2 Questions regarding my PCS and recovery
 

I have PCS from getting 2 mild concussions 10 days apart from each other (the first one was in 27 October 2014).

I have a couple of questions regarding what I should do:

1. I'm taking Ritalin on a daily basis to treat my ADHD (this was not caused by the concussion as I've always had ADHD). Can this slow recovery and harm the chance of making a good recovery? I think it might slow my recovery (because Ritalin is a potent psychoactive drug which is a powerful stimulant), but I'm not sure. Can I keep taking it right now?

2. I'll have a field trip of my school in about 2 months from now. The trip's length is 2 days, and involves many physical activity and physical challenges (some climbing, walking on rocky mountains long distances and such). Is it safe for me to go to that trip? I'm afraid that the physical activity, such as walking and jumping on rocks and stones might be very bad for me because of my concussion.

So what do you guys think?

Thanks,
-ProAgonist

Hey man,

Ritalin is in the psychoactive drug class known as phenethylamines which like you said are powerful central nervous stimulants. I'm no doctor so you should discuss this with a licensed physician.

That being said, my advice would be to discontinue use immediately. I'm not sure how your brain responds to the medication but plenty of young people are prescribed stimulants for conditions where they actually shouldn't be taking them.

For instance, when I take a stimulant drug, a rush of neurotransmitters known as dopamine and epinephrine rush through my neural synapses. This offsets the natural balance known as homeostasis and this problem is exactly what our injured brains are already dealings with. In my opinion, taking stimulants would be just feeding fuel to that fire and requiring your brain to work harder and in effect delaying your recovery.

I can't comment on the Ritalin except to say experts disagree. Some say it is OK. Others say it stresses the brain.

You have two months to start being active enough to get a sense of your ability to safely do the activities of the field trip. The important things is to learn you own safe level of doing these activities. You need to establish an "I'm in charge of my own movements' attitude so you don't let others push you into situations that are beyond your safe physical abilities.

You might consider getting a helmet if you will need to be scampering across rocks with unstable footing. A bicycle or skate board helmet or mountaineering helmet may be worthwhile.

Edit: it's actually norepinephrine and dopamine that are affected by stimulants not epinephrine and dopamine. I believe there is also serotonin activity. My post was submitted early!

Adding to that thought, if your brain is in the select few percent of the population that actually need stimulants than that is out of my knowledge. How long have you been taking Ritalin? How does it make you feel when you take it?

For the second question, there is no way for any of us to predict how you will be feeling in two months. The safe answer is an absolute no. Based on your previous posts, it would be best for your recovery both physically and psychologically to rest and not take any risks. Just think of how you would be second guessing yourself if there were any incidents. Your brain is probably not ready for jarring and moving around violently. Please take it easy until you have no symptoms.

Remembe don't take my advice as fact but I do have some limited knowledge from college and experience regarding the biochemistry of stimulants and I would like to help you as much as I can.

Be well.

-Danny

Regarding discontinuation of Ritalin -

Central nervous system stimulants should not be discontinued abruptly. It really does depend on the dose you're taking but usually Ritalin would be tapered rather than discontinued immediately.

Just be aware that if you've been taking Ritalin a long time and at a higher dose and you decide to stop it, you may have withdrawal symptoms.

I agree with Danny. Very few who are prescribe Ritalin and such stimulants actually need them. They are not harmless drugs.

Thank you, Mark. What you said does make sense, but I've heard cases of people that their symptoms completely disappeared after a few months, and then they went to do some physical activity which caused their symptoms to return and stay there for a very long time (one user in this forum said that he healed after 3 months, went snowmobiling, and his PCS symptoms returned for at least 2 years even though he didn't hit his head while snowmobiling). That sounds scary, so how much do you think I should wait? As I mentioned, symptoms can return after heavy physical activity, even if you feel fine. So how do I know in 2 months from now if I can go to that field trip or not?

