You can try a dose of caffeine in the AM and it will be cleared by the evening. I don't drink coffee but occasionally take an 84 mg caffeine tablet just to get going on a bad morning.

While everyone's different and may find different approaches helpful, it's very wise to start with the safest approach and then work your way through various meds if needed.

Caffeine is one of the safest, as Mark has pointed out.

I have a complicated medical and neurological history, with lots of pre-existing severe fatigue prior to a TBI and whiplash. I had suffered a random assault in (in broad daylight) just over 2 yrs ago now. I have not recovered 100% yet.

I have also suffered moodswings since the assault which maybe the TBI and/or PTSD.
I control those with Depakote 24/7. I cannot be without an anti-epileptic drug (AED) for mood stabilization since the assault. I have used low-dose Depakote (375-500mg/day) for this. (Depakote also helps with my neuromuscular disorder and my headaches, thus it is the AED we'd chosen to use.)


As for stimulants-

I have tried: caffeine, Provigil, Nuvigil, Ritalin and Adderall.
Yet another option I am now trying: Wellbutrin (bupropion)

Some people do really well on one of the above.

I have found my brain function changes and we often must switch/rotate meds/approaches. It's very frustrating, Luckily, my specialists don't find this as frustrating as I find it.

The TBI left me extremely fatigued, with some periods of agitation.
When I am very fatigued for long periods, I can use Adderall at a very low dose, in the immediate release form. At the right time, it can be very helpful to me. If/when I am going through an agitated period, I do not touch Adderall.

Currently, we are trying Wellbutrin (bupropion) as an everyday med.
I have just started bupropion this week, so will see if it's helpful.
(Any stimulants are on hold when trying bupropion as they cannot be safely combined with bupropion.)

If you have medication coverage, most insurers will require a pre-authorization for each Ritalin and Adderall. Most also require a trial with Ritalin before moving to Adderall. These meds are quite expensive in generic form for a monthly supply without coverage.

I hope this info helps.

To Our Healing,
DejaVu

I've had concentration problems the entire 2 years I've had PCS. I always feel foggy-headed and my working memory is bad so it impairs my focus if I am presented with too much information at once. My brain gets "tired" more easily. While on adderall, my brain doesn't get as tired and I feel I have more cognitive ability to use all the brain power I have. Before I had these most recent concussion problems, I could take an instant release adderall or two and have no feeling of comedown other than slight tiredness. While having PCS this effect was greatly amplified, and is now still kinda bad. Also with PCS now if I have too much I might even have a bit of depression on the comedown. I think how negative an effect it will have will depend on how bad and what kind of symptoms you're having with your PCS. And about coffee, I'm not exactly the same as I was before as the mental energy effect it can provide is not nearly as strong for me now and I feel I have become more tolerant to the positive effects and more sensitive to the negative effects. But slowly, all of this is improving.

Dejavu, how did you feel provigil was in helping your fatigue in comparison to adderall. Also, did you feel like "yourself" on provigil or did you feel "drugged"? When I take adderall I feel like I'm "on" something and am considering asking my doctor about provigil for the fatigue and concentration instead. Hope you feel better, btw.

I did some reading about Provigil. That stuff is scary. When used consistently and long term, it disrupts the sleep cycle in ways similar to cocaine addiction. The cognitive and memory enhancement function is lost and memory function decreases below the baseline memory skills that existed prior to the Provigil.

Be very careful with it and use it only for times when there is a serious need to be on top of your game. The long term use symptoms sound similar to the foggy brain common to PCS.

I've been to two psychiatrists and they both suggests similar meds for focus/concentration/attention/impulsivity:

Stimulants: Vyvanse / Concerta / Adderall

Non-Stimulants: Intuniv / Kapvay / Strattera /Aplenzin

Mood Stabilizer(?): Wellbutrin / Efexxor / Elavil / Lamictal

I haven't tried them yet. Let me know if you had any luck with those listed above.

