Posts Tagged ‘depression’
April 22, 2012 | 
Author 
Poster seen in Robbins Headache Clinic
It was a little over a year ago that I had the pleasure of meeting Dr. Robbins. Like most headache/migraine patients I had spent many years bouncing around between Family Practice doctors, Internists, Allergists, Neurologists, all to no avail. At the time I walked into Dr. Robbins clinic, I had little expectation that I was going to find any answers, let alone any actual treatments that would reduce the frequency or severity of my migraines. I was haggard, depressed, hadn’t slept well in weeks, and was tired of going through the same routine with doctor after doctor. I’m sure he was glad to see me too.
My wife (who is an Anesthesiologist) received a recommendation to the Robbins Headache Clinic from asking several colleagues if they had any idea of who might be able to help me with my migraines, and Dr. Robbins was mentioned. As we reside in Arkansas, the prospect of traveling all the way to Chicago for treatment did not sound appealing, at all, and I was reluctant to commit to an appointment with a physician I had never heard about, especially if it included flying across the country. In all honesty, I was jaded, and felt at that time that there was no one who could help me. Like most of you reading this blog, I was already convinced that this would be a waste of time and money. However, being a curious creature, I decided to do what everyone does these days when they want to start an investigation into a person’s expertise and character, and I was very methodical in my Google search. (I actually have a black-belt in Googlefu, so I was confident I would find an excuse not to make the appointment.) Once I began reading his hundreds of articles and several books, my doubts began to diminish. Then, I came across his curriculum vitae (CV), (which to a layperson such as myself, I knew to be a Latin word meaning, “much smarter than you will ever be.”)
I began pouring over the CV for obvious signs that he was not the doctor for me (e.g. majored in Bowling during college, or perhaps spent 9 years doing “magnetic therapy” in a foreign country that I couldn’t locate on a map. The problem was, Dr. Robbins has the longest and most extensive CV I have ever read in my life. Matter of fact, not only had he authored at least two books, but also had written over 200 peer reviewed articles that had been published in every reputable medical periodical in existence. As I began to analyze his CV like a forensic detective surveying a crime scene, I began to realize that even for a person with a degree in English Literature and a minor in Philosophy, this was going to take an extensive amount of time, and coffee, in order to absorb all the information contained therein. I got through half of his CV before I conceded defeat. Joyce’s Ulysses took less time for me to read, and I think I even understood more of that book than all the letters attached to Dr. Robbins’ name, except the MD.
I began to realize that this doctor was better trained in headaches, pain management, and preventative medication than all the other doctors I had ever seen, combined. So without admitting to my wife that she was right about scheduling an appointment with his clinic, I reluctantly scheduled an appointment, and began planning for another horrible experience with a doctor that didn’t understand my migraines. As I stated above, I arrived looking like a walk-on for the TV series The Walking Dead.
Dr. Robbins greeted me with a big smile, and so did his staff, and as I looked around the waiting room, I began to notice several things different about his clinic that I had never seen in other doctors’ offices. Covered from wall-to-wall was literature on headaches/migraines, including handouts of his most recent studies and published articles. As I sat in the waiting room, perusing the various literature, I noticed a sign on the entryway into the office, which simply read: “Keep Calm and Carry On.”
For reasons I still can’t express, that sign evoked a lot of emotion in me, like it was specifically put there for my benefit. Something about the words conveyed a sense of inequity that was recognized by all, especially the patients, and yet at the same time I conveyed a sense of not surrendering, to keep moving, to keep fighting, “to carry on” despite the onslaught of pain and suffering. I remember thinking that this sign was perfect for a migraine specialist’s office, as I think most of us feel a sense of unfairness about our disease, a certain injustice that we all share. From being unable to control the pain, to the misconceptions of doctors, employers, friends, and even family; a lot of times I think we feel we are fighting a losing battle against not only the medical establishment, but against society as a whole, and yet we continue to fight. We get up every day knowing that today we are very likely to experience the worst pain we have ever felt in our life; traumatic pain, devastating, and debilitating pain, which we have no ability to control. To me it feels like a great deal of the time I am at war, besieged and attacked by my own body and mind, and there is nothing I can do to stop it, nothing. Perpetual warfare, in any circumstance, is enough to drive even the most balanced person to insanity and hopelessness.
My appointment with Dr. Robbins did not go as I expected. He was compassionate, considerate, he listened to what I had to say, and for the first time in my life, I was actually invited to sit down in his office and talk about my migraines. I had never even seen the inside of an actual doctor’s office before, and to this day, it is the only time it has been offered. Not only did I leave his clinic that day with a better understanding of my migraines, but I had weapons (I use that word purposefully, because I am at war) to fight back against the perpetual onslaught of pain, and indignity suffered by all of us. And as it turned out, Dr. Robbins was the only doctor I have ever encountered that was able to help decrease my migraines.
