Migraine

I would appreciate any input from you all on this topic and when it's too much. I am seeing the NP today in my neuro's office primarily due to depression. My meds:
-75 mg Topamax at night
-250 mg Depakote at night
-100 mgmg synthroyid in the morning
-400 mg vit B2 (in 2 doses)

I believe the depression is from the Depokote. She is running labs (metabolic series, valproic acid level, Thyroid including a T3 if the Thyoid level is abnormal and a CBC with platlets).

I can't be sure of that as when I started the Depakote I was in a pretty sorry state from the Zonagrone. I did seem pretty euphoric initially though.

Over the last 4-5 weeks each day has become more difficult. I stare at my work. I am not motivated at home. Gardening does not even give me much pleasure and it is usually one of my greatest pleasures. Everything is a chore.

I've wanted to blame it on work, the dog, the children, my sister, the phase of the moon, buying new tires, really anything else I could think of. But I can't avoid dealing with it any longer. I am seeing a therapist. She helps, but my daily issues really are not that overwhelming. It's life. It happens.

So I spoke to my manager last night. She was very supportive and appropriate. But she said something that has me wondering. She asked me if this was severe enough I should consider some type of leave? I didn't have an answer for her. But I know many of you have issues with depression and/or migraines that have lead you to going out for periods of time. What have been your final triggers?

With the zonogran, it was easy, I truly could not function. My limbs were like dead weight. I'm not like that.

I will of course be discussing this with the NP today. But you insight into your own situations would be very much appreciated.

Thank you and take care,

Cindy

Cindy -

I've been sitting thinking about this. I can't advise you in any way about the medication issues, they're totally outside of my experience. Of course talk to your neuro about them and hopefully some kind of adjustment can be made that works for both your migraines and your mood.

But depression is familiar to me. I guess your question is, when is depression severe enough to take a leave of absence? I have been depressed periodically myself - I never took a leave of absence from a job because of it. But I have been self-employed for 17 years now and there were certainly periods when I backed way off on my work due to depression.

I think you have to gage - is your mood keeping you from functioning at work? How much is it interfering with your functioning? And would being out make you feel better or worse? It's great that you're seeing a therapist. These are things to talk to her about too.

The other thing is, what can you do to enhance your mood? These are not depression cures, but I find that regular exercise and regular meditation go a long long way to keeping my mood up enough to function. I have been in a very difficult place for the last year or so - with many major stressors happening at the same time, and I have mild level depression. I'm sure it would be much more severe if I didn't take time to enhance my mood in those ways.

Hope this helps. Keep sharing - we're here for you.

- Megs

I have Major Depression. I've been on antidepressants for years and plan to take them for the rest of my life.

Depakote made me severely depressed. So depressed that I was hospitalized twice. You may be onto something that the depression is related to the Depakote. Did it start getting worse when you started taking the Depakote?

What you're describing is exactly how I feel when my depression is out of control. Not taking joy in things like gardening is a sure sign for me that I need to get in to see my psychiatrist and talk about my meds.

If your preventives are working (I can't remember, sorry), I'd be reluctant to discontinue the Depakote, but you can consider adding an antidepressant. You're seeing a therapist, so that method of treatment is covered. Having a professional to talk to is great.

I'm currently taking Welbutrin and Cymbalta. They're keeping my mood under good control. I'm not as energetic as I could be, but I'm in pretty good shape. I'm feeling better as my head pain is getting under control.

I've been on the Welbutrin for 7 or 8 years but have only been on the Cymbalta since December. I had been taking Effexor, and my new specialist had me switch that to Cymbalta, after I'd checked with my psychiatrist.

I had to quit work because of my head before my depression was diagnosed, but I'm sure the depression was a part of the mix that made it impossible for me to function as an attorney. So I don't have any personal experience on taking a leave to get depression under control.

But my thought is that a vacation would be nice. Just a vacation to stay at home, maybe get details like bills and laundry under control, and work in the garden, and cook for the freezer? A couple of weeks might let you de-compress.

