I'm not sure which category I should stick this in - here is appropriate (sudden drop off in medication efficacy post-concussion - concurrent with other prolonged symptoms), but perhaps someone in another topic may know something as it relates to mental illness, attention deficit, and medications.

anyhow.. I've been in treatment for the last 3 or 4 yrs under the care of a psychiatrist for what, to my understanding, is a disorder somewhere in the bipolar spectrum, alongside an anxiety and panic disorder, and very recently ADD.

I started Adderall about two months ago, with varying degrees of success at different doses and between the IR and the XR, etc, but I have never not felt SOMETHING.

I sustained a moderate concussion on May 1st (very ridiculous, careless move - wasn't watching where I was going, slammed my head into some 2x4s sticking out of the cab of a truck parked in front of my car), and as of that week - the Adderall just plain stopped working. At the time of the accident, I had been taking 1 30mg XR/day - sometimes with an IR booster 1 or 2x a day btw 7mg and 11.25mg. I had some shortly after it happened (I didn't immediately realize it was a concussion - I didn't think I hit my head hard enough - and it was a lazy Saturday, so I thought it might perk me up.... but no.... then the fatigue came, the dizziness, etc) and felt nothing, same in the following few days - it had no affect whatever. Even if the dose wasn't perfect for focusing (my psychiatrist and I were still working that out), it at the least perked me up a little... over that week, and the following week, I gradually upped my dose... I was soon up to 70+mg over the course of a day (12-14hrs, certainly not all at once) - more than double what I had been taking and little to no effect whatsoever. I can't concentrate. At all. Perhaps worse than before, but it's hard to say.

It's now the 20th of May. I have persistent headaches, moderate-severe light sensitivity... and some other miscellaneous things that are hard to pull apart from pre-existing conditions. Example: I started having severe panic attacks about a week later (and, similar - though perhaps not related - to the adderall experience, I had to take 2-3x more xanax than I ever have before - despite being off of it since 2008), I'm not sleeping, I can't concentrate to save my life! Situational factors obviously include pre-existing attention issues, same with anxiety and sleep issues... also, I'm in a high period of stress: my room mates were breaking up and I was panicking at the prospect of moving at the end of the month (not possible - luckily everything worked out), my partner and I breaking up, and end of semester exams next week (and I can't focus! I neeeeed to study :/).. oh, and a damn sore neck the nurse at school just gave me a muscle relaxer for.


I don't know what to do... I have a follow-up appt with my psychiatrist on the 26th (after starting the XR a week and a half prior to the concussion).

Any insights?



Oh, and this is my third. The first seven years ago, and the last one (I think - unconfirmed, as I wasn't seen at the ER till approximately 8hrs after the incident, and they completely ignored my complaints and the following hysteria as I was primarly there for a potentially-broken foot, but I'm pretty sure it was one) having occurred late last August - less than a year ago.
The first one was the worst of them (stage diver landed on my head - his spine and ribcage landing square on top of my head. brutal.), the second one was... well... crappy..., and this one didn't FEEL bad, but (not surprisingly) has resulted in the worst (it was immediately followed by 48hrs of dimished cognition and a weird agraphia thing that had me totally freaked out - it went away) and longest lasting symptoms. I didn't have any lasting symptoms after the others, even the first really bad one in which I blacked out for a second - except for a lot of neck strain.

A concussion chemically alters your brain. It makes sense to me that "mind" medications would not be as effective if your brain chemistry is different. I would definitely recommend talking to your doctor. The best things for a brain recovering from a concussion is rest, no stress or stimulation. Taking your Adderall might be counter productive. I was also told that the side effects from medications could be worse if you have a concussion.

All the things you describe with attention/focus issues, anxiety & panic attacks, headaches, fatigue, light sensitivity are probably due to your concussion. My daughter suffered from most of these after her concussion. The first 3 months were the worst and then she slowly started to improve. The 6 month mark seemed to be a big turning point.

