When can you start SSRI
 

When is PCS diagnosed? I have read anywhere from days to weeks to 3 months after the injury on the internet.

I ask because I am going to start an antidepressive SSRI for EXTREME anxiety. Supposedly these meds are prescribed for POST concussion, but I have not seen anything for during concussion, can I start at any time?

Any help greatly appreciated

Josh,

Post Concussion just means after the impact. Once you have had the head impact, everything after is Post Concussion. If a concussion does not manifest symptoms after a few days, then it is a mild short term concussion.

SSRI's are not prescribed for PCS. They are commonly prescribed by doctors who just want the anxious patient to go away. Since there is nothing a doctor can do for a concussion, they prescribe meds so the patient feels 'treated.'

There are two kinds of anxiety after a concussion. The concussion caused anxiety is related to the fatigue and the tendency to become overwhelmed by too much stimulation, either visual or auditory. There are some other less common anxiety symptoms from a concussion but these are the common ones.

The non-concussion anxiety is from the subject being told bad information about their concussion. They are told that they should be feeling better already. Or that the hit was minor so they should not be having symptoms. Or, they are not willing to be patient while the concussion symptoms have a chance to resolve. Or, others are putting too much pressure on the subject to do too much, too fast.

So, the important question is whether your concerns are causing the anxiety or whether you have a low threshold for visual and auditory stimulation.

An important issue with PCS is simple. Have you accepted your current condition so that you can work with it rather than against it? There are many things that can be done to minimize symptoms. They are all behavioral changes. Sort of like, You will never get over your concussion if you keep banging your head against the wall.

Rest, good diet, environmental and behavioral changes, etc. can make a big difference.

An SSRI may cause more problems that it helps. Not a light decision.

My best to you.

Hi Mark.

I hope you are wrong about the doctor thing, or if you are right, they really want to get away from me.

When you talk about being overwhelmed, do you mean like with 'loud noises' 'cause that really drives me up the wall. I have to say even loud people make my skin crawl at times.

Yes,

Loud noises are often overstimulating. Your brain usually can filter out the stimulation that is not important or relevant. This filtering mechanism is often made dysfunctional by a concussion. When the loud noises are present, they overwhelm the brain as it tries to focus on the issues at hand. With so many issues being brought to the brain's attention, the brain struggles with "over-attending."

Over-attending is a common struggle for PCS subjects. It is the opposite of multi-tasking. If you try to multi-task, but have over-attending limits, the multi-tasking with cause an overload.

One could think of it as a highway with many lanes going the same direction. Let's say 10 lanes. For the PCS subject, those ten lanes may try to enter the brain and get processed. The PCS brain can not process all ten lanes at the same time. If the traffic (sensory input or different issues) is going slow with enough distance between cars, then they can merge to the two functional lanes and get 'processed' past the processing bottleneck.

Unfortunately, most PCS subjects have not learned how to limit their environment so the traffic is going slow and with good spacing. They have all ten lanes going 70 miles per hour and bumper to bumper. When they try to squeeze through the processing bottleneck, a collision occurs.

Just like an accident of the highway, traffic comes to a stop and needs time, maybe hours to get sorted out and going again. Fortunately, the only damage is temporary. Rest, a lessening of stimulation, and time will allow the brain to get reorganized and start up again.

This over-attending problem can have changing limits. On good days, the brain may be able to process much more simultaneously. On bad days, from poor sleep or other stress factors, the brain is much more limited.

One way of measuring this over-attending limits is with digit-span. Digit span is the number of items the brain can keep in live processing at the same time. At 2 years old, it is 2 digits like in Yes and No. It increases with age to 8 at 8 years old. It may increase beyond eight for those with higher levels of intelligence.

You can measure your own digit span with simple memory tasks. There are some online sites that will test it visually. Some evenm offer an auditory test. ( the original research was auditory) You view or hear a sequence of numbers and/or letters. You will respond by typing them immediately after seeing/hearing them. The point where you can not remember the sequence is roughly your digit span at that time.

Early after my injury in 2001, I could not enter a phone number without breaking it down. The first three digits, then two digits, then the last two digits. Sometimes, even the first three digits were a struggle. I would fail at the third digit.

So, yes, loud noises can be too many digits or an overload of stimulus that, due to its loud volume, creates a chaos of all the stimulus at the time.

Just like this answer. I have offered too much information for some PCS minds to absorb and process.