I agree with Megs about exercise. I walk, and I think it's an important part of my overall migraine strategy. Besides, I get out in the natural light and fresh air and get to spy on the neighbors. All that is great for my depression.

Think about the antidepressant angle. Many of them are great preventives.

Gretchen in Mississippi

Thank you both. You have provided me with some excellent "food for thought" as the saying goes. I am not normally a depressed person. The root cause of what is going on, I hope the NP will be able to help me determine today. She may want to wait for the labs to make sure there are not other contributing factors. I certainly will not fault her for that.

I have a vacation scheduled starting 5/17, but DBF and I are going out of town. Which isn't necessarily bad. We are going and doing things I really want to do.

If I am started on an antidepresant this week, between now and the end of my vacation (5/26), I could start seeing some result form it.

Again, thank you both.

Cindy

Another thought is the Synthroid. Some people find depression lifts or is easier to tackle on natural replacement hormones. I started out with Levoxyl, and did horribly on it, because it wasn't "real" enough, and had no T3. I thrive on Armour, though, and the brain fog stuff is so much better. I've heard people say it affects their depression issues in a good way to get that added T3. It might be something to ask about.

Hi Cindy,

I took a moment and counted up how many of the meds on Teri's list are anti-depressants--21. Depression is part of life, especially life with a chronic disease. Getting help for depression and taking anti-depressants is necessary to make sure other medical problems can be addressed. So many times depression makes everything else unbearable.

I once read a in a Clifford Simak (sci-fi book) a description someone falling a sleep in a soft warm fur robe. The more the man relaxed in robe the more it seemed like he was paralyzed. He felt so comfortable and just wanted to fall asleep, until an alarm bell went off in his mind and he realized what was going on-- he was slowly being paralyzed and would not be able to move. I have come to think of depression as a suffocating blanket that really does envelop us.

When that alarm bell goes off in our mind we need to act or the depression will suck all life out of us, and paralyze us.

Sounds like alarm bells are going off in your mind and you need to act.

If it takes a break to fight depression it is worth it for your life.


Mary in NM

I tend toward depression anyway, but living with chronic migraines has undoubtedly made my depression much more severe.

I take Celexa and Lamictal and this combo works quite well in managing the chemical component of my depression. I do see a therapist (almost weekly), which has been invaluable. And I have to agree with Megan that mindfulness meditation is an extremely wonderful tool to have in your kit for managing both pain and depression.

As for the Depakote, I'd explore that question with your doctors and formulate a plan for examining whether that could be the cause. I really can't say, but it wouldn't be too surprising that such a strong drug could affect you that way.

I am on disability now, and I would have to say that the severity of my depression was a factor in my inability to work. But it's sort of a chicken and the egg thing. I have genetic tendencies toward both depression and migraines and they both exacerbate each other.

I hope approaching the depression on a number of fronts might bring you the relief you seek. And if it seems right to take some time from work and that is possible, please listen to your body. It has taken me years to finally listen to what my body is asking of me, and I put myself through a lot of grief by fighting myself for so long.

Diana

Droolie's got a good point about the thyroid as well. I'm on Armour thyroid as well, and if I miss a day boy am I miserable. I get tired, apathetic & more depressed within 24 hours. None of the synthetics (like synthroid) have T3, according to my doctor, and T3 is actually the form of thyroid hormone that has the most effect on our functioning.

Might be worth a look. Armour is natural thyroid extract from cows, I think.

- Megs

Cindy, it looks like you've gotten some great input already. I don't have much I can add, since I've neither been treated for clinical depression by a psychiatrist nor taken a leave of absence for my depression.

I will say that my very recent experience with Topamax is that meds can absolutely add to depression. My depression is normally relatively mild, manageable with a therapist and other (non-medicinal) tools. I've never taken antidepressants for my depression, and it's only recently I've dealt with depression severe enough where I would feel it might be necessary. I am very happy to see that you did the right thing in going in to see the RN at your doc's office and had some bloodwork done to try to get to the bottom of this.