I was prescribed Ritalin for my ADHD. I have always had severe attention problems, so the Ritalin helps me manage my concentration and study.

When I take the Ritalin, I feel that it's very easy to focus on whatever I want. My appetite is really low for the most of the day (since it's sustained release Ritalin - Ritalin LA). Other than that, it also makes me feel good, optimistic and highly motivated. It gives me a lot of self confidence, and sadly sometimes it causes me chest pains.

I'm actually withdrawing from Ritalin right now (day 4 of withdrawal). I always stop cold turkey for different reasons (this time - I'm on vacation from school so it's just unnecessary to take it now). The withdrawal is not very nice - I feel very hungry, extremely tired, I get headaches and I can't focus at all and also I don't have any motivation. It's really uncomfortable, but tapering off would take a lot of time and I prefer stopping abruptly, even though it's tough.

I have withdrawal symptoms every time I stop, and the feeling is just terrible. If I go to school while withdrawing from Ritalin, I'll easily fall asleep there and won't even bother taking out my notebooks because I'm so lethargic.

I take Advil to manage the pain from the headaches during withdrawals - it is a great help. I also have to sleep much more, and I usually gain a few kilograms in the first week after stopping Ritalin (the length of the withdrawal is usually 6-7 days).

ProAgonist,

You said "That sounds scary, so how much do you think I should wait? As I mentioned, symptoms can return after heavy physical activity, even if you feel fine. So how do I know in 2 months from now if I can go to that field trip or not?"

I suggested that you have 2 months to start being physically active. Start now with simple walks then progress to more strenuous walks or hikes. It symptoms manifest from the hikes, slow down. You can only find your tolerance for activity by doing it. Nobody can predict your tolerance.

It sounds as though you could skip the Ritalin altogether for a while. You don't want to stop and start medications while you are recovering. The best thing to do is to decide whether you want to keep taking it or stop taking it and stick to your decision so that your brain can readjust to either condition. Switching it up is only gonna make it harder for your brain to heal itself.

I can't imagine going through withdrawal and having PCS at the same time. I feel for you, I really do. Hang in there buddy!

ProAgonist.... I have been reading along here, and I do think we need to clear up something...

How old are you? Are you living at home with your parents?
Any decisions for a minor, should be made by your parents or guardians and your doctor.

It is true that long term methylphenidate use (and also amphetamines) for ADHD can result in depleted dopamine, and also depression. If you do a drug search you will find depression listed for both.

This link is a site that lists side effects to drugs reported to the FDA. The actual reports are not common, so the numbers are low.Most doctors do not report at all.

http://www.drugcite.com/?q=methylphenidate

You can click to enlarge/expand any item in both listings.

I really think you should spend some time reading the sites that explain side effects to methylphenidate.

You have to realize that everyone's injuries are different even though many of us have very similar symptoms.
I think my main mistake with that snowmobiling trip was that I went from like 10-20% activity level (Only activity I did were the 20-30 min easy walks every day) to 90-100% within one day.
Another thing to keep in mind that some people might have actual injuries to other organs in the head, not just the brain. For example I was diagnosed with a fistula in my inner ear recently, and that would explain why every time I exerted myself I felt way worse for a while (fistula reopening and then slowly healing again).

I understand what you're going through right now, trying to find all the answers, I think all of us on here were in your shoes at the beginning.

The simple truth is that there isn't a set of rules for recovering from PCS, everyone's situation is different. I have friends that suffered head injuries that were way way worse than what I had and they recovered within 1-2 months.

One advice I can give you is start very easy exercises, like walking for 15 mins and see how you feel the next day. Do that for a week, and if you feel fine move to 20-25 mins walking.
Then try a stationary bike with a heart rate monitor. Try to keep your heart rate elevated for 5 mins at first, again see how it feels and slowly increase after one week.
I started with like 80 bpm for 5 mins for a week and went up from there very carefully.

