I Woke With A Song Stuck in My Head

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Reader’s Question

I am a 24-year-old female. In March of this year I woke with a song stuck in my head (so I thought). I now have constant music playing in my head. When I hear a song on the radio, TV, etc. it stays in my head till I hear another. So I pretty much have a radio in my head. It’s been 4 months since this started. My primary doctor thinks it’s depression. I’ve had post-partum depression before and I know what that feels like. This on the other hand is different. I cannot sleep so I take Tylenol PM to sleep. If I wake up in the middle of the night a song is playing that I heard during that day. I can’t focus. My personality is totally different. I have no desire to laugh. I cannot comprehend new things. I lack feelings (being happy, sad, or loved). I just have music continusly playing in my head, and that’s what I focus on. It’s hard to focus on anything else. I have tried 5 different antidepressants, but none have worked. My physician has not done blood work or any kind of testing. I need help on were to go next. I would deeply appreciate any advice. Please Help! I want my life back.

Psychologist’s Reply

That song stuck in your head is called an “earworm”, at least that’s the nonclinical term for it. I addressed this issue in a previous Ask the Psychologist question entitled “Tormented by Earworms”. You can find it by looking in the OCD section on the side bar of this post.

From a clinical standpoint, an earworm is really a musical obsessive thought. It’s a symptom associated with Obsessive Compulsive Disorder (OCD) or an OCD symptom linked to depression. The earworm — like an obsession with germs, disease, physical appearance, or rituals — is a repetitive, obsessive song or part of a song rather than a thought or behavior. Instead of constantly worrying about germs or the size of your nose — you’ve received a song that won’t go away.

For treatment, your physician is on the right track. Earworms, obsessive-compulsive disorder, body-image disorders, eating disorders, depression, and post-partum depression are all felt to be related to low levels of the neurochemical Serotonin. It’s very common for individuals who are depressed to suddenly get an earworm, start counting things, become germ phobic, etc. It’s all caused by the same problem with brain chemistry. Your family MD has correctly identified the foundation of the problem.

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However, if you look at the symptoms you describe — you are experiencing a clinical depression. Loss of humor, inability to feel emotions/pleasure (called anhedonia), sleep problems, mental and physical fatigue, poor concentration, etc. are all symptoms of depression. You have also received the additional OCD symptom of earworms — the obsessive musical thoughts. This is fairly common. Some treatment considerations:

  • Your depression has returned…just in a different form. It is not uncommon for depression to resurface and if you conduct a stress inventory, you’ll probably see that your current level of stress, responsibility, obligation, and social issues has reactivated your depression. Importantly, it’s just depression — not another or different mental health problem.
  • Your physician has prescribed several antidepressants. That’s treatment in the right direction. However, depression with OCD features is somewhat different than depression without OCD features. While both are depression, the neurochemical recipe is different. For this reason, we have several antidepressants that are approved for OCD as well as depression. These are your first-choice antidepressants.
  • While your physician has the right diagnosis, depression, he/she may be inexperienced when OCD is in the recipe. The majority of antidepressants are actually prescribed by nonpsychiatrists. Common issues are 1) prescribing at a starter dose and not increasing the medication, 2) starting at too low a dose, 3) switching meds rather than increasing, 4) discontinuing medications too early, and 5) having difficulty if another significant symptom exists such as OCD, hallucinations, etc. For this reason, I would recommend consultation with a psychiatrist. A psychiatrist is best trained to treat combinations of symptoms.
  • The positive side of this situation is that as both the earworm and the depression are linked to Serotonin — treatment will improve both at the same time. With the right medication at the right dose, the earworm will fade out and the mood will lift. On the negative side, once you have a history of OCD surfacing with depression, OCD features will always serve as your warning sign that you’re becoming too stressed or depressed in the future. Ten years from now, if the earworm returns, it’s a signal that your Serotonin level has dropped and you are becoming depression. It’s not a signal that you’ve heard a great song. Be alert for it and imagine it working like that “engine” light on your automobile that tells you when the automobile is running too hot.
  • Counseling/therapy may also be helpful in dealing with the current stressors in your life. As a mother with a young child, we often become so busy that depression gradually sneaks up on us. Learning to identify stress levels and discuss stress-management strategies is very helpful.

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