Hey Mrs. D,

I had my tilt table test and mentioned that I was on Amitriptyline and asked about the enlongated QT. Good news! My heart is fine and my QT is normal according to the head rhythm cardiologist in the Western NY area.

Thanks so much for keeping this site so informed and aware of the right questions to ask. It really helps to feel confident and informed when seeing the various doctors that we see.

Thanks again!

Dear Sunshine

I went through a whole raft of severe concussions that ended with me getting hit by a car at age 15. Since my first bad concussion was at 11 months old, along with skull fracture, I never experienced *not* being depressed. There were other reasons for that I won't go into here. My point is that antidepressants were a godsend, starting with Prozac which I started when it first came out. I found that their effectiveness decreased over the years, and tried different ones. Now I take Cymbalta, which works "okay," and somewhat addresses the chronic pain syndromes I have. I have *not* found any particular dietary supplement to be that great, other than making sure I'm loaded up on the B complexes found in the "Stress" tabs, etc. Another good one is Melatonin, because concsussion syndrome really fouls up sleep, with something called Central Apnea. That's when your brain forgets to tell you to breathe at night.
Melatonin helps to regulate sleep rhythm. My son as Asperger's syndrome and swears by it.

hope this helps

gershonb

The only large scale clinical study of anti-depressants and TBI, not funded by the drug companies themselves, indicated that SSRIs didn't help TBI depression, and in some cases, made it worse.

The study was done at Toronto's Sunnybrooke Hospital. After I showed it to my psychologist all suggestions that I consider SSRIs stopped immediately.

I got into a depression about 6-7 months after my accident. I guess it had to do with me not getting any better. I expected to be fine after 6 months.
I couldnt stop researching about PCS to help me understand what was going on. That made me more stressed and exhausted.

My GP sent me away with no help. I later got refered to a neurologist that put me on SSRI as soon as I felt ok with it, after some thinking.

This was a major turningpoint for me. I noticed the different in the way that my thoughts didnt get me back in the regular loops of thinking and processing it all the time. This kind of set me free a little bit and also made me accept my situation better.

What my doctor was REALLY careful with was that I would not get a dosage unnececary high.

I started on 5!!!!! mg of citalopram and raised it to 20 over two weeks time.
Stayed on 20 a longer time (thats what my doctor had calculated for me) and I noticed a big difference. So I didnt raise the dosage any more.

My dad has had a stressrelated depression and has tried serious amounts of SSRIs. First off...not a good idea to switch like that...But anyway he tells me that if I feel that this works, then stay with it and dont try to "get a little better"...

I have seen lists of some people taking MUCH larger doses than me...This is individual ofc but sometimes I think people have a too high of a dose.

My thoughts on the topic.

Emil

rydellen,

You brought up some very interesting and important points. You assumed that your depression was from your fretting about not getting better. You also commented about getting stuck in the looping thoughts.

These are two very big causes of depression. The brain, especially after a brain trauma, can be easily overloaded. This constant thinking or fretting about "when will I get better" or "why haven't I gotten better" points to a common problem in the concussion community.

Doctors, especially GP's, PCP's, Family care, etc. often over state how fast and complete our recovery should be. They also dismiss us as psychological problems without any basis for their diagnosis. This can lead to the premature prescribing of anti-depressants.

It would be much better if there was more support within the medical community for the concept that a concussion or other brain injury needs two things to help recovery.

Time and patience. Those who recover quickly are fortunate and not to be compared to those of us who don't recover quickly, if at all.

There are no quick fixes for our brains. They will recover only when given the opportunity to be free of stresses, both emotional and physical.

The frustration of these doctors when they do not see us recovering as they expect with their limited understanding should not be dropped on us. A simple, "I don't know how long it will take for you to recover. Everyone is different." would be a big help.

Instead of dumping it back on us, they could direct us to help that can teach us how to live with our current condition while we patiently wait for time to take its course.

Instead they say, "You should have recovered by now. There must be something else happening." This leads to the anti-depressants.

Do they make a difference? The research tends to be inconclusive. They may help us be less anxious. But do they hamper true physiological recovery?

A number of researchers believe that SSRI's SNRI's, Tri-cyclics, and MAOI's cause or put us at risk of long term damage.

We need to stop being so compliant and taking the anti-depressants without challenging the doctors. Many of us have challenged them, but more need to. Big Pharma needs to know that we will not roll over and play dead to their push to medicate us.

