Antidepressants - are they the answer?
 

To make a long story short, I hit the right side of my forehead on a glass wall while looking down at my phone a month and a half ago. The first month was excruciating but my headaches, earaches, and other symptoms are lessening everyday. I'm starting to feel more and more like myself again slowly but surely. I've been trying to eat healthy and staying hydrated along with taking vitamins everyday. Even my "emotional flatness" is going away a little...I am smiling, laughing, and more talkative. The only problem is that I'm still not literally "feeling" any emotions. I don't feel the adrenaline, guilt, empathy, happiness bursts, etc., that I used to feel before the injury. The emotional highs and lows seem to have gone away. I don't find pleasure in nature, etc., as I used to. Or, for example, I'll find something funny and I'll laugh, but I don't physically feel uplifted inside as I used to when I laughed. I know it may not sound like it makes sense. I started seeing a therapist this week and she suggested I start taking an antidepressant soon. She was actually insistent that I start, because she thinks my serotonin and dopamine levels are out of balance. She said I must have damaged that aspect of my brain and if I stay on meds for the next 3-6 months then my brain will "relearn" how to produce emotions.

I don't know though - what do you guys suggest? What if I start taking meds and then after I stop them, I fall back into emotional flatness except worse off than before? And will antidepressants even give me back my emotions? I used to be extremely passionate and emotional/creative before my injury.

I was thinking about getting an MRI done to see if maybe there was nerve damage or something... my CT scan last month showed no bleeding or swelling. However, I didn't get an MRI done yet. Someone please give me advice =/

Speaking from personal experience, anti-depressants cause flat emotions. Being off Paxil, an SSRI anti-depressant has lifted a load of flat feelings that I carried for 14 years.

If your therapist thinks you are deficient in serotonin, try taking L-Tryptophan. Source Naturals make a 500 mg tablet that you break in half to reduce the dose. I take 500 mgs twice a day. I can tell I need the L-Tryptophan because I can tell when I am late on a dose. It has a 12 hour half life so you need to take it twice a day.

btw, L-Tryptophan is an essential amino acid that is the precursor to 5-HTP which is the precursor to serotonin, melatonin and another neurotransmitter. It is in dairy, meats, and other foods.

It leaves your system quickly so it is not a big commitment.

I would recommend to just about anybody to try to avoid anti-depressants beyond some of the low dose anti-depressants for PCS headaches and insomnia.

My best to you.

HI!
First off, just learned by being here...
Most people do not get MRIs until around one year, still having problems, or at their insistence or if they have a superdoctor. It is nice for peace of mind though or to also check for neck injuries. I did not get one till 11 months or so. I would not be too concerned that you did not have one, unless symptoms increase rapidly.

As far as antidepressants, I feel I have to label myself as a non- med taker unless necessary:) So I will go out on a limb and say
1. You are super early in recovery. Flat affect is normal in head injuries and will pass with time.
2. I think a lot of chemical stuff goes on in our brains after head injuries that heals.
3. From my personal experience, I tried antidepressants because of headaches, but they made me terribly depressed and side effects were awful. I waited a long time before I tried them.

As Mark said, the small dose for headaches is different then a dose for treating depression.

I think that docs like to give meds out and I just feel that it is too early for you. They want to do a "treatment" but you just need time.I think that Mark's natural suggestion is great.

For you I would pass on the pills! Your symptoms are normal and will get better. The pills will always be there if you choose to try later. For me I felt that my body always did best with the least medication, most rest and good vitamins.

I agree, it is too early, you need to concentrate on getting rest and avoiding too much stimulation at this stage.

From my own experience I wasn't prescribed Cymbalta until the 4 month point. Looking back I wish that I had been prescribed it earlier because it turned my symptoms around and I suffered needlessly, it alleviated insomnia, pain, fatigue, lifted my mood and in turn all my other symptoms reduced.

4 months after starting Cymbalta I am still on this medication, but it should only be for the short term because PCS is temporary. I don't think using natural remedies would be enough, the combination levels of Serotonin and Norpinephrine to promote healing and reduce pain cannot be achieved without using SNRI's like Cymbalta or Amytriptyline.

