Antidepressants and PCS
 

Question: can antidepressants be useful in helping with recovery from PCS symptoms, such as a mild headache and tinnitus? My mood is not really the issue - for the most part, I've been holding up reasonably well (other than occasional mild depressive/anxious feelings when symptoms flare up). I'm at the 5.5-month mark since my injury, and have been gradually making progress. Overall, I'm now around 7.2/10, and had a couple of good 7.3/10 days last week. My headache has gradually lessened, my sleep has improved, the setbacks have fallen off considerably, and my bounceback time from symptom flareups is better.

However, I still have some remaining issues, mainly to do with exertion:

- Mild headache - it mostly doesn't bother me at rest and is typically around 2/10 in severity, but it still tends to flare up from overexertion - for example, from walking for more than 20 mins, traveling to appointments or overdoing it cognitively

- Tinnitus (relatively mild and tolerable at rest - usually no more than 3/10 - but it can also flare up from overexertion)

- Mild insomnia and tendency to oversleep (eg, waking once or twice, sometimes weird dreams, getting up around 9 am instead of my usual 7 am)

- Occasional anxiety/"off" feeling/edginess (again, this is generally not an issue at rest, but can flare up from overexertion or stress)

So, my questions are: might a low dose of an antidepressant (or other medication) help in reducing these symptoms and improving functionality, or at this point would it be better to hang in there without medication and allow the body/brain to heal on its own, however gradually? Any other recommendations to help build up exertion tolerance?

I personally am on 2 diff antidepressants that i was not on prior to my PCS. One was for the depression, the other was for the headaches. Im on celexa and nortriptyline. A lot of people are taking amitriptyline (elavil) for their headaches. If you havent tried it yet, ask your neurologist if they think it would benefit you and get rid of your lingering headache.

I'm curious to know how many are on either nortriptyline or amitriptyline. I tried one of them but early on ...and wouldn't take it after the 2nd day bec I thought I felt sooo much worse on it. I have since realized that it was the over exertion of going to the doctor ..the trip there and back did me in.

Those meds generally take a few weeks for their effects to take place. If you only gave it 2 days, that really isnt enough time to see if it helps or not, unless you had a severe allergic reaction, then stay away from them.

Help
 

With in the last 5 or 6 years i had one very severe concussion and 2 more that were worse than i thought they would be based off the trauma i had. Since then i have noticed my mood swings and anger have gotten worse. I find myself depressed and i dont know what to do. I am not sure where to start as i just began researching because my symptoms are getting worse i feel where do i start?

greenfrog,

You are being far to analytical about your symptoms. This is likely a big part of your anxiety and depression. Recovery from a concussion is never a straight line. It is a roller coaster that almost never repeats the same track. You will notice trends with triggers, exertion, etc. but they will not always cause the same symptoms in the same ways.

My signature has a Bible verse because "being still" is an important part of recovery. It does not mean you can do nothing. It means not reacting to every single event or symptom.

Elavil (amitriptyline not my mispelling nantriptyline) has shown to help with the head aches. At the small dose that is prescribed (10 mgs), it will likely not have much impact on depression.

An anti-anxiety med may be helpful so you can lower your stress level. Just be aware that, 1. They take up to 6 weeks to become effective. 2. They can be miserable to stop using. (I know this first hand) 3. Their effect on the brain, especially an injured brain, is not understood. Some question whether they cause long term problems, even after they have been discontinued.
4. They are risky for women who may become pregnant.

I would love to not be taking an SSRI but I have tried stopping and it was not a nice experience. Some of the side effects are annoying such as sweating profusely with only minor exertion and occasional nausea. Other side effect impact others such as interfering with sexual functions, libido etc.

I just had an funny but weird/disturbing event. I went back and added (nantriptyline) after Elavil in the paragraph above. I know I spelled it wrong and it was underlined with the red squigglies. When I right clicked to see if the correct spelling was suggested, the suggestion was 'pantyliner.' Somebody at Microsoft needs their head examined. I would never have thought pantyliner was in the MS spelling dictionary. There are plenty of words I use and misspell often that are not in the spelling dictionary.

btw, Notice the misspelling. My brain mixed up the A and the N in the first three letters of amitriptyline that I was trying to spell anatriptyline. My brain gets so confused, I can't even misspell words the way I want.

My best to you all.

interesting about the sweating profusely part with only minor exertion. Ive noticed this when i do my little workouts. I used to teach aerobics classes at full exertion and barely sweated....so odd that i sweat so much now. Must be my SSRI. Thanks for your input Mark

There are some outdoor winter activities I have not dared doing. If I got in a pickle, I would sweat myself into hypothermia trying to get home.

I can have beads of sweat dripping off me like rain drops. It is a common side-effect of SSRI's. I wear only cotton because polyester stinks real fast when you sweat in it. Cotton does not have the same problem.

Greenfrog,

It's good to hear your symptoms are improving. Alot of the complaints you have are the same as mine. I am on Elavil. The doctor started me at 25 mg for a week and then doubled the dose after a week.

