Depression... DEEP depression
 

I have days where I feel fine... I am happy nothing ****** me off and then I have days or hours where I just want all this over with... I want to feel like me again... I want to be able to work... I want to feel like I am not the only one that feels like this...

I am on Nortriptylin which I have read is a anti-depressant... how long does this take to work? I have been on since 4-24... this is the only med I am on now...

ideas, suggestions?

Sarah,

I have those same roller coaster emotions. I find that on the down times, I need to find something to occupy my mind so that I can avoid thinking. I play Solitaire and try to find anything simple to do.

It is a tough row to hoe but be assured you are not alone. NT may be the only place where others understand and have experienced what you are experiencing. We are here for you.

My best to you.

Thanks Mark... yes, I have been playing a lot of candy crush and bejeweled... from outside appearances it looks like i am ignoring my family... and that is the last thing that i want to do but right now, if I open my mouth I am truly afraid what is going to come out, I will bite their heads off...

The worst part is that when I cry it makes my headaches worse... why is that?

Sarah, you are definitely not alone - and I can absolutely relate to the crying exacerbating the headaches. I assume that it has something to do with the blood flow, etc. as this occasionally happened to me before PCS if I cried a lot.

One thing that helps me, and that is getting easier now with decent weather returning to the midwest, is just getting outside to have some sunshine. I had a lot of trouble this winter, and I've found that being able to even sit outside on a park bench and people watch for a bit provides a pick me up - and this is backed up by studies on seasonal affective disorder and the use of light therapy as treatment for depression. Some also argue that vitamin D has potential as a treatment for depression, which is of course part of what you get from sunshine. Everyone has a different coping mechanism, though, so it's worth paying attention to what yours is. If you're having a bad day, try some different things - go for a walk, play candy crush, read, hug a pillow, etc. and make note of what seems to help. That can help you to establish a plan for when you start to notice that things are bad.

Nortriptyline is a tricyclic anti-depressant, but the doses prescribed for PCS are normally lower than those prescribed for clinical depression. I assume you were prescribed it for headaches, and not psych symptoms? What is the dosage?

Also, if you are concerned that you are clinically depressed, please speak to a psychologist or psychiatrist - they are qualified to diagnose, where primary care physicians and even your neurologist are not. They can better direct you to a treatment plan with or without medication, such as cognitive behavioral therapy and/or a different medication like an SNRI that will target both serotonin and norepinephrine (nortriptyline only targets the latter) without the side effects that come with higher doses of nortriptyline.

If you are on a dosage of Nortriptyline that is high enough to combat the depression, it can take up to 6 weeks to have an impact. Has it helped at all with any of your other symptoms?

Note: I am not a doctor or trained clinical psychologist. I have an undergrad degree in psych with a specific focus on biological psychology, and worked in behavioral health before returning to graduate school for my PhD in another field. So, these notes come from a place of some knowledge and experience working with people with depression, but I wouldn't consider myself an expert!

Rugby,

You are a wealth of knowledge when it comes to this... thank you!

I am on 50mg at night. It has been amazing for the headaches...

Prior to this I was on Lexapro for anxiety... since it was no longer doing anything my neuro took me off of it and said that this should work for both... thoughts?

Sarah,

Are you using any of the Vitamins and Supplements regimen ? The L-Tryptophan and L-Theanine can be very helpful. You should be able to take both even though you are taking the Nortriptyline.

I occasionally need to take 100 mgs of caffeine (half of a NoDoz) which is like a cup of coffee. My brain will get sluggish and need a wake me up.

Mark

I am taking magnesium, B, D, and fish oil... add the others or are they part of any of these?

One of the largest, and to my knowledge, only study NOT funded by the drug companies, that looked at anti-depressants in TBI patients was done at Toronto's Sunnybrook Hospital:
sunnybrook.ca/media/item.asp?c=1&i=258

The L-Tryptophan and L-Theanine are not in the others. How much of which B's are you taking ? The Recommended Daily Allowance for B's is seriously lacking for those of us with a compromised brain. A B-50 complex plus 2500 mcgs of methylcobalamin B-12 and 200 mgs of B-6 is a good start.