I am taking the maximum dose of Paxil, 60 mg. Have been for 9 years. I need it because my brain condition leaves me with a brain that gets stuck looping on mundane meaningless things, like the spelling of a word, a license plate number, a stanza from a song, and other stupid and annoying thoughts. I have never had the frets and worries common to OCD even though that is my diagnosis.

I am waiting for an alternative. I have tried a lower dose but the looping come right back. The looping can last for hours, even days. It is exhausting.

The side effects of the Paxil and the long term risks are also scary but that is a problem for the future. At least I can live day to day.

Rydellin,

There are therapies you can do which have been shown to dramatically reduce symptoms (and in some cases even completely eliminate symptoms) of head injuries. And the good news is, they come with very little to no side effects, especially when compared to antidepressants. I would encourage you to look into these:

neurofeedback
Hyperbaric oxygen therapy
Cerbrolysin
Vision therapy
Oxiracetam

Good luck!

sunshine1alb,

What's up? I read your posting regarding your symptoms and the slip and far in the shower. You said that you've had some headache, fatigue, concentration, and vision problems. Are the headaches pulsating (migraine) or pressure (tension) like? Post traumatic headaches are common but if you've there's a co-morbid disease like depression, then it's best to treat that first. 50% of people with MILD TBI (concussion w/ no loss of conciousness) develop a mood or anxiety disorder within a year of the accident. Some people's symptoms are chronic and don't go away for years, like myself. A loss of memory is very common. Gladly, you don't have any serious complications from the TBI, although what you feel now is probably pretty debilitating.

Diminished concentration or distractibility are common in mood and anxiety disorders, but could occur with a migraine. Vision problems, well that's serious. Are the vision problems associated with a painful pulsating unilateral headache, because migraine causes aura's w/ vision distortion. You also said increased sensitivity to light, which is common with migraine. Migraines are common after TBI as well. I don't get them, so I can't relate. Anti-depressants are used off label migraine prevention, although anti-convulsants are first line agents, and Elvail is successful in 65% of tension head sufferers.

As far as mood and anxiety go, be weary of any eating and sleeping changes, weight gain, insomnia, daytime sleepiness, loss of energy. Sometimes its really hard to gauge your cognitive and mood changes when you've got physical problems. But it's important that you do, because the diagnosis and treatment of mental disease is usually based on an objective point of view. Those around you can't feel your pain, but they can detect behavioral changes, and a lot of the time physical problems coincide with those changes. The sufferer may think "well, my mood is changing because of my physical problems" yet the mood is more important, especially when those physical and cognitive symptoms can be caused by hundreds of conditions. WHO (world health organization) claims that physical complaints are the most common presentation of depression in developing countries.

I developed chronic depression and anxiety a few days after a mild concussion and the disease got very bad as it went untreated. Initially, I had some luck with Effexor, but it stopped working. Recently, I've had some luck with an MAOI.

I recommend this book: "Traumatic Brain Injury" by By Jonathan M. Silver, Thomas W. McAllister, Stuart C. Yudofsky Google Books preview
It covers everything you'd want to know and gives a lot of details about treatment for post TBI headaches, mood disorders, and other serious complications. It even suggestions for non-pharmaceutical treatments.

thanks all

depression is and effect of TBI but the problem is that many docs that do not, specialize in tbi or pcs prescribe these drugs willy nilly ( SORRY UK LINGO)

and keep uping the dose if they don,t work once on them you must come off them with extreme care, !!!!!!!!!

I found they made my cognition worse and mood swings volcanic and dangerous to those around me , I am no longer taking them and are better for it,

this is not to say they may not help many people , but just not me ,

also we run the risk of being labeled depressive and the true reason ignored.

with frontal lobe injury the personality is effected emotion is not processed in the way it once was , so a feeling of nothingness may result also depersonalization

now I speak from a point of view of a tbi victim as apposed to pcs because this brain injury conditions, is so wide and as complex as the brain its self, antidepressants may well help but not in my case

please note Melatonin can make you have lucid dreaming/night mares and is banned in the uk zopiclone helps me with sleep but I only take it if no sleep pattern is begging to form I find it has less residual effect your doctors can prescribe,this Melatonin is off the shelf in the USA

I must say that since I have been on nortriptyline (2 weeks) my headaches have gotten much better. I still have trouble with lights and noise and doing things that make my brain go back and forth, but as far as being able to cope at work, it has gotten much better. If someone would have just listened to me 10 months ago, it would have been great. But, I am feeling better and that is all that counts. I am only on 10 mgs. and am supposed to go to 20 mgs., but think I will wait. If I can control the headaches with the least amount of drugs, that would be even better.