Hi tbi-survivor,

I had horrific headaches on Provigil. I also felt very spaced out.
Everyone is different though. Many people do well on Provigil.

I have felt more like myself on Adderall, as far as cognitive functioning goes.

With any/all stimulants, I have to watch for signs of agitation. If/when those signs show up, I discontinue the stimulant (if I had been taking one that day).

My doctor and I had chosen the short-acting formulations, whenever possible.
This way, I could choose to have the assistance of a stimulant early in the day and could choose the hours. (Yet, not daily.) That way, I did not overdo and the med did not interfere with my (messed up) sleep.

I will not use any stimulant on a daily basis.
I do not want to get into becoming addicted.
I also feel like there is not enough info. about the safety/effects of long-term use (of any of the stimulants).

There are lots of options for stimulating meds. Many more options than I have mentioned.

Thanks for the well wishes. I hope you feel better soon, as well.

Warmly,
DejaVu

I wholeheartedly agree with Mark.

There is not enough info on the long-term use of any stimulating med. The info that is available isn't very favorable for any stimulating med.

I will not use any stimulant every day.
If I use one, I choose a fast-acting stimulant, planning which hours I need it.
I will only choose morning hours so it does not interfere with sleep.
I also make sure I am in an environment conducive to focus, not an highly stimulating environment.
(For instance, I would not take a stimulant and then go to Walmart. I might take a stimulant and work on paperwork, read, etc. -- in a quiet environment.)

To Our Healing,
DejaVu

Hi Mystical,

Great lists of stimulants and non-stimulants.
I haven't seen your "mood stabilizer" list as designated mood stabilizers. These are generally classified as anti-depressants. For instance, Wellbutrin can be very agitating. Low dose Elavil is often used for pain and sleep. There is much talk about returning to the older tricyclic anti-depressants at higher doses to treat depression when SSRIs fail. Elavil is a tricyclic anti-depressant. (Tricyclics were popular before SSRIs were avail, SSRIs avail approximately late 1980's-1990's).

Mood stabilizers are usually anti-epileptic meds or lithium. The AEDs include: Depakote, Tegretol and some related AEDs are also tried as mood-stabilizers (Neurontin, Topamax, Lyrica, Keppra, etc.)

I have had some good luck with the more sedating SSRI meds for sleep and pain, less agitation.
(Citalopram, for example. however, citalopram is becoming increasingly controversial, as to effects upon the heart. I don't like using it with all that has come out about it over the past year or so.)

With the more energizing anti-depressants, I can become too agitated.

I am, however, giving low-dose Wellbutrin another try at this time. Carefully.

(I have an M.D. fairly experienced in using these types of meds in lower doses through "compounding" by a compounding pharmacist. We may go that route at some point.)

I have had good luck with low-dose Depakote, which is an anti-epileptic med, and a potent mood-stabilizer. It calms my brain so it's not as susceptible to overstimulation and evens out mood changes. I had needed Depakote immediately after my injuries, for the same reasons and for impulse control. Depakote can also help with headaches. It's been over two years now and I still need Depakote, I have tried tapering and discontinuing and find myself desperate. I am a mess without it.

We are each different. While a lot of information will state people with PCS primarily suffer from depression, I have found my own experience to be very mixed (more like Bipolar 2). I have to be very careful of the same meds as a person with bipolar 2. This may be the degree of PTSD involved for me. Not sure.

Caution and due diligence, as well as informed consent, are important with every medication. Consider both short-term and long-term potential effects.

Do the potential benefits outweigh the potential drawbacks?

To Our Healing,
DejaVu

I started adderol 3 weeks ago. 2.5mg in morning and noon. So far I have noticed a large improvement in my overall symptoms. I was on amantadine before and tried another drug similar to adderol without favorable results. My DR explained that all the stimulants are similar but hard to tell which one will show results based on unique hormones of each individual.

I have had some lows with this drug and good highs but so far benefits far outweigh drawbacks.