B6- 12.5mg
B12- 500mcg

Riboflavin-30mg

D3- 5000 iu

Magnesium- 300mg

Sarah,

I'd add a B-50 complex to your current B's. You need the full set of B's for the B-6 and B-12 to work best.

Hi Sarah.

Some ideas to consider, I have found mindfulness meditation to be helpful, it can take different forms, I like to practice compassion meditation or gratitude meditations when having down days. If you are physically able I have found gentle yoga and massage therapy to be helpful.

it probably seems like forever but as brain injuries go your is fairly recent. Best to you as your recovery continues.

:hug:

Hi Mark,

Whilst on this point of vitamins. Can you please clarify is there is a difference between B100 and B50 complex?

I am currently taking daily:

B100 vitamin B complex x 2
B12 1000mg x 2 (re ordered to get methyl based one in lozenges as this one is Cyan based)
Vitamin C 1000mg x 2
Curcumin c3 complex 1000mg x 3
Vitamin D3 5000iu x 2
Omega3 fish oil 1360mg (952mg EPA/DHA) x 3
Multibionta multivitamin with probiotics and minerals x 1

To be added shortly once packages arrive:

Vitamin e 400iu x 2
Magnesium bis-glycinate with calcium x 4

I hope I got it right please advise if I should be adding anything further. BTW I returned to work today. Being the first day it was a bit overwhelming. Back in tomorrow then rest it up. I don't want to start singing praises yet but do feel the regime has helped today.

I have never in my life devoured so many caplets, tablets. omg at PCS.

Regards
Rosa

I can definitely relate to what you are feeling! Some days I am very happy and coping great with everything and the next day, or even just a few hours later I will be depressed having serious thoughts of suicide and such.

I let myself feel like crap for maybe a day or a few hours without doing anything more than I want(which is usually to lie in bed watching a movie or tvshow not talking to anyone or doing anything at all), and then I force myself to get up and I start distracting myself by going outside, playing with my dog, being around people, and I find that I can snap out of this state of depression as long as I am distracted.

As quickly as I can drop into it, I seem to be able to pull myself out. It's constantly up and down.

I am trying to figure out what triggers these depressive states for me so I can be proactive but so far I havent come up with much except for stress, which I guess is anything and everything hehe. I feel kind of ashamed of having these extreme ups and downs and before my head injuries I had never experienced this kind of cycling mood, it was more stable either depressed or not for longer periods of time. I don't really know how to handle it except for distraction, but I hope it helps you to know you're not alone!:hug:

Rosa,

A B-50 complex has 50 mgs of most B's and 50 mcgs of B-12

A B-100 complex has 100 mgs of most B's and 100 mcgs of B-12.

You should be fine with just one B-100 complex per day.

Your D3 is probably more than you need. Most do well with just one 5000 iu per day.

Sarah,

50mg is still on the low-mid end for the anti-depressant/anti-anxiety properties of nortriptyline, though I could see why your doctor wouldn't want you on both drugs. If it is intended to treat your anxiety in addition to headaches, give it a few more weeks to kick in and if it's not helping, you should tell your doctor that it's working for one but not the other - he might titrate the dosage to 75 or 100mg, as finding the right dose can vary by person. Additionally, it is always worth speaking to a psychologist or psychiatrist, as a lot of research on anxiety suggests that the most marked improvements come from a combo of the right medication and cognitive-behavioral therapy. Of course, the research that I've read is not in patients with TBI; the study that Hockey posted is about TBI patients, though, and seems to imply that a multi-mode approach is best.

Lunalu - have you tried journaling? It's really challenging to retrospectively evaluate triggers or specific stressers, but if you can record things you might be able to find more useful patterns. It sounds like you're working hard at figuring out how to cope, and especially at getting up and out when you know you need it - keep it up and I hope things improve.

Also: Please, if you are ever having serious thoughts of suicide (or even a passing, non-serious thought), know that there are resources to help you. You should never hesitate to call the national suicide prevention hotline if you are in the US: http://www.suicidepreventionlifeline.org/ 1-800-273-8255, and other countries have similar services. There are caring counselors who will talk 24/7.