My best to you.

My doctor told me that its benefitial to start SSRI at once after a TBI or persistent concussions. Most patients with prolonged PCS will develop a depression and SSRI from early on will reduce to depression and therefor give your brain more power to heal while it can (mostly the time near the injury).

It has also been proven that SSRI enhance the brains plasticity somewhat.

I am on it myself on a low does and it made me spend less time in loops going through stuff in my head. Less anxiety etc. This took a looooot of energy my first year after the injuries.

It may not be a good idee to start SSRi to early though. But, in persistent PCS I find no reason why you should go on it!

Emil

rydellen,

Can you provide any background info regarding SSRI's and enhanced brain plasticity?

I have never heard of such a claim. I am always eager to read new research.

Even your statement : < My doctor told me that its beneficial to start SSRI at once after a TBI or persistent concussions. Most patients with prolonged PCS will develop a depression and SSRI from early on will reduce to depression and therefor give your brain more power to heal while it can (mostly the time near the injury). >

I have never heard such a claim. Taking SSRi's is not a lightweight decision. I am concerned about your doctors cavalier attitude toward prescribing SSRI's.

[Pharmacological possibilities in the treatment of brain injuries. Correct choice of drugs can optimize rehabilitation]

http://www.ncbi.nlm.nih.gov/pubmed/17902412

Hopefully you can get a hold of the full text. I cant locate it in my universities catalog through pubmed for now unfortunately. But I guess you might have access?

I dont have any proof other than what my doctor told me about her own and others research. I think it says in this article that it benefitial to start SSRI early in servere injuries.

On TBI patients with brain surgery done to them it is extremely important to put in pain-meds post-surgery. Its has been shown that the outcome for a brain that doesnt have pain is much better rehabilitationwize. Especiella right after surgery. Anything that takes a lot of energy from you...Pain, anxiety and so on is bad for the brain in the initial injured state. THIS however is not in the reaserch provided but thats something else they had done earlier.


Tomorrow im attending a lunch-presentation for a med company just about to get a clinic trail running on neuroprotective substances in TBI.

http://www.neurovive.se/

Emil

Progesterone has been shown to be a very effective neuro-protective. A doctor at Emory U is trying to patent the use of progesterone for TBI and mTBI.

I wonder if the Swedish company whose link you noted, has tried to mimic the effect progesterone has as a neuro-protective. Sometimes, the drug developers try to patent a drug that just causes a natural substance to be increased in the body/brain. They can't patent the natural substance but they can patent a drug that causes the natural substance to be increased or better utilized. Patented womens hormones are a great example.

I am wondering about the efficacy of SSRI's for mTBI/concussion. There is a lot of concern about the impact SSRI's have on an injured brain.

Many PCS subjects are not taught/told how to reduce the stress and anxiety in their post concussion lives. They are also frequently told that they should not be experiencing such levels of symptoms from such a mild impact. Not only is low stress/anxiety important during the immediate recovery phase, but also for life thereafter. Very old research (1970's) shows that stress to the brain will cause a return of concussion symptoms. This includes those who thought they were recovered to 100 percent.

I am caught in the catch-22 of needing a max dose of paroxetine. I am concerned that it is also limiting the recovery of my brain. The question is simple. Does the benefits of an SSRI outweigh the negatives of it?

The study you linked appears to relate to much more severe brain trauma that that impacting people on this forum. The list of drugs used for a patient who is hospitalized is long and varied. It is almost as if many of the drugs are to treat the side-effects of the other drugs.

I wholeheartedly agree that the research shows that lowering stress to the brain is very important. The toxins that accumulate due to the emotional, and physical stresses to the brain will undo or prevent some or all of the recovery. I learned this almost 30 years ago when my doctor put me on a serious nutritional regimen. It improved my function in great fashion within just eight weeks.

That is why I keep harping on nutrition as an integral part of mTBI recovery and long term success.

My concern about SSRI's and other strong psychotropic meds is about how they alter the function of neurotransmitters. The evidence about the difficulties withdrawing from a long term use of SSRI's tends to suggest a change in how the brain functions. It is almost like the brain has to recover from the SSRI. It only takes the brain two to six weeks to get the full value of the SSRI but it can take twelve weeks or more to get the brain to accept the absence of the SSRI. In the mean time, the patient is often miserable.

btw, I could not access the text or even an abstract of the article you mentioned.