There is research from the University of Buffalo (http://concussion.buffalo.edu/) that seems to show very positive results from careful cardio exercises (usually over a span of 3-4 months).

Mark,

Can I raise my tolerance for physical activity by being physically active?
And if I don't raise my tolerance and then go on a heavy physical activity, can I cause myself brain damage because of the sudden spike in physical activity? (If that can cause symptoms to return, it means it can cause brain damage, no?).

DannyT,

Skipping the Ritalin sounds like a very good idea for concussion recovery, but sadly I cannot study well enough without it. I was prescribed Ritalin last year for my ADHD, and it really helps me study. Before starting the Ritalin, I couldn't focus at all in class, had very bad grades and got myself in trouble for my hyperactivity and impulsivity (saying inappropriate things at the inappropriate times). The Ritalin helped me finally change it and become a better student. I can stop taking it, but it'll mean I'll return to be a bad student again and get bad grades, which can seriously harm me at the future.

Regarding the withdrawal - Yes, it's not very nice to go through withdrawal from Ritalin and PCS at the same time, but I'm doing it well. It's difficult, but I'm determined to improve my situation and get rid of the PCS. Also, immediately after stopping the Ritalin a few days ago I started taking extremely high dose Omega 3 every day (took it for 5 days now), and it is a great help. It's making me feel better and better every time and I'm very optimistic! I'm still extremely hungry and sleepy because of the Ritalin withdrawal, though.

I'll return to taking my Ritalin tomorrow (I go back to school), and keep taking the extremely high dose Omega 3 every day for a while to improve my situation. I hope the Ritalin won't worsen it, because it's just a medication that I have to take as I explained above.

mrsD,

I'm 16 years old and I live with my parents. They know everything about my ADHD and the Ritalin prescription and I let them know every time that I take it.

I am fully aware that Ritalin is a powerful, potent stimulant of the CNS which works similarly to Amphetamines, but I still think I should take it.

Unlike recreational drug users that get harmed from their use, I take therapeutic doses (low doses compared to recreational users) of Ritalin to treat my ADHD. The dose makes a big difference - what may cause great harm at a huge dose might not cause any long term damage at a normal/low dose.

So I don't believe that at these doses, it causes dopamine depletion in the long term (it causes a dopamine depletion, though, but my dopamine will return to normal if I just stop taking it for a week). Even if it does cause slight dopamine depletion which is not so easily reversible (I truly think it doesn't), it's still a medication I have to take to manage my life and do things correctly. I just cannot allow myself to be that bad student that makes noises and disturbs the class at many lessons, I cannot allow myself to get such bad grades even after studying well (or at least trying to study, since it's very hard without the Ritalin), I cannot allow myself to be impulsive and make the wrong decisions, and I can give many more examples of why I should take the Ritalin to treat my ADHD. I never abused it and never will - I am a responsible user of my medication.

russiarulez,

I have also heard of people that get very bad concussions and make an extremely good recovery within a few months. It just seems so awkward that sometimes, the people with the lighter and milder concussions are the ones that suffer for much longer...

And about the activity level - do you think that if you would have gradually increased your physical activity level, the snowmobiling activity wouldn't have made your symptoms returned? I mean, you said that before the snowmobiling your activity level was 10-20%, and at the snowmobiling it was 90-100%. Do you think that if you would have raised it every week (for example, 20% activity on the first week, 30% on the second week, etc,.) gradually and just a little bit every time, the snowmobiling wouldn't have caused your symptoms to return? Am I right?

And that field trip is very important to me, I really want to go to it and have some fun. But at the same time, as I said, I'm very worried about the jarring the my brain will receive from all the unstable footing at all the rocks on the mountains (if you were walking on mountains you know how it feels - you have to jump between the rocks and it makes your body shake VIOLENTLY). I'm very afraid it'll be bad for my brain.

So do you think that if I gradually increase my level of physical activity, I will be able to just go on this field trip without problems? I'm planning to soon start some regular physical activity and gradually raise my level of that activity, so will that help me raise my tolerance for physical activity for the field trip (so that my symptoms won't return during the trip)?