Also, while I'm thinking about it, the anticonvulsants (including Depakote) have recently been linked to suicidal thoughts, so if you at *all* start heading down that road, please get help immediately. Our article on that is HERE. This is serious business because the thoughts can come on suddenly. I don't want to scare you, but if you think the Depakote may be contributing to your depression, do keep this in mind, and you may want to talk to your DBF about this as well.

All that said, in my experience, I don't necessarily see depression coming on so much as I all of a sudden notice how bad it's gotten. That's usually the point at which I realize it's time to get some help. Mary's analogy is a great one, and all those encouraging you to listen to your body are right on. I'll add that, in these sorts of situations, you really can't beat your instincts.

If your instincts are telling you to take some time off from work - whether that's a day, a week or a month - you should take heed. If your instincts think it will be better for your mental condition to stick it out, then go with that. I know for me, at this point, it's essential that I keep working as much as I can, since it's one of the (only) ways I still feel like a contributing and useful person. I try to take time off here and there - leave work early or call out - if I need the mental health day. It's not a perfect system by any means, and I still fight my body a lot. If my instincts start telling me it's time to take a longer leave of absence from work, then that is what I'll do - as hard as it will be for me to leave since I really do enjoy my job.

I hope what I'm saying here is making sense. Go with what your gut is telling you. Hopefully by now you have some answers, or at least some direction, from the nurse.

Hang in there, hun - we're all here for you, no matter what.

I cannot begin to tell you how much I appreicate the input all of you have given me. It helps tremendiously. Perhaps if I took time off I could endulge in a spelling course....or typing.

On a more serious note. I've posted under Doctors and Clinics about my visit. The bottom line is I'm still on Depakote with 10 mg of Lexapro added.

I was aware of the depression being a side effect of the Depakote, which is why I went in. One of the labs she had drawn was TSH with T3 if the TSH was abnormal (I think that's how it was written). My PCP generally does TSH, and T3, T4 annual as part of my physical. She does not require the TSH to be abnormal. I will ask her though about the change in type of hormone being taken and her experience with it. I stopped seeing the Endocrinologist about 2 years after the Graves Disease was diagnosed and treated as I experienced no problems and my thyroid levels went into normal ranges and have stayed there.

I am off for 10 days starting 5/17, so that will help. I also find if I take breaks during the day, other than lunch and enjoy the fresh air and sunshine I feel better. I really should just set an alarm to go off and take the 10 minute walk.

Again, thank you all. Your input and experience is very helpful to me.

Cindy

Really, honey, there may come a point in time when you may have to weigh whether the depression is worth the reduction in migraine attacks that the Depakote is providing. If you've never been a depressed person before, it's telling that Depakote is causing depression in you.

I've been through a few bouts of depression that I've never had formally diagnosed. It's hell. Mine always went away immediately when my thyroid levels got right again, but I know depression.

We love you and we're behind you and beside you.

Everyone has given you lots of info to digest. When I was on depakote, I did not have problems with depression. I did however have SEVERE depression on topamax. It was so severe that I couldn't function at work. I think it was part of what made me seek temporary disability. Once I went off the topamax, I felt more normal, more like myself.

Being on both depakote and topamax is like giving your body a double whammy. Both have depression as a possible side effect so it's no wonder you feel depressed.

I too am on armour for thyroid. I can't do the synthetic thyroid meds because they make me feel wired. I know if I forget my armour for a day, I feel sluggish and tired, which is similar to feeling depressed.

If you've never considered taking a leave for medical reasons, let me say I definitely encourage it. I paid into my disability insurance for over 20 years and never once used it until this year. I worked through all my migraines and med changes. I finally hit a point where I couldn't keep up at work anymore and was so severely depressed due to the pain and the meds that I knew it was time to take a break. My doctor told me that when you're ready, you'll know it. I KNEW I was ready to go on medical leave for this. Plus it gives you time to focus totally on lifestyle things that impact your migraines. I have gotten a better handle on what my triggers are since I've been off.