I just wanted to add, that rather than take advice here, it might be worthwhile speaking to a doctor about the merits of medication. My quality of life was 1 out of 10 prior to commencing Cymbalta, it is now 9 out of 10.

mouse1's experience and success with Cymbalta is unique to mouse1. The comment "I don't think using natural remedies would be enough, the combination levels of Serotonin and Norpinephrine to promote healing and reduce pain cannot be achieved without using SNRI's like Cymbalta or Amytriptyline. " has no basis in research. Amitriptyline is not an SNRI. It is a tri-cyclic anti-depressant.

If you read the research about Cymbalta, it was approved after only being studied in 4 published studies. The law suits against Eli-Lily are starting to pile up. It is currently one of the most highly promoted psychotropic drugs. When one looks into the way psychotropic drugs are designed, they attempt to replace weak systems. SSRI's were originally modeled after St John's Wort. The actual method of action for them is unknown.

In comparison, there are plenty of natural supplements that the body and brain know how to use because the body already uses them. In some, the body needs more than the normal levels. In others, there is a lack of the substance requiring supplementation to get to the body's normal level. B-12 is a good example. mrsD can explain how some people just do not absorb B-12 in it's common form.

Environmental factors, pollutants, and toxins in our food and such can throw these normal balances out of whack. The study of ortho-molecular psychiatry is a good example. There is a lot know about balancing out of balance systems. Finding the out of balance situations can be difficult so a trial and error process is often used. Most drugs are prescribed with a trial and error protocol. There is far more art and gamble to meds that is let on. Unfortunately, the profitability of patented drugs pervert the idea of seeking the best interest of the patient.

I wish profits did not get in the way of finding the truth about drugs. Unfortunately, that will never be the case.

They can be lifesavers
 

I'm pro-antidepressant because they work for me. Other people will have had bad experiences, though I haven't read what others have said. Anti-depressants have literally saved my life. I'm on Wellbutrin right now, and before I started taking them, I felt so lifeless, so lethargic, so negative, so detached. As soon as I got the dosage right, two weeks later, it was like a flip was switched and I was myself again. I won't stay on them forever, but I'll stay on them for a year before I go off. I still

As others have said I think a month and a half is too soon. Your injury needs time to heal to attain some level of emotional stability. I would think anti-depressants would exacerbate the flat affect you describe, and could complicate assessing your recovery.

What type of therapist is recommending this? I have a tremendous amount of respect for speech pathology and occupational therapists, but unless the therapist you are talking about is a psychiatrist (who is also a MD), I’d see one before taking the meds recommended by a non-medically trained therapist.

Mark,

With all due respect I was comparing the suggestion of using something like L-Tryptophan to my own experience of using an SNRI, because the two are incomparable. You are also not taking L-Tryptophan in isolation.

If you are in the acute phase of PCS my own opinion is using something like L-Tryptophan or indeed supplements might not be enough. Cymbalta is without doubt both an excellent pain killer and antidepressant and very fast acting, my doctor listened to my symptoms and prescibed it and my symptoms started to reduce within days. Within weeks of taking it I was back working again.

Of course the medication worked for me and it might not work for other people, but acute symptoms sometimes need strong medication to resolve them.

Credit to you for finding a natural remedy that works for you after long term use.

I just met with my brain doc (neurologist) this morning where I discussed weaning off the Lexapro because of the flat feeling and other side affects I was experiencing and trying the L-Tryptophan. He was good with that and also recommended melatonin & magnesium at night for my insomnia.

I was prescribed Lexapro by the work comp doctor about a month after my concussion when I began falling apart. I didn't know I had PCS until she diagnosed my symptoms. To be fair, the Lexapro did get me out of the critical stages of my depression and anxieties.

Mouse, I'm glad the Cymbalta is working for you. It does work for pain management. I was on it a few years ago for pain management for nerve damage in my right ankle and I began to shut down emotionally. I moved out from a live-in relationship ( & ended that relationship), changed friends and started drinking after 11 yrs of sobriety.

With all that said, I'm not against SSRI's or SNRI's but I don't like the side effects I've experienced from most of them (I have been diagnosed previously with depression & bipolar) and with the successes of people taking the L-Tryptophan I'm willing to try a more natural route.

BTW, I have put together a few 24 hours since then. :)

jazzy,

You might hold off on the melatonin since L-Tryptophan is a precursor to it. Take your evening dose of L-Tryptophan a few hours before bed. You could even take a bit more at your evening dose. I routinely add a half a tablet when I feel like I need to settle a bit more. Seems to help.