If you have any suggestions to me what to do in order that I can go on this field trip and return home without getting any setback of my PCS, please tell me. As I said, this field trip is extremely important to me so I want to know what is necessary to do so I can go to that field trip.

Thanks,
-ProAgonist

Pro..

You said "Can I raise my tolerance for physical activity by being physically active? And if I don't raise my tolerance and then go on a heavy physical activity, can I cause myself brain damage because of the sudden spike in physical activity? (If that can cause symptoms to return, it means it can cause brain damage, no?)."

You can raise you tolerance by slowly increasing your activity level. You do not want to push to a point of causing symptoms to return. At the first sign of symptoms, stop the activity. Next time, do that activity to a lower level of exertion. Causing a return of symptoms will ONLY DELAY YOUR RECOVERY. It will not cause brain damage. If it causes new symptoms and the existing symptoms to be worse than they ever were previously, then, you are pushing way to hard.

The point is to carefully learn your tolerance level so you can avoid exceeding it. If you are going to go an a hike, you need to plan for the effort to return. Hiking three miles and finding out you have reached or exceeded your tolerance still leaves you with the need to hike back. So, if you have determined that you can tolerate a 3 mile hike, turn back after hiking 1.5 miles.

There is no use taking high dose Omega 3 for a short period. If you want healing, you need to take it for months.

Regarding Ritalin. If you mess up your dopamine system, it can leave you with long term problems. Here are some good articles http://breggin.com/index.php?option=...d=30&Itemid=37

Mark,

I'll start with the Ritalin - as I said, before starting the Ritalin I was a very bad student, and honestly I think that without the Ritalin I would have dropped from high school because of my bad grades. My severe inattention problems caused my grades to be low, and they just got lower every new year when things got more demanding. My ADHD does not allow me to perform normally in life, and that could seriously harm me in the future when I will look for a job and raise a family (it's not just school - ADHD is a real disorder, unlike many think, that creates difficulties in many areas in life). So, even if I don't take the Ritalin, I would have to use another medicine to control my symptoms - and sadly, apart from stimulants, not many medications are effective for treating ADHD symptoms. I sadly often find that ADHD is being underestimated - again, it's a REAL disorder with real consequences on the people who have it.

Regarding the dopamine system - it's right that Ritalin is bad for dopamine regulation and can harm the dopamine system, but most of the time, it's temporary.

If we get into details, the active ingredient in Ritalin is Methylphenidate - a potent CNS stimulant that works by inhibiting the reuptake of dopamine into the releasing cell. That means that after dopamine is released, instead of returning to its releasing cell, it continues binding to its receptor repeatedly for a long time. The higher amounts of dopamine in the synaptic cleft are translated into an increased ability to concentrate, increased self control, decreased hunger and motivation (the ability to concentrate is the primary effect which is necessary for ADHD treatment).

In the long term, the results of repeated administration would be an upregulation of dopamine reuptake receptors (more reuptake receptors means that more dopamine can be reuptaken at the same time, leaving you with lower amounts of dopamine), and a downregulation of dopamine D2 receptors (decreased sensitivity to dopamine molecules in the synaptic cleft). These consequences happen because of homeostasis (the body's attempt to keep it's internal environment balanced), which you probably have already heard about. It's just the body trying to balance the imbalances caused by Methylphenidate (Ritalin).

On the other hand, stimulants from the Amphetamines class (such as Adderall) are neurotoxic and can lead to permanent brain damage from long term, high dose consumption. They are neurotoxic because of their mechanism of action - unlike Methylphenidate that inhibits the reuptake of dopamine, Amphetamine (Adderall) reverses the reuptake process - that means, instead of dopamine being reuptaken, it's being continously released. This creates high levels of oxidative stress inside the synaptic cleft that leads to the death of dopamine neurons (at many cases this is irreversible). Apart from the oxidative stress, the Amphetamine molecule damages the cells by itself (it is a neurotoxin). That menans that Amphetamine destroys cells just by interacting with them.

