[SarahSmile0205]

I have days where I feel fine... I am happy nothing ****** me off and then I have days or hours where I just want all this over with... I want to feel like me again... I want to be able to work... I want to feel like I am not the only one that feels like this...

I am on Nortriptylin which I have read is a anti-depressant... how long does this take to work? I have been on since 4-24... this is the only med I am on now...

ideas, suggestions?

[Mark in Idaho]

Sarah,

I have those same roller coaster emotions. I find that on the down times, I need to find something to occupy my mind so that I can avoid thinking. I play Solitaire and try to find anything simple to do.

It is a tough row to hoe but be assured you are not alone. NT may be the only place where others understand and have experienced what you are experiencing. We are here for you.

My best to you.

[SarahSmile0205]

Thanks Mark... yes, I have been playing a lot of candy crush and bejeweled... from outside appearances it looks like i am ignoring my family... and that is the last thing that i want to do but right now, if I open my mouth I am truly afraid what is going to come out, I will bite their heads off...

[SarahSmile0205]

The worst part is that when I cry it makes my headaches worse... why is that?

[rugbyphd]

Sarah, you are definitely not alone - and I can absolutely relate to the crying exacerbating the headaches. I assume that it has something to do with the blood flow, etc. as this occasionally happened to me before PCS if I cried a lot.

One thing that helps me, and that is getting easier now with decent weather returning to the midwest, is just getting outside to have some sunshine. I had a lot of trouble this winter, and I've found that being able to even sit outside on a park bench and people watch for a bit provides a pick me up - and this is backed up by studies on seasonal affective disorder and the use of light therapy as treatment for depression. Some also argue that vitamin D has potential as a treatment for depression, which is of course part of what you get from sunshine. Everyone has a different coping mechanism, though, so it's worth paying attention to what yours is. If you're having a bad day, try some different things - go for a walk, play candy crush, read, hug a pillow, etc. and make note of what seems to help. That can help you to establish a plan for when you start to notice that things are bad.

Nortriptyline is a tricyclic anti-depressant, but the doses prescribed for PCS are normally lower than those prescribed for clinical depression. I assume you were prescribed it for headaches, and not psych symptoms? What is the dosage?

Also, if you are concerned that you are clinically depressed, please speak to a psychologist or psychiatrist - they are qualified to diagnose, where primary care physicians and even your neurologist are not. They can better direct you to a treatment plan with or without medication, such as cognitive behavioral therapy and/or a different medication like an SNRI that will target both serotonin and norepinephrine (nortriptyline only targets the latter) without the side effects that come with higher doses of nortriptyline.

If you are on a dosage of Nortriptyline that is high enough to combat the depression, it can take up to 6 weeks to have an impact. Has it helped at all with any of your other symptoms?

Note: I am not a doctor or trained clinical psychologist. I have an undergrad degree in psych with a specific focus on biological psychology, and worked in behavioral health before returning to graduate school for my PhD in another field. So, these notes come from a place of some knowledge and experience working with people with depression, but I wouldn't consider myself an expert!

[SarahSmile0205]

Rugby,

You are a wealth of knowledge when it comes to this... thank you!

I am on 50mg at night. It has been amazing for the headaches...

Prior to this I was on Lexapro for anxiety... since it was no longer doing anything my neuro took me off of it and said that this should work for both... thoughts?

[Mark in Idaho]

Sarah,

Are you using any of the Vitamins and Supplements regimen ? The L-Tryptophan and L-Theanine can be very helpful. You should be able to take both even though you are taking the Nortriptyline.

I occasionally need to take 100 mgs of caffeine (half of a NoDoz) which is like a cup of coffee. My brain will get sluggish and need a wake me up.

[SarahSmile0205]

Mark

I am taking magnesium, B, D, and fish oil... add the others or are they part of any of these?

[Hockey]

One of the largest, and to my knowledge, only study NOT funded by the drug companies, that looked at anti-depressants in TBI patients was done at Toronto's Sunnybrook Hospital:
sunnybrook.ca/media/item.asp?c=1&i=258

[Mark in Idaho]

The L-Tryptophan and L-Theanine are not in the others. How much of which B's are you taking ? The Recommended Daily Allowance for B's is seriously lacking for those of us with a compromised brain. A B-50 complex plus 2500 mcgs of methylcobalamin B-12 and 200 mgs of B-6 is a good start.