Do you think you fully recovered from the concussion you experienced in August? The reason I ask is that I wonder if you the ADD symptoms you were experiencing prior to this concussion where related to your previous concussions or truly ADD. Through out my daughter's experience, she exhibited ADD type behaviors that she never experienced before her injury - basically concussion induced ADD. As she has improved, they too have gotten better.

Well, yes and no... I've been looking up and reading research papers and articles on concussions, treatment, theory, etc, and aside from the evidence that TREATMENT with meds is unreliable and spotty I have found nothing to substantiate an assumption that it significantly alters the brain on a neurochemical level as it pertains to medication administration... but right - the logic is clearly there, I agree.

Well... omitting stress is pretty much impossible right now. So, that's out. I have dropped my hours at work, however (due to panic attacks, mostly). I went to urgent care after the accident and the doctor there said it was fine to continue taking medication as long as they weren't NSAIDS or narcotic pain killers that could mask critical symptoms.

All that stuff is stuff that's been problematic since my early teens. Err.. not everything. Insomnia has been around a long time, ADD symptoms have been around a long time (I just feel like it's a lot worse now) - this is just the first time I've been medicated for it. Depression and anxiety and panic started rearing it's ugly head when I was 22 or 23 (I'll be 27 in a couple months). It's really hard to say what is or isnt related to this or that.

What happened last summer didnt leave any changes in mood or processing or personality or anything at all beyond the night it happened. I probably had a headache, but that was it.


The only symptoms I'm certain about are the light sensitivity, the headaches, and meds not working (and consequently the not focusing, easily distracted, can't stay on task stuff is flaring up - worse than before? dunno). I am not sleeping much... a few hours a day... but I wasn't sleeping much better before the accident - the only difference I'm noticing is that I seem to be tolerating the deprivation more than I typically do (I worked overnights until recently - only for about 6-8 months - and have had a hard time acclimating). Normally, after about 4 days of such few hrs of sleep I'd start getting cranky and miserable, and crash... now I just keep going... keep going and get nothing done.

Hello, Colors - From my own experience, confirmed by friend who is an excellent psychiatrist, the Adderall, ADD Rx meds won't "work" with concussed brain, i.e. won't do any good and potentially harm. You cannot, should not try to revv-up a concussed brain. It plainly needs *lots of rest*, *lots of down time*.

I understand & can appreciate your 'crunch-time-crisis' here at the end of the semster. Can you possibly get a medical letter documenting/ explaining your present conditions --- and arrange with your professors/Dept. Chair/Dean, whomever to appeal to --- to accept 'temporary incompletes' in your classes, until such time as you may be able to better focus, concentrate?

And get your feet firmly on the ground with all these changes in your head, brain, central nervous system, carefully under the guidance of a TBI-knowledgeable neuropsychiatrist; or at the very least working closely with your present psychiatrist ... please?

I know that you are trying to do your best to keep up with the school work. However, as you've said,
"now I just keep going... keep going and get nothing done." So it's not working for you. And it's not healthy for you.

I know, I know. It's really a kicker right here at the end of the semester. But, don't keep spinning your wheels going nowhere fast and perhaps doing further damage to your precious & bright brain.

We're on your team here, Colors.

twenty6colors,

First, sorry to hear of your struggles.

Second, I wholeheartedly agree with nancys. Your symptoms could all be caused by a concussion or other brain trauma, whether by physical trauma, chemical trauma, or emotional trauma. PTSD can cause the symptoms you have as well as a high fever, chemical (drugs/alcohol/inhaled) toxins, etc.

Stimulants are definitely counter-recommended for a struggling brain. There is volumes of research about the long term effects of Adderal and Ritalin on a so-called healthy brain. The neuro-chemical effects of a concussion are also well known.

You said, <I went to urgent care after the accident and the doctor there said it was fine to continue taking medication as long as they weren't NSAIDS or narcotic pain killers that could mask critical symptoms.>

As is common knowledge in the PCS community, very few doctors have any valid understanding of concussion. NSAIDS are commonly prescribed for the headaches and body aches that accompany a concussion. The symptoms to be aware of are similar to a stroke, muscle weakness, inability to stay awake/loss of consciousness, vision or hearing changes, and even some psych issues like mental confusion, hallucinations, delusions, etc.