So when talking about long-term permanent effects, the real danger here is with Amphetamine (and also all drugs from the Amphetamines class). Methylphenidate, unlike Amphetamine, is not neurotoxic (unless given in mega high doses). Research shows that rats and monkeys recover from long term Methylphenidate administration eventually (although some recover in a few weeks and some take months), but not all rats and monkeys recover 100% from repeated Amphetamine administration.

Also, in the website you posted I can see studies about Ritalin causing psychotic episodes and depression, but I couldn't find an article that concludes that these effects are permanent (if they're not permanent, it's not a problem because the medication can be stopped the moment they start appearing, and the person will recover).

And about the physical activity tolerance - if I push too hard and my symptoms return, isn't that a sign of new brain damage that I caused to myself? And even if I, by accident, push hard enough to cause my symptoms to return, it'll only delay my recovery, but not cause any further brain damage? I'm worried that it won't only delay my recovery, but also cause more brain damage (the field trip that involves physical activity and hiking). And if it doesn't cause new brain damage, what is the reason to the return of the symptoms after heavy physical activity? The delayed recovery sounds like it carries more risks with it (I hope not).

Thanks,
-ProAgonist

Thanks for your answer. Then we understand each other that you include your parents on all decisions about drugs and supplements you discuss here, before making any change at all?

Pro,

"And about the physical activity tolerance - if I push too hard and my symptoms return, isn't that a sign of new brain damage that I caused to myself? And even if I, by accident, push hard enough to cause my symptoms to return, it'll only delay my recovery, but not cause any further brain damage? I'm worried that it won't only delay my recovery, but also cause more brain damage (the field trip that involves physical activity and hiking). And if it doesn't cause new brain damage, what is the reason to the return of the symptoms after heavy physical activity? The delayed recovery sounds like it carries more risks with it (I hope not)."

Physical activity that causes a return of symptoms means your brain is still recovering. Your brain can be in an extended 'still recovering' condition even if you are symptoms free during low stress times. The injured brain will forever be sensitive to stress. The more and better it heals, the more it will be able to tolerate stress.

The brain needs to re-establish its mechanism for self-regulation. Without self-regulation, symptoms will manifest. You need to slowly work on helping your brain re-establish its ability to self regulate. If you choose not to try to help it re-establish this ability to self-regulate, you should not go on this trip. A return of symptoms can result in loss of skills/functions that keep you safe. A lack of balance, motor control, etc. could increase the risk of you falling and further injuring yourself.

Since it is apparent that you do not listen well and take an extreme effort to convince, your ability to make wise decisions while on this trip is questionable.

mrsD,

Yes, my parents know about all supplements and medicines I'm taking.

Mark,

Sorry if I sounded like I tried to convince you with what I wrote. I just wanted to understand what exactly causes the return of the symptoms, and you now explained it perfectly, and thank you for that.

Right now, I'll most likely won't go on that trip (according to what you have said, if I understand correctly, it is safer not to go on that trip). I'll let my brain more time to heal before I go to do such activities. You are totally right about that, especially about the part that the return of my symptoms will increase the possibility of getting injured during the trip.

I do listen to you and take your advice, Mark. It is important to me because I know you understand a lot about concussions, and I'm sorry if it sounded like I'm not responsible or trying too hard to convince you. I'm usually a responsible person that thinks twice about all most every decision I make, so I'm sorry if I made it sound like I don't listen and don't take your advice.

And if you were talking about the Ritalin in the convincing attempts, I'll explain it shortly - I know it's not very good for my brain right now, but without it I'll drop out of high school. If I could treat my ADHD without Ritalin I'd happily do that, but I can't allow myself to stop taking Ritalin because I will drop out of high school and that will ruin my life (this is very serious). I'm sorry if I made you think I'm not listening about this issue, but it's not like I have too many choices here. Also, my parents would probably disagree with me about stopping the Ritalin and wouldn't allow me to do that.

