11. EMDR and antidepressants

11. EMDR and antidepressants

30 March 2024

Stress is often said to be a trigger for migraines and while this can be so, it is unhelpful and vague. Stress! What is that? One woman’s stress is another woman’s spur to action! I always prefer overload. And then, because migraine is complicated and involves the brain, and it has stumped the brightest and the best researchers, explanations have easily drifted towards it being a sort of mental condition: early trauma, perhaps, or damage in an accident; abuse, even.

Studies have shown – and yes, they can show anything you like – that migraineurs are more likely to suffer from depression, and depressives are more likely to get migraines and much else, including strokes, which is why antidepressants are offered as a prophylactic (daily preventative). My feelings are the opposite. If I didn’t get migraines, my overload reaction may well give me depression. That thought always cheers me and makes me smile, even when in horrible pain.

I do not confuse low mood with clinical depression. Low mood is the lot of most humans at some point, for whatever reason. It is quite possible to tolerate and ride it out without medication.

Depression, though, is where serotonin comes in, as it carries messages between nerve cells in the brain and throughout the body. It plays a key role in many bodily functions such as mood, sleep, digestion, nausea and much more. Serotonin levels that are too low or too high can cause physical and psychological problems. It is now thought to be – thought being the crucial word – the underlying neurotransmitter involved in migraine, based on a lower-than-normal level of serotonin (5-HT), which is why the mainstay acute treatment since the mid-1990s is a class of drugs called triptans, which act on serotonin receptors.

About 90% of serotonin is found in the cells lining the gastrointestinal tract. Only about 10% is produced in the brain.

Triptans are thought to work by stimulating serotonin, to reduce inflammation and constrict blood vessels, thereby stopping the headache or migraine.

Although I took antidepressants for some time as prophylactics, as described earlier, because I was not depressed, citalopram in particular (a selective serotonin reuptake inhibitor – SSRI) just made me smile more. And coming off it was a nightmare.

So, I went deeper into the mental illness arena when my attentive GP suggested EMDR (eye movement desensitization and reprocessing). It had come the way of his practice because a psychiatrist in Lochgilphead Hospital – then a psychiatric hospital – was having some success with it and was training others. I was assigned to a trainee who visited Oban hospital. She was to attempt to unearth any trauma lurking in my psyche. A cranial osteopath (they were all the rage) suggested I may have had a very early childhood accident and indeed, as a newborn, I was tipped out of my bassinet by my four-year-old brother who didn’t want another sister. This was considered an hilarious family story! If it had traumatised me and/or damaged my brain, this new psychotherapy just might help.

EMDR is a psychotherapy devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories which may be causing various mental and physical reactions, including post-traumatic stress disorder. Basically, it involves moving your eyes a specific way while you process selected memories. The aim is to help you heal from distressing experiences far more quickly than you may with a talking therapy. I considered myself very lucky to be getting it and indeed had it for a year, two or three times a month.

The eye movements track the therapist’s hand as it moves back and forth across your field of vision while holding some traumatic event or thought in mind. If it works, the painful events are transformed on an emotional level. And again, unlike talking therapy, the insights are not so much from the practitioner’s interpretation, but from your own accelerated intellectual and emotional processes.

Therapist-directed lateral eye movements are the most commonly used external stimulus, but many other stimuli, including hand-tapping and audio stimulation are often used.

Although I enjoyed these sessions and spent most of them weeping over remembered events, mainly involving separation from my mother or fear of my angry father (tissues were supplied), the migraines continued.

Photo by Daniele Levis Pelusi on Unsplash

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