I would suggest trying to find a neuro-psychiatrist who has a good understanding of concussion. A good physician will want a complete medical/physical history. Any emotionally traumatic events will be important.

This would also include any sport or other physical activities where you may have experienced any form of physical impact or shaking to your body.

Dr Julian Bailes in Virginia has coined a new term for this, sub-concussive impact. He has demonstrated that sub-concussive impacts can have an effect on your brain, especially if you have many of them such as a shaky roller coaster ride or a heading the ball drill with a soccer team. His definition of a sub-concussive impact is a trauma that does not manifest with any symptoms as the time of the impact.

It is not uncommon for an impact to the brain to not manifest with any symptoms until a few days or sometimes weeks later.

Concussion researchers have recently softened their advice against stimulants for PCS subjects. Although they still advise avoiding them, the limit is a cup or two of normally caffeinated coffee a day.

Your hormone levels can also be out of balance. Not an uncommon problem for PCS.

You need to understand how stimulants effect the neurotransmitters your brain uses to function. Stimulants are designed to effect these neurotransmitters. They will increase the production of some and decrease the production of others. Caffeine has this effect on nor-epinephrine and epinephrine. This can cause your heart to race and even your mind to race.

The direct connection between your hormones and neurotransmitters as just as important. Some have both actions depending on the cell they impact.

If your doctor considers you to be borderline bi-polar, you should be getting advice to be careful with stimulants. Anxiety and panic disorder are negatively impacted by stimulants.

btw, I have three siblings with bi-polar/anxiety struggles. We have decades of experience. I have an anxiety disorder that resulted from a very minor concussion coupled with PTSD.

The medication issue with concussion is problematic because our medical system is so overly controlled by the pharmaceutical industry. Publishing against Big Pharma is hazardous.

Regarding work/environmental stress. If you cannot reduce it, you will be struggling for a long time. The brain cannot heal with the ups and owns of stress constantly challenging it. In fact, the stress can cause ALL of the symptoms you have.

Do a search for nutrition on this forum. You will benefit from a stress/brain focused nutrition/vitamin regimen.

I hope this helps you.

My best to you.

All this makes me wish I'd thought to see my psychiatrist shortly after the concussion, but I didn't realize she'd have much to say/know much besides switching up the Adderall - which I was probably going to do next time I saw her anyway, so I didn't see a reason to reschedule.

I saw my primary this week, however, who said there's pretty much nothing to be done - concussions can take months to recover from yada yada - but that I probably have some coup/contre-coup bruising and loosely recommended a CT, which I've scheduled for tomorrow AM. She also said, obviously, the lack of sleep, the stress, and the adderall were all making things worse and prescribed me a sleep-aid (short script - until I can see my psych). She thought the Adderall could be contributing to, if not causing, the spaciness - however, advised me to continue its use and defer to my psychiatrist (she didn't want to tweak my psych's meds and I already had an appt scheduled for this week anyway). In retrospect, the XR did seem to space me out more than when I was off it, but it was definitely not CAUSING it. So, I dropped the XR, but I've still been taking the IR sporadically and in small doses (11.25mg) - it helps a little, only briefly, but it's better than nothing. Also, after two months of use I'm not sure how smart it would be to stop cold turkey, so I've just reduced my intake. I'm still pretty spacey/unfocused on or off of it, either way. The 30mg XR seemed to kick it up a few notches for sure though :/

My hours have been reduced at work, but not significantly (I had pre-existing intermittent medical leave I've been using lately, but I can't continue using it as frequently as I have this month). I'm considering dropping my summer courses, but I'm going to wait to speak with my psychiatrist first.

Unfortunately, I can't reschedule my exams. One professor won't be in town, and the other is a youknowwhat. I had already confronted her last week requesting extended test-time (per a documented disability w/the school to which she's obligated to comply) and she gave me hell - just about accosted me about it and told me it was bs... soooooo I don't think an incomplete would go over too well.