We are all here for you while you decide what's best of you to do. Take Care.

Hi Cindy...

You really have gotten great advice, but I want to put my two cents in because I have been on Topa, a depakote/lexapro cocktail, and had to take a month off from work a few years ago because of my depression....

Summer of 2003, I had a full on episode of major depression. I had struggled with depression my whole life (looking back I should have been on anti-depressants since my late teens). It was like what MaxJerz said, I didn't really notice it coming on, I just realized how bad it had gotten. It had been getting worse and worse since January, but by May I was crying in the bathroom at work at least three times a day. It felt like I had a constant weight in my chest.

Finally, I woke up one morning and I just couldn't get out of bed. Not "I don't want to". I literally couldn't will myself out....

I sought treatment immediately. I have a psych degree, and I knew what was going on. I was put on 10mg of Lexapro and 500 mg of Depakote. I was told by the psychiatrist the depakote enhanced the functioning of the Lexapro and would make it work faster.

I was put on short term disability for 4 weeks by my PCP (since I wasn't under the regular care of a psychiatrist) until my medication kicked in and I could function again. (I refer to it affectionately now as "calling out crazy").

I stopped the depakote after about a year, but have been on Lexapro ever since. (Though I am back on depakote now for migraines). I will be on Lexapro for the rest of my life. I function better on it than I have EVER functioned in my life. I don't have to struggle through everything anymore.

So, the truth is, if your boss is offering and one of you physician's will approve it, some time off while you wait for the Lexapro to kick in or while your med cocktail gets tweaked, it really can help.

I really hope the Lexapro works out for you. Or your doc gets you off the depakote. These meds are all so tricky and there is so much guesswork involved.

Feel better, take it one day at a time, and we are always here if you need us.

Cindy,

I'm really impressed that you're taking the initiative to deal with this problem right away. I think you're getting a lot of valuable input, and I'm sure you'll find a solution with your doctor.

My two cents: I never had problems with depression in my life until I was put on Depakote, and it happened again with Tegretol. With the
Depakote, I was actually experiencing some improvement, but when we kept pushing up the dose to get a significant level, my depression got worse and my doctor told me that this was not an acceptable tradeoff, and that we had to find something else. Her view was that since I had never had trouble before with depression, it did not make sense to add a new medical problem.

On Tegretol, I became so indifferent to everything that I couldn't even talk to or relate to my kids. I barely mentioned the problem to my doctor till she asked, I said, "Well, I don't feel like I care about anything" and she asked for an example, and I said, "Well, my kids, for example". She said, "We're stopping this drug. We can't do this to you".

I have always been glad that she didn't encourage me to just stick out that trial - her view being that we would eventually find something that didn't totally mess up my mood. And we did - Lamictal turned out to be completely tolerable, didn't change my mood at all, and worked.

I am totally supportive of your decision to take some time off for this med adjustment. Sometimes there is just no other way to do it, and the SSRIs can be tough to start up (I'm a clinical psychologist so I've seen plenty of people through the first two weeks while they're getting adjusted). You have to put yourself first, and this is both about your physical and your mental health.

From those two drug experiences, I have heartfelt sympathy for how awful you must be feeling. I do hope you'll continue to consider with your doctor whether this tradeoff is worth it. It might be different if you had a prior history of depression, but honestly, if you've been OK so far, I might consider exploring different antiseizure meds. There sure are a lot of them.

Keep us updated. And take care of yourself. Good self care and health habits and positive self-talk and relaxation and all that good stuff really does help with the depression symptoms!

Lynne

Hey Cindy,

Any chance your mood has ben affected by being hypthyroid? My Sol's thyroid is all wacked due to her lupus and she takes 350mcg levothroid. Until they reached that level of meds her mood was depressive and when her thyroid gets a tad wacked (which it does every so often so they check levels every 6-8 weeks) we notice things like increased fatigue, muscle aches and lower mood.

Just a thought.

Peace,

Dave