly in me. Either way, I do have depression associated with chronic pain and for a while had Major Depressive Disorder. I respond quite well to the Abilify really. It is quite remarkable the difference.
Here is the thing depression and pain are quite tangled together. I find treating one without the other is rather difficult. Both my were being treated at the same time at the pain clinic and I feel this is why I responded so well. For years, I wasn’t effectively treated for either… partly do to no response to preventatives and partly due to this negative mood response to antidepressants.
When both are not treated the depression Amplifies the pain response. Not only we feel pain more we react to pain more. We Respond to pain more. We dwell and ruminate on pain more. We feel the pain is endless, the suffering is endless and we question why we have to suffer so. We lose our motivation, our life satisfaction, our desire to improve and set goals. Work suffers because we are not motivated to tolerate that level of suffering and work… nor should we have to, as such we should have pain management at the same time. But we are sapped of the motivation and energy required to battle the pain effectively and the desire to seek out effective treatments or even act on those treatments… like lifestyle changes.
I am not saying I do not wonder why I suffer now. Not saying I am not aware I will suffer this pain indefinitely now. Not saying I do not dwell on it too much sometimes. But with depression it is heavy on the mind. It weighs on us. The effort required to exist with pain is Too Much. Why try to work? To socialize? When the pain is so Much? The thought of aggravating the pain and the absolutely fundamentally exhausting effects of it is just intimidating. You cannot bear it.
Not to mention you are mentally fatigued from the depression and the pain. And you cannot seem to shake it. You sleep too much on some days. Very, very little on others.
And your self-worth tanks because you feel fundamentally useless. The less you manage the more you criticize yourself for it. And you never, ever give yourself a break.
For me things I needed to do was:
- Proper medication: Not saying everyone with depression associated with chronic pain needs medication, because that isn’t the case. But my brain needs the boost.
- A pain psychologist: A psychologist who specializes in chronic pain or illness is very beneficial because it is unique… the tangled pain and depression. They compound. And coping strategies are therefore unique. I found this to be very beneficial.
- Pain management: Like I mentioned, if the pain isn’t somewhat, a little, a tad, treated at the same time I would have found it remarkably hard to respond well to the coping aspect of the treatment. Not to mention acceptance of the pain. All of that comes with moderate pain management. We, it seems, are destined for only mild to moderate pain management and the rest comes from coping strategies. The exception to the rule are people that exceed expectations and get down to episodic again or their migraines stop… or some other crazy result… but some of us, it isn’t in the cards. It is more Intensity control and less Frequency control. Or it is for me anyway. And then, acceptance of that and learning to cope and attain a certain level of quality of live with coping strategies.
Certainly this isn’t easy by any measure of the word. I began to get depressed some ten years ago and didn’t get treatment until a couple years ago. Basically, I denied I needed it. Thought everyone would feel like that with the pain. But of course everyone doesn’t feel that way with chronic pain. And then even when I did accept it, I hid it (6 reasons I hid my depression post). There is just a lot of stigma against it. And I expect myself to Handle the Pain. See myself as weak when I don’t. No idea where I got that notion from. I don’t see other people walking around with this sort of pain handling it better, now do I? But then I did get a lot of judgement at that time that I likely absorbed.
Either way these days I do a lot of things to manage my mood in addition to medication.
- Spend time on myself and my hobbies… down time.
- Self-care when I need it.
- When the pain is high specifically do self-care on that. Treat with magnesium, ice, meditation, Japanese mint oil, triptan on triptan days, my Oska. Really do a lot to relax myself after work and temper the pain so the next day will not be a continuation of it. I have a plan for my pain and I enact it. I do the same on less intense days, but more mellow. I go full out on the intense days.
- Socialize. We are social animals and being a hermit never really did well for me with the isolation factor. So made a conscious effort to socialize more. It does in fact boost the mood.
- Exercise. Another mood booster. Just not as fun. At all. Boring really. Have no idea how this boosts mood. But apparently it does. So there you go. Some people enjoy this. I am not one.
- Gratitude journal. I do a gratitude/productivity/goal journal. The gratitude journal is actually recommended by psychologists. You say three things a day you are thankful for. Forces the brain to focus on things you appreciate. Even small things. Harder than you think with depression for sure. So, ‘the pain doesn’t suck as much today’ isn’t Quite the goal in mind. For me, one would be I am thankful my spouse cooked super today. Or I am thankful I got a great nights sleep. And I am thankful my cat is doing better with his new pain medication (poor fellow is getting old). I also write down some simple things I accomplished, so I get a sense of being productive. This can be anything at all. And one small goal for the next day.
I really struggled a great deal with motivation when depressed. So routine was a major issue. Felt too tired. Too much pain. Too ambivalent to everything. I read a book that suggested to fake it till you make it approach. Until you have motivation to do until you have. Establish a firm routine and keep to it, but do not criticize yourself when you do not stick to it. We have bad pain days after all. I would set a time for exercise. Plans for socializing I would stick to no matter what. Meditate every night. Ten minutes consistently of housework even on bad days (this was a good point from my mom. Even on high pain days light housework for ten minutes is conceivable and then you feel productive). I have no idea if it was working though, I still felt like I had no motivation. But somewhere in there it creeped back, so it is a slow process, like everything.
To conclude, treatment of depression can be a very long and slow process, medication or not. But it certainly helps with quality of life when we do treat our comorbid mental health issues. Even medication for depression doesn’t snap, resolve the depression, the remainder of the issue is felt to us to manage. There is always the management strategies that are needed. Pain complicates depression. Depression complicates pain. For this reason, pain management is important and so is a good psychologist. I stress that it is important because migraine with aura, even without depression factors, has a three times as high suicide risk… when you factor in depression there we really have to take care of ourselves and our pain. Depression is a life sapping insidious disease and while I get why it would be more common with chronic pain, it seems like it is kicking us while we are down. Mood management is just as important as pain management for me. I find them equally vital for my coping.