September is Suicide Prevention Month. Suicide Awareness is a cause close to my heart as I have had a few attempts due to unmanaged chronic migraines. It is also Pain Awareness Month. And these go hand in hand with chronic migraines.
It is a hard topic for me to write about. It brings back echoes from my past I would rather not think about. However, if we do not talk about this subject the stigma will remain and people will not seek help when they need it.
The Facts on Migraines and Suicide
- Of all people who have migraine disease women with Migraine with Aura have the highest suicide risk
- Severe and frequent attacks are more likely to lead to suicidal ideation
- People with Migraine without Aura are just as likely to have suicidal ideation as people with Migraine with Aura but less likely to act on the thoughts
- People with Migraine with Aura are 3 Xs as likely to attempt suicide than those without migraine, whether they have depression… or not.
- Migraine with Aura is more likely to have recurrent depression than migraine without Aura
- Some research suggests those with migraines experience Anxiety and/or Depression up to 5 X that of people without migraines. Migraine.com
- Women who get migraines are at 41% greater risk of depression Migraine Again
- Young women (under 30) 6 X more likely to get depression as those over 65 Migraine Again
Medications may increase suicidal ideation and risk
Compared with topiramate (Topamax), the following migraine drugs are associated with high suicidal tendencies:
- Gabapentin (Neurontin)- 40% higher than Topamax
- Lamotrigine (Lamictal)
- Oxcarbazepine (Trileptal)
- Tiagabine (Gabitril)
- What I would like to point out is the suicide rates exist without depression with migraine with aura. It is a risk factor those with aura have to deal with. Three times as likely as those without migraine.
- Another important factor is our higher risk of depression and when you have chronic migraines (15 or more migraines a month) And depression it can make it extremely difficult to deal with and cope with the pain.
Things I want us to think about
- How often and intensely we have suicidal ideation. And if our suicidal ideation has turned into thoughts about Planning or Intent which is the major danger zone. If you are in the danger zone a) go straight to the ER to protect yourself b) tell someone and talk about it such as spouse or family member and c) definitely it is time to see a psychologist.
- How is your general mood? Do you find yourself having thoughts of hopelessness? Have activities lost their appeal? Is your motivation just stagnating? Is it possible you have depression to a degree or a major depression? I highly recommend a psychologist for pain management and depression. Hell, just for pain management.
- Assess your coping. Sometimes we are coping quite well. Sometimes we are struggling so hard. Stress is at an all-time high. It feels like we are being crushed or suffocated. And we have no choices. This can be a risk factor for suicide when we have chronic pain… like we are locked in a box of suffering and cannot get out so we resign ourselves to suffering forever… then inevitably it occurs to us that we shouldn’t have to suffer like this. Psychologists who specialize in pain can help with these thoughts.
- Analyze your wor situation. Do you feel overwhelmed? Trapped? Way too stressed? like you are getting worse just being there? It may be time to consider alternatives. Flextime. Work from home. Go down to part-time.
I want us all to be safe. Feel safe. And seek help when we need it.
I feel this way because I have Been there. And I didn’t seek help. And I had two suicide attempts. And fell into a deep depression. I did get help and saw a pain psychologist. I was diagnosed with Major Depressive Disorder. I was in therapy for some time but it was not sufficient for my depression so I saw a psychiatrist recommended to me and was put on a medication (Abilify) for the depression. It helped immensely and then we could focus more on pain management in therapy. But before that was a very dark time for me. I was in denial. Denial I could have a career and hold down a job. Denial my depression was as severe as it was. That I could handle it myself. That the pain I could deal with myself even though it was just unmanaged and treatments were not working and my migraines were every damn day. It was the perfect storm. And I am lucky I survived.
Be mindful of medication
Some migraine preventatives are SSRIs and used for depression. They often have the side effect of worsening depression and suicidal thoughts and actions. And I am one of those people that gets that side effect a lot. So often I cannot be on those medications at all. And the thing is you do not necessarily notice it right away because pain does come with depressive moods. But we have to be mindful when this is worsening and thoughts are darker and more frequent when on a new medication. My first suicide attempt was due to a medication I was on. Not that I didn’t have a problem with pain and depression… the med was just the kicker to the brain that pushed me over the line. And they are not the only preventatives with that side effect. So when we take something new and we are on a three-month trial a good mood journal or mood app is a great idea.
We also have to be concerned about medication mixes. So SSRIs, triptans and other medications that affect serotonin… which can cause what is called Serotonin Syndrome.
Chronic pain sucks
Chronic pain does a number on our moods. Period. And we have a risk for depressive moods, episodes or mental illness. Sometimes day by day we do not pay attention but if we track it we can see a downward trend that is not so good at all. Since I Have been suicidal and I Do have depression I do maintain a mood app that helps me keep track of mood trends. I do really recommend such things to just keep track of your mood trends.
And when you know you are down, just not in a good mood due to high pain, or in a funk… it is good to do the things you know get you out of that funk. (11 ways to give yourself a mood boost) And these are not things people that are healthy really think about but for us moods can really affect how we cope with pain. And so doing any small thing you know works for you, is a good idea. Or a good self-care day.
There is a link between migraines and depression even if the link is not known yet. And that means we have to treat our depression and our migraines. In order for me to have proper pain management, I HAD to have effective depression treatment. And for me, that meant therapy and medication. If I had not treated that then I would not have been able to effectively manage the pain. You need to treat both. Both are equally important. And we need to know we are at Risk for Depression. And this Risk causes our risk for suicide to increase. It decreases our capacity to cope with pain. It is dangerous if not treated. It is a Major risk when combined with chronic migraines.
Like I said I went through a dark time. I just didn’t mention it lasted over a decade. And I didn’t seek help until after my first suicide attempt… and sort of had to at that point. Because before that I excelled at hiding my depression behind smiles and laughter and jokes. I felt worthless and hopeless and desperate with pain. But I hid it because I felt weak and like I should just be able to deal with it and deal with the pain. If I have one regret it is not seeking a psychologist a lot sooner than I did. Prior to my attempt. And therefore saving my family and myself that trauma, which it is. It is a trauma that lingers and makes it difficult to write posts like these even though I know they are very important. I have a deep bruise on my soul and thinking about it reminds me of that time.
What I did eventually was:
- Changed doctors. My doctor was an indifferent douche who called my suicide attempt ‘an extreme reaction to pain’ and did Nothing to help with that pain.
- Got a new doctor who listened to what I actually said. She sent me to the pain clinic.
- Pain clinic put me on pain killers (tramadol slow release which I do not rebound on and about the only one they will ever even try with migraines. I went to their pain 1o1 group.
- I saw the pain clinics pain psychologist for some time. And it helps me with my depression and pain management
- I saw the pain clinics psychiatrist which helped me find an effective medication for me for depression that wouldn’t have the side effect issue I was having with most of them.
- I reduced work to part-time. And when I got sicker a bit back, well, then I became disabled fully,
Everyone’s path is going to be different. I just hope that when you need it you get the help you need and don’t suffer more than a decade like I did. Just remember we are at risk and we have to be careful. And we need to seek help when we feel our mood trends have changed for the worse. Or any time we want because a good psychologist really does help us work through all the hard issues and emotions that come with chronic pain. So I definitely recommend that.
Suicide rate in migraine patients
The migraine depression link
Migraine and Suicide
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