I'm not trying to convince you to stop Ritalin. I am just cautioning you. Ritalin is like throwing a monkey wrench into your recovery. You will likely have quite a roller coaster ride as you go on and off the Ritalin. The Ritalin may be contributing to your anxiety issues. I can't say. Just wondering.

You should seriously consider the vitamins and supplements regimen as a long term/life time issue. You need to learn how to manage your brain safely.

It's hard to tell what really caused the severe comeback of my symptoms after that trip. It might've been the physical exertion (I had to pull the snowmobile out of snow several times), or it was due to the jarring/vibration (I rode fairly fast on a bumpy trail all day), or probably the combination of everything.

At that time I didn't consider a trip like that to be very demanding, I thought that I was taking it easy by staying on the trail, avoiding deep snow, not dropping off cliffs in the mountains. etc... I took frequent breaks and told my riding partners that I need to take it easy when they tried to talk me into doing more challenging riding.

Nobody here on the forum or in your life (that includes doctors) can tell you for sure that if you do x number of weeks of increased physical activity, you will be fine to do the field trip.

Again, you have to understand that your injury is unique to you. And your recovery will be unique as well. Just because we have similar symptoms, it doesn't mean that what worked/did not work for me will work/not work for you.
I understand that you're looking for answers, but other than "be careful and see how it goes" there's really no other answers.

A note about drugs and doctors saying things. I was prescribed Xanax for my constant anxiety after the concussion. I took it a couple of times, but then read all the nasty stuff about it on the internet and decided I'd rather suffer anxiety. After my snowmobiling trip it all came crashing down again so I decided to listen to doctors and take Xanax. At first it did wonders for me, I felt almost a 100% better, but after a week or so the effect started to be short lived and not as good. I was taking a very low dose (two to three times less than what I was prescribed). Doctor didn't really explain anything to me other than "take as needed up to three times a day". So eventually by the third week I realized that I'm getting addicted to it. I called my doc, he said it's impossible to be addicted to it on such a low dose and such a short period of time so it would be ok to stop taking it if I wanted. So I did....
Let me tell you, what followed was downright hellish experience for about 3 days. From what I could gather online, I was going through the classic benzo withdrawal.
Later I talked to a neurologist about this experience and she said that an injured brain can be very sensitive to any drugs (especially the ones that mess with it), and although in most cases they don't see any adverse effects of Xanax at the time/doses I was taking it, it is possible that in my particular case I developed an addiction.

The other side of it is that Xanax was masking symptoms, and when I should've been feeling like crap and forced to rest, I was working full time and living a normal life, so in the end it was way worse after I stopped taking Xanax.

I had severe anxiety this summer with full on panic attacks, and I still refused to take Xanax again. I would much rather suffer anxiety/panic than deal with benzo hell again.

I'm not saying that you should stop taking Ritalin, but be cautious about it, do your own research. Like Mark said it might be causing or contributing to some of your symptoms. And I believe he's right, I do remember reading about long term damage from it.

I grew up without taking any drugs, even things like Advil. Now after this concussion I had to take a bunch of different ones and it screwed up my stomach last year in a really bad way. Now I have reaffirmed my belief that drugs only make it worse. They have their place, but most of the time they're not the answer.

Do some research into ADHD, for example problems with eyes can lead to issues with concentration. For example here's some info - www.alaskavisiontherapycenter.com

My son has ADHD.... he was able to stop Ritalin in high school, based on using essential fatty acids and magnesium and Bcomplex to rebuild his neurotransmitter system and receptors.

I know all about Ritalin, as he took it for 5 years. He was able to stop in 10th grade.

I am a professional who knows drugs for a living.