A few months later, I was studying a legal case that surrounded around a set of facts of concerning trademark infringement. The plaintiff in the case tried to claim a copyright infringement against the defendant for the use of a slogan, none other than, “Keep Calm and Carry On.” The plaintiff, as I learned, lost the lawsuit. The poster pictured in the upper left corner had been created by the Ministry of Information by order of the British government in 1939, and was designed as a propaganda poster to increase morale among the British public during WWII. It was distributed around the city squares and government buildings to prepare the public for what was thought to be a certain invasion by the Germans. It was intended to display the unmitigated pride and fearlessness of the British population who were awaiting imminent destruction. The crown displayed on the poster was intended to remind the population that it was a direct message from their King, speaking to his people. The posters were intended to convey the message that no matter what happened: invasion, bombings, complete destruction of town and country, that it was the duty of the populace to remain strong, no matter what agony or suffering would be inflicted upon them. It was meant to invoke a sense of pride, courage, and calm dignity for which the British are commonly known. It was meant as a message for people that were under siege, facing an enemy that they had no ability to control or defeat.
As I sat there reading the case, I understood why I thought it was perfect for a migraine specialist’s office and why it had meant so much to me at the time. I had realized something innately in that poster that spoke directly to the way I was feeling, even though I didn’t realize it at the time, the poster really was meant for me and others like me. It is a message that no matter what happens to us, no matter how unfair the circumstances may be, or the pain inflicted, it is our duty to fight the good fight. As Churchill would later state, “Never give in, never give in, never; never; never; never – in nothing, great or small, large or petty – never give in except to convictions of honor and good sense.” I can’t think of a more apt saying to have in the office of a doctor dealing with people who are chronically ill, and are constantly under threat of bombardment at any second, for the worst pain they will ever experience or imagine.
Since the copyright on artistic works expires after 50 years in the UK, and the phrase was in such common usage, the image is now in the public domain, hence the many companies selling t-shirts, coffee mugs, hats, books, and posters- just like the one in Dr. Robbins’ office. It is amazing to me to think of the history involved in this one simple message, which after 73 years, found its way into my life at a time when I felt the weakest, and has indeed inspired me to fight, and to never, ever, ever, give up. The next time you feel hopeless, helpless, like everything is at its worst and you simply can’t take it anymore, I implore you to remember this story and the history that made it manifest, and to never give up. No matter what is happening, do your best, do your duty to your family and loved ones, and “Keep Calm and Carry On.”
I always welcome any thoughts, experiences, critique, or accolades in regards to my posts. Please feel free to share your stories and comments with me and others. The more we communicate the more we learn, and the sooner we will find better solutions to sustain the imminent bombardment. Thanks for reading, and may you have a pain free day.
DISCLAIMER: I am not a healthcare provider, and I do not provide any medical advice, diagnosis or treatment. The information presented here is designed for general informational purposes and discussion only, and is not intended to replace a physician’s judgment about the appropriateness or risks of a procedure, medication, product or diagnosis. Always consult your doctor about any medical questions or conditions you may have.
Posted in headachedrugs, Miscellaneous | 
Tags: chronic migraine, cluster headache, depression, disability, Headache, headache clinic, keep calm and carry on, migraine | 
6 Comments »
A new study published in the journal Translational Psychiatry demonstrates that a blood test can make the distinction between teens who are depressed versus those who are not. By diagnosing a person with depression using objective data, scientists hope to identify it as reliably as cancer or diabetes are diagnosed. ”Once you have a measurable index of an illness, it’s very difficult to say, ‘Just pull yourself together,’ or ‘Get over it,’ ” said lead researcher Eva Redei, a professor of psychiatry and behavioral studies at Northwestern University’s Feinberg School of Medicine. Researchers hope testing for depression will eliminate the stigma that often stops people from seeking medical help. Close to two-thirds of the country’s 2 million depressed teens are too ashamed or embarrassed to get help according to a federal report released last year. Additionally, being able to diagnose depression in adolescents can significantly improve the likelihood of long-term positive results. Dr. Andrew Leuchter, a UCLA psychiatrist sees the results as promising. ”Depression early in life can make repeat episodes more likely, and as a result, more urgent to treat.”
The researchers added that they plan on testing adults for depression in the future. Chicago Tribune 4/18/12 Melissa Healy
Researchers recently studied patients with medication overuse headache to see if they experienced decreased quality of life, as well as increased depression and anxiety. These patients, who underwent an inpatient withdrawal program were asked to complete questionnaires related to depression, anxiety and quality of life. The questionnaires were filled out prior to the start of the withdrawal program, as well as six months after the conclusion of the program.