In any case, I've had plenty of down time, technically. I haven't worked all week... and I've hardly touched my books, though not by choice...

Oh, the Adderall wasn't keeping me "going", and I didn't mean to imply that I was pushing myself very hard by its use... just that I haven't been sleeping (neither here nor there)... and on a whole am not getting anything done. Can't really spin a stuck wheel, if that makes sense :/

Thanks for your concern. Hopefully things will get sorted out soon...

I think I said off the bat - these are my pre-existing conditions, these are my current symptoms, I can't make heads or tails bc it can all go either way. I'm not making any assumptions about which came first or how. I can, however, say "this is worse than before" and "this is new" and go from there.

I'm aware of the drug/hormone/emotional disorder interplay - psychopharm's a hobby. However, I've found little in terms of a stimulant's (or anything else for that matter) effect on a concussed brain that would be any different than another brain - besides the obvious, common-sense, fact that ANY detrimental effect/side-effect could be potentiated. While physiological in nature, any concussion is individual and consequently no one could say that in *every* case neurotransmitters x, y, and z are going to be affected in [this] way, proportional to a, b, and c and therefore [these] drugs should be avoided due to [this] specific action. In all the literature and research I've gone over in the last couple weeks, there's been no such claim. If you could point me to any such publication or research (it's likely I'd have access if it's in a journal, even if not open to public), as far as the "long-term neuro-chemical consequences" of a concussion I'm very much be interested and would appreciate it. This is pretty much what I've been searching for and have come up empty handed, so it'd help a lot.


Generally, the effects (short as well as long-term) of brain trauma don't stem directly from any change in neurochemistry, but rather the region of the brain that's damaged and the cognitive/physiological processes those regions of the brain dominate (ex: hippocampus and memory, parietal lobe and sensory functions, etc) - as far as I've been able to dredge up. However, it would follow that: if chemical a is dominant in region x and region x is damaged, chemical a would suffer some variance and consequently any drug affecting said chemical would vary in efficacy, etc etc.

As an aside, and not to sound hostile - just sayin', I don't appreciate the presumption that I've been ill-advised or that my psychiatrist (or myself) is making the wrong decision in prescribing me stimulants. While yes, they can exacerbate anxiety (and have - under specific conditions), one can not say that it is best that they not be described due solely to some umbrella generalization. Unfortunately, I got the best of it all: bp/anxiety/add. It's also common knowledge that they often present co-morbidly and are often treated the same way they would have been otherwise - the trick is just finding the cocktail that works the best.

Both my primary as well as my psychiatrist have been seeing me for years, both have a solid understanding of my present and past conditions (and situational influences/occurrences) and both work together/communicate in my treatment. I would, and do, entrust my life to them both.

That doc in urgent-care, however... no, I wouldn't trust him farther than I could throw 'em! He was profoundly negligent in his assessment (sent me home with a "grade zero" when I didn't even show up until ~3hrs post-injury and could barely stay upright, could hardly fill out the paperwork for admission - couldn't remember the meds I was taking - was slow in response, etc... very negligent). Unfortunately, this happened on a Saturday afternoon and I was SOL, ya know :P


Happy trails
Hopefully this all gets better soon.

I am confused. What kind of help are you looking for?

Most concussions have diffuse axonal injury as a major component. Whether there is a bit of coup-contra-coup focal injury is hard to diagnose, especially in a non-specific concussion. The concussed brain with a heavy load of stress will likely be a neuro-chemical mess. Treatment is usually focused on treating the symptoms.

Imaging a concussion rarely shows any abnormality. Small brain bleeds usually show up at about the third day and are absorbed quickly thereafter. A high resolution MRI may show some problems but rarely will a normal resolution (1.5 Tesla) show any problems.

Brain mapping (qEEG) can show the dysfunctions in waveforms, etc. but are rarely used with concussion. qEEG is commonly used to diagnose ADD/ADHD.