Here is my EFA thread:
http://neurotalk.psychcentral.com/thread6092.html

The average ratio in most modern humans today is 20+ Omega-6 : Omega-3. In order to normalize the brain and nervous system it should be 1:1 up to 1:5 (omega3 to 6's)

Studies have been done specifically on ADHD kids, showing they have dramatically low Omega-3's.

So your use of Omega -3 fish oil will undoubtedly help your ADHD.

In the meantime you might want to read this newer article on long term methylphenidate use and its safety:
http://www.medicaldaily.com/long-ter...fficacy-245927

http://www.thefix.com/content/resear...m-brain-injury

Unfortunately, the newer research is refuting the older.
I am most concerned for your anxiety and depression postings here. Some or all of that could be due to your medication alone.

While this new study only found improvements in ADD inattentive, it is still worth reading:
http://psychcentral.com/news/2014/12...ype/78113.html

My son was diagnosed during a two day lengthy testing intake at a Children's teaching hospital here. His diagnosis was ADHD with anxiety as a secondary diagnosis.

Thank you all for responding.

I think sometimes ADHD is underestimated for its impact on peoples lives. I don't think I can explain it better than I did, but this disorder can ruin lives. So with the Ritalin use, it's a question what's more important to me - stay in high school and get good grades so I can work at a comfortable job and earn well in the future, or stop the Ritalin and recover more quickly form my brain injury? While I see in recovery an extremely important thing, I think it is more important for me to stay in high school (I'll drop without Ritalin) so I can live a good life in the future. It's sometimes hard to explain, but some people just need these medications. People that don't have ADHD can never understand how negatively it affects people who have it.

I'll try lowering my dose soon and see if I still have positive results from the Ritalin. This is going to help for sure, because a lower dose means less stress on the brain, doesn't it? So I'll try gradually reducing my dosage until I feel it's starting to loss effectiveness - once I feel it, I'll stop lowering my dose.

mrsD,

Thank you for your comment. I'll start with the Anxiety and Depression.

I started taking Ritalin at the age of 15. About half a year sooner, when I was 14, I was diagnosed with ADHD. The ADHD was the main reason I went to get a diagnosis (I suspected I have ADHD and it turned out to be correct), but the diagnosis also included a psychological evaluation which showed a few more results about me.

The psychological evaluation tested also for issues and anxiety and depression. The score was from 1 to 10 - a score of 1 means a strong genetic predisposition for issues of anxiety/depression, and a score of 10 means a very big distance from anxiety/depression (no genetic predisposition for these problems).

I scored 1 on the Anxiety test (lowest possible score).
I scored 1 on the Depression test (lowest possible score).

That means I have a significant negativity bias (a strong genetic predisposition for depression) and issues such as severe social anxiety and moderate-severe OCD (a strong genetic predisposition for anxiety).
This doesn't exactly mean, though, that I'm currently suffering from severe depression, but it does show that I'm highly vulnerable to issues of depression and worsened anxiety in the future.

In other words, I have always lived with anxiety and depression, a lot before the concussion and a lot before the Ritalin. These issues are genetic and not caused by any medication. I scored the lowest score possible on the tests for Anxiety and Depression (as I said, 1 on both of them) before starting any medication.

Regarding the Ritalin - I notice that sometimes while on the Ritalin, my anxiety will become worse (although sometimes I also get a boost of self confidence from it). I mean, sometimes it just cause me to feel that my OCD is slightly worse while on the Ritalin. This isn't permanent, though, and will disappear when the Ritalin wears off.

I have an extensive knowledge about Omega 3 and its importance for the brain, especially a concussed brain. I know it contains 2 fatty acids (EPA and DHA), where one acid reduces inflammation (EPA), and the other acid builds new connections between neurons and helps repair damaged neurons (DHA). In addition, 30% of a nerve cell's wall is made of DHA - so we can literally say they are the building blocks of the brain!

