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Migraines and Depression

Being in pain so fierce that the only recourse is to hide in a dark, quiet room until it is over several times a year would make anyone sad.  Migraineurs, though, are five times more likely to develop clinical depression than people who do not have these debilitating headaches.  Conversely, people who are depressed are three times likelier than happy people to become migraineurs.

Many scientists view the intertwining of migraine and depression as a chicken or egg situation.  They are patently comorbid, but does one cause the other?  If so, which one starts the process, the migraine or the depression?  The answer is not that simple.  Migraines, depression, and, unsurprisingly, insomnia, a state associated with both conditions have something in common.  All three are associated with neurotransmitter deficiencies in the brain.  

Doctors believe that while they are related, depression and migraine headaches have distinct causes with a similar neurobiology.  For years, doctors blamed depression in migraineurs on their resultant loss of quality of life due to headaches.  Now it looks as though the link is a biologic shared mechanism rather than psychology.

One danger for clinically depressed migraineurs is possible drug interaction between their depression medication and their migraine drugs.  In July 2006 the FDA recognized one such danger, that of mixing triptans for migraines with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin and norepinephrine reuptake inhibitors), used to treat depression and mood disorders. Combining the drugs can lead to a condition called serotonin syndrome.

Serotonin syndrome occurs when there is too much serotonin in the body.  Symptoms include hallucinations, increased heart rate and body temperature, fast changes in blood pressure, and gastrointestinal upset.  Sometimes a patient has no choice but to take these medications together, but they need to weigh their options with their doctor and be monitored closely for serotonin syndrome.

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