Does anyone have any good info about antidepressant usage during PCS recovery?

For example, are SSRIs the antidepressant of choice for most people with PCS? Is a lower-than-normal dosage appropriate? (I think I read somewhere that this might be the case b/c of brain sensitivity.) Are there some SSRIs or other antidepressants that are contraindicated for people with PCS?

What I'm finding is that the ups and plateaus are tolerable (if frustrating and tedious), but the setbacks are just brutal mentally and emotionally. I would prefer to discuss this issue with a neuropsychiatrist, but I may end up having to talk to my family doc about it, as it will likely be a while before I can see the neuropsych. Any suggestions would be much appreciated...

* Also, I'm willing to consider alternatives that may have fewer side effects (5-HTP, maybe?). Other things being equal, I would prefer to avoid antidepressants, which I've never taken before. The problem is that PCS makes some of the things that I relied on to stay depression-free prior to my injury (work, exercise, getting outdoors, socializing, etc) less available as therapeutic options. So I'm casting about for ways to keep depression at bay.

greenfrog,

Have you started and maintained a good nutritional supplement regimen?

Anti-depressants are not the worst thing you can do for your PCS but they should be considered carefully, like you are suggesting. Personally, I don't believe any doctor but a doctor with extensive training and experience prescribing psychotropic medications should be prescribing such medications.

Too many GP, PCP, Family Med, and other such general doctors prescribe at the drop of a hat when there should be more evaluation of the patient's condition.

I have been on an SSRI at maximum dose (paroxetine 60mgs) for 12 years. I don't take it for the anti-depressant effects but know that it helps me with the ups and downs. I see more downs when I fall of the wagon of my supplement regimen.

In 1982, I was treated for severe depression without any meds at all. I was given B-12 shots weekly and started my vitamin and other supplement regimen. Over the years since then, I have become lazy about my regimen and paid the price every time. My wife would notice and comment that I need to get back on my regimen.

Vitamin and such regimens do not cause an immediate change. It can take weeks or a couple of months to start to see improvements.

There are also thought behaviors that need to be understood. Rather than getting frustrated and anxious at every sign of a return of symptoms, one needs to accept the symptoms and take the behavioral steps to help resolve them.

I just know that when I am having a bad day, I need to take it easy. I knwo the things I can do and the things I need to avoid. For those with a regular job, this will be a more problematic situation as some jobs can have periods of intense workload and stress.

In these situations, getting good support from family, friends and such will be important until the workload returns to an acceptable level. For others, there may be a need to find a different job that is less stressful.

Keep in mind that some of the roller coaster of PCS will likely be with you for years to come. Making life changes to accommodate this will be an important part of long term career planning.

Mark,

Thanks for your suggestions and comments.

I take 2000 IU of vitamin D3 per day. I also take a multivitamin with (among other vitamins) the following daily dose of B's:

B1 25 mg
B2 50 mg
B3 25 mg
B5 25 mg
B6 25 mg
B12 1000 mcg
Folic acid 800 mcg
Biotin (is this a B?) 25 mcg

I've also been taking a fairly high dose of a high-quality fish oil daily (about 4 - 5 g). I've been eating reasonably well overall I think.

I was already on a low dose of Prozac (20 mg) before my concussion. After the concussion, I had a big increase in anxiety & depression, so my MD raised the dose to 40 mg. It did help the worst symptoms such as racing thoughts and uncontrollable crying and helped me be able to rest and relax more.

Since my concussion in October, I've struggled with severe depression/crying spells/panic attacks. I have no history of depression or anxiety before my concussion. I'm now on 75 mg of Zoloft which is a pretty low dosage (max=200 mg). The depression is very subtle now and the panic attacks have almost completely subsided (with the exception of one during a relapse last week). Of course the progress is also from my brain healing, but I'm very pleased with the results.

I've also been taking a B-complex vitamin, omega 3 Fish Oil, and a multivitamin for about 6 months now. I've never been one who wanted to rely on medicine. You seem hesitant as well. I can't see the harm in giving it a try. If it doesn't benefit you, you can always decide to not take it and taper off of it.

And Mark's right about the GP and Family Med doctors... Your best bet is finding a neuropsychiatrist or concussion specialist. Good luck!

greenfrog,

Your B-12 looks to be more than you likely need. It should be tested with a blood test. Or, you may not absorb it through your gut well at all. Then you would want to take it sublingually or by injection.

On the other hand, your other B's appear to be low.

I take a B-100 complex (2x B-50 complex) I can tell the difference when I only take one B-50 complex. I also add 100 mgs of B-6 so my daily B-6 is 200 mgs.

I take 380 mcgs of B-12 and maintain a good B-12 blood concentration, just above the high end of the normal range.

I take 1300 mcgs of Folic acid and my blood test shows my folate levels to be right where then should be.

I also never took antidepressants and was hesitant at first to go on them. But now Im on 2 for different things. Im on Celexa 10mg to help even out my mood since i was very low energy and almost flat affect. The other is being used off label for my headaches. Nortriptyline 40mg at night. Some people on here said it was a high dose...but it has taken away my headaches completely until 5 or 6 pm at night and has made life so much easier. I also do B12 and B6 injections and take a super B complex along with multivits and fruit and veggie smoothies. Seems to be a good cocktail for myself and i have so much more energy and despite a few hours were headaches creep their way back in, feel like myself again. I'm about 10 weeks out.

It's weird - most of the time I'm not depressed at all (I've experienced some mild depression before, so I know the difference). Mentally and emotionally, I feel pretty together during the "plateau" periods (about 70% of the time) and "better" or improved stretches (about 10-15% of the time).

It's really only during setbacks that the depression-like thoughts and emotions come crashing in. And these periods (around 10-15% of the time thus far), while extremely unpleasant, seem to be getting briefer - the last two have lasted for a day or two only, whereas earlier ones seemed to sideline me for 3-5 days or more.

These two states (plateau/improving and setbacks) are like day and night. During the former, I feel OK - I just have to cope with the tedium and uncertainty of recovery. During the latter, I feel awful and completely pessimistic, and my symptoms seem to get worse.

I guess my hope is that over time, as I become stronger and more resilient (and more attuned to my triggers), the setbacks will become less frequent and less severe - and hopefully will end altogether someday.

In any case, I will ask the neuropsychiatrist about antidepressants (and medications generally), if only to have an option if the problem continues to recur.

Depression that only lasts for a day or two is not worth the side effects of taking an anti-depressant. I would recommend trying to find other ways of dealing with these short periods.

I recently read that SSRI's reduce the amount of time the brain spends in REM sleep. Since REM sleep is when the brain does its healing, maximizing REM sleep should be a priority.

The normal clinical standard for depression is depression that lasts for weeks at a time.

You sound like you are just having the ups and downs of PCS, but then, it is still worth getting a professional opinion.