When I first started them I was exhausted. I slept for two weeks. I would wake up in the morning and have my coffee, eat breakfast and then it was lights out until dinner. 16 hours of sleep a day for two weeks did help me tremediously.

It cut down the migrane headache so it was bearable and I noticed the migrane which took up every minute of my day would give me "breaks". This allowed me to have some time to try and enjoy some part of my day pain free.

The longer I take it the more I'm improving. I still suffer the migranes and awful whooshing sounds. I still get tired but have problems sleeping and now anxiety and depression. It hurts to think too much. My balance issues have improved alot. Only when I'm exhausted I have trouble.

I had my Nueropsycholgical evaluation yesterday.... (Stressful...lol) and although the report wasn't written up she gave me an overall impression of what she thought.

She said I was a very bright person who has a head injury. She thinks my memory/cognitive deficits are exhaberated by the physical symptoms I am having. She feels my anxiety and depression from having to deal with the symptoms are not helping.

I was started on Lorazepam yesterday. I told them no when they first offered. I didn't want to be over medicated and from experience anxiety medications can be hard to come off from. I did my research and thought long and hard about that.

My quality of life right now is severly effected by my physical symptoms so I want to try the medication to see if it helps. If it doesn't I'll stop but I have to try.

She also wanted me to get therapy. I had done so in the past and had good and bad experiences. She told me it's to teach me coping mechanisms to deal with my injury. This sounded like a good idea for me. Again if I dont like it I can stop.

I cant tell you if you should start a medication but I can give you my experience. I'm only three months into this. Yesterday the Psychologist told me it takes a year to eighteen months to heal. Not what I wanted to hear. I was very angry last night. I was exhausted and my husband and son knew it was not a night to mess with me.

My poor husband started my laundry for me and when I got home I had two loads to hang. I was not in the mood and I only wanted to rest. I pulled a little temper tantrum...(so not like me lol) My poor kitchen cabinets...slam slam) tee hee...

I vented and then I rested. I know we have good days and bad days... and I have to remind myself..... it could always be worse.

Hope you all have a great day...

Thanks for all the helpful responses.

My inclination is to stay off the meds if I can help it - this is also my doctor's recommendation, although he says that sometimes meds will be appropriate, especially if depression becomes a significant issue.

I actually feel basically depression- and anxiety-free about 85-90% of the time. Every so often (when my symptoms flare up) I wonder whether meds might help with the recovery process, maybe just giving an overall boost to my brain (and possibly stimulating some neurogenesis and/or other positive effects), but for the most part I seem to be OK without them.

Mark: I agree that "being still" can be very helpful. It's amazing how much stress (sometime induced or "facilitated" by my own thoughts) can make my experience of PCS worse, while conversely, being relatively stress-free can make it much more manageable. I've always been very bright and analytical, which can be a strength in some contexts, but a liability in others (I think these qualities can be both helpful and an impediment in PCS recovery).

There are no meds that increase neurogenesis or other brain repair.

The best therapy for the brain is to prevent the stressors that hinder it, such as emotional, dietary, environmental, etc. and to provide the opportunity for it to heal as best as it can, good nutrition, appropriate mental tasks, restful sleep, etc.

Moving forward with life regardless of you current limitations is important. There are lots of skills you can learn as you move forward with PCS. It can make you a better person as you look at yourself and especially as you look at others. Being analytical, you likely had little tolerance for others laziness and screw-ups. Being able to accept you own limitations can help you understand others limitations. Hopefully, you are learning how to differentiate between others who are lazy or foolish and those who are struggling at a task.

being still can help you learn how to better "choose you battles." Learning how to choose your battles is a fabulous life skill.

btw, are you a Kermit aficionado or is there another basis for your screen name?

My best to you.

I'm on amitriptyline (25 mg) and had similar experience being very sleepy at first. Sleepiness and headaches both improved after a couple of weeks.

I was on 20 mg of prozac pre-concussion and had to bump up to 40 mg post-concussion because I was having major anxiety & depression.

I still have some down moments but overall am much more stable.

hehehhe-Mark-you amde me laugh with not being able to misspell the way you want! Preach it!

I was taking amitriptyline for pain only and it worked wonders.

Eowyn: did the prozac help at all with the PCS symptoms, or just with the anxiety/depression? (I guess it might be hard to know, if you were taking a lower dose of it before your injury.)

freezer: have you remained pain-free since taking the amitriptyline?

My issue is not so much pain or anxiety/depression -- I'm now feeling pretty decent with minimal symptoms when I'm at rest or doing light activity -- it's that the headache, tinnitus, overall crummy feeling, etc. still amps up when I increase exertion. So I'm just taking things slowly and hoping that my exertion threshold gradually increases over time.

No, I don't think the prozac helped with anything but the mood problems. I still had terrible headaches and nausea after increasing my dose of that.

Amitriptyline has done wonders for my headaches, though. I'm not 100% pain free all the time but I am MUCH MUCH MUCH more functional (able to work part time in low-stimulus environment as opposed to not being able to leave my bedroom or turn the light on).