I also know that a lack of DHA in the brain could mean problems with the amount of monamines floating around (for example, not enough DHA can lead to problems with the metabolism of dopamine in the brain). Low levels of dopamine in the synaptic clefts are the main cause of ADHD symptoms, and not enough DHA in the brain can cause and sometimes also worsen existing ADHD symptoms.

Saying that, I have started an Omega 3 regimen a few days ago. Right now, I'm taking 18 grams of Omega 3 per day (will reduce that soon to 9 grams as it becomes unaffordable in these amounts of 18 grams daily for long periods of time). While there are noticeable improvements in my ability to focus after taking the Omega 3, these improvements are nowhere near close the improvements that Ritalin causes. Omega 3 only helps a little bit with focus, but doesn't do anything to control hyperactivity and impulsivity - unlike the Ritalin which helps a lot more with focus and with reducing hyperactivity and impulsivity.

That is not to say I'm going to stop taking the Omega 3. I'll return to the Ritalin in a few days (probably), but am going to keep taking Omega 3 because not just that it helps with repairing damage from concussions and speeding up recovery, it is also highly neuroprotective. That means that even if Ritalin causes permanent nerve damage (which I highly doubt it does), Omega 3 can protect me from this possible damage and prevent some of the hazards that may arise from Ritalin use from slowing down my recovery from the 2 concussions I had (the second one, luckily, much milder than the first).

On another note, I apologize if it sometimes appears like I'm repeating my things. My OCD just sometimes causes me to think that I should explain myself extensively because at times, people have a too hard time understanding me (I'm wondering if it's true sometimes). Therefore, to avoid any possible misunderstanding, I'm sometimes repeating my things. I'm sorry if you find this irritating. I'm afraid I also have a few problems with expressing myself coherently through writing, as can be seen by the repetition of certain words too many times in different contexts in my paragraphs. Moreover, English is not my native language, so it just adds a little bit to the difficulty of expressing my thoughts and ideas by writing (these issues are not related to the 2 concussions that I've gotten and have appeared years before). Again, I apologize if it makes it harder for you to read and understand my paragraphs (if it does, please tell me!).

I thank you all for taking your time to help me and I appreciate it a lot. It is very helpful to me and gives me hope and motivation to continue doing the activities I did before the concussions (of course, nothing risky or extreme) and eventually recover with time. Hope and optimism is important, and I believe it is also essential for recovery! ;)

I am open to new ideas and would love to hear some ideas from you (if you have any) and some feedback about what I say, do or should do.

Thanks again! :)
-ProAgonist

You need magnesium to metabolize the Omega-3's and also Bcomplex which has the B6 in it. B2 helps with the activation of the B6 and so the complex is best.

It takes some time for the Omega-3's to work. I do think you are overdoing them. The highest I saw was patient taking 13 grams, and he was under a doctor's care for an autoimmune kidney ailment. The Omega-3 fish oil saved him from a kidney transplant in fact.

To begin with I had my son on a special high DHA fish oil by Carlson's. He took 2 or 3 a day with meals of this for all his high school. He was on 60mg a day of immediate release. (The long acting wasn't out yet then. He is 33 yrs old now)

He is now trying the Krill oil. When we get together I can really see the ADHD in him. He became cavalier about it and stopped for many years. And now he realizes he will need them for life.
But without Ritalin all thru high school he scored very high on his ACT testing and got into a very good university. One class tripped him up so he had to make it up. It was called discrete calculus or something like that, and was pretty incomprehensible. (he now has a computer science degree and a nice job). How you perceive yourself, is really a huge part of ADHD IMO.

At the end of 3 months you should see some results. In our case it was enough to stop the Ritalin. And my son really bloomed then. He said he could write much better off it. He also used to get a stiff neck from it. When we started the EFA regimen in this house we used flaxoil, evening primrose as well as the fish oil. After about a year we dropped the first two. But my husband still uses flax every day...says it helps his psoriasis.

So be patient ProAgonist... the body has to use the fish oil to rebuild and that takes time.