At the beginning of the study depression was present in over 65% of the patients, and anxiety in 71% of the patients. Quality of life was decreased when compared to normative data. After looking at the post-program statistics, the researchers concluded that inpatient withdrawal therapy led to a significant improvement of quality of life, depression and anxiety in the patients. It was also noted that poor mental quality of life, depression and anxiety seen in patients at the start of the program was associated with poor outcome in terms of headache frequency. Clinical Journal of Pain 5/12
Posted in headachedrugs | Tags: anxiety, depression, medication overuse headache, quality of life | No Comments »
Just released research indicates that middle-aged women are approximately 40% more likely to become depressed if they have migraine headaches.
The study, conducted at Brigham and Women’s Hospital, Boston suggests that the risk of depression stays raised even if the pain stops. “For women at least, migraine is a risk for depression.” “But there’s no good biological reason why the link would not apply to men,” says lead author Tobias Kurth, M.D. Previous research suggests that the risk of depression rises as the severity of migraine increases. Kurtz said he and his colleagues will address that issue in the future.
Jason Rosenberg, M.D., director of the Johns-Hopkins Headache Center who was not involved in the study said “Its been well-known that migraine and depression occur together much more commonly than can be explained by chance.” However, Rosenberg cautions that the participants in the study were over the age of 45. ”Most women develop migraine when they are well under 40.” ”An older population could skew the results one way or the other.”
While there is no simple explanation for a migraine-depression relationship, frequent migraines may bring on depression by lowering a person’s quality of life, and biological factors may be involved as well….. CNN.com 2/22/12 Matt McMillen
People with headache have anxiety and/or depression at higher rates than those without headaches; we look at these conditions as “shared comorbidities” that people inherit. When people are born, they are more prone, genetically, to these conditions. I believe they are “side by side” conditions that we inherit, not that depression causes headaches or vice versa. Certainly, severe headaches may fuel and increase anxiety and depression, and depression may worsen headaches, but these medical comorbidities do not actually CAUSE each other.
Headaches are a physical, not psychological, illness, and the same for anxiety/depression; there are many differences in the brain for all of these situations, and viewing them as “all in your head, or psychological” is unfair and misleading.
These comorbidities do drive where we go with medications, so if someone has headaches and depression, we would usually try and find an antidepressant that treats both. Just like if a person has headaches and high blood pressure, we would go with high blood pressure meds. The idea, of course, is to minimize meds, and attempt to treat 2(or 3) conditions with one medication. Exercise,yoga/pilates,psychotherapy, etc. are also crucial for those with anxiety/depression.
The American Journal of Clinical Nutrition recently published results of a study aimed at older adults and their consumption of vitamins B6 and B12. The study revealed that depression was more likely to be found in adults with the lowest intake of the B vitamins. However, for each additional 10 mg of vitamin B6 or Vitamin B12 the adults consumed, the risk of developing depression in a given year decreased by two percent.
In a separate study, reported by the U.S. Department of Agriculture (USDA) women with low levels of folate (vitamin B9) were more likely to be depressed. In the same study, men with low levels of folate did not show an increased likelihood of depression. This same USDA study found that low levels of folate were linked to symptoms of dementia and cognitive decline in men and women.
Vegetables, meat, nuts and whole grain products are good sources for Vitamin B6. Meat, poultry, fish and dairy products contain Vitamin B12. For Folate intake try leafy green vegetables and legumes….Duke Medicine Health News Volume 11G
The holidays are a time of celebrations and family gatherings. From Thanksgiving to New Year’s, we often spread ourselves too thin-we get too little sleep, eat and drink too much, and have high expectations for ourselves. But once the holidays are over, it can be a time of emptiness and depression. About 25% of people have feelings of lonliness and letdown in January. People have more illnesses in January which can be attributed to the “letdown effect.” This is characterized as “a condition where high energy or activation levels in the body are immediately followed by a rapid drop in activation levels.”
According to B. Greenberg, author of Wrung Out By Ringing In The Holidays, it’s important to know “there’s no reason to feel badly that you feel badly, and no reason to force your feelings to be different than what they are.”
Try to stay active and engaged with people you enjoy. Talking about your feelings of letdown with friends may help, and you may find they share similar feelings. As always, seek help from a professional if depression lingers.
Research at the National Institute of Mental Health shows that mental health disabilities are on the rise, even as physical disabilities are declining. Hundreds of thousands of Americans age 65 and under rated their difficulties with tasks, and then chose the reason from a list which included conditions such as arthritis, obesity, as well as a category of mental health issues defined as “depression, anxiety, or emotional problems.”
From 1997 through 2009, the non-elderly population mental health disability rose by a third. Study authors at Johns Hopkins say this indicates that Americans are beginning to understand ”that psychic distress can be debilitating and that ailments like depression and anxiety often come with physical symptoms.”
It’s important to have medical care that understands and addresses the causes as well as the symptoms. Migraine patients often have underlying ailments, such as depression or anxiety, that manifest themselves in pain. Each patient is unique and it is essential for the physician to understand what conditions are affecting the whole person, in order to successfully treat the patient.
