I saw my primary physician yesterday regarding my headaches and PCS symptoms. She feels I am depressed and need to see a psychiatrist. She said that psychiatrists are certified in both neuro and regular medicine. I feel that I am having problems with my head because of the injury. Will a psychiatrist be able to distinguish whether my symptoms are coming from a head injury, antidepressants I am on, or my seizure medicine. This is all new to me, but I find that I don't have very much patience and want to make sure that I am going to the right person the first time.

Thanks for any advice.

I'd see your neurologist, if you have one.

My neurologist is the one that prescribed my antidepressants and a whole host of meds to control the symptoms that popped up after my first head injury.

I'm not a doctor, but the way I see it- depression is depression, regardless of the cause. I feel that way about all my symptoms... knowing the cause doesn't matter much in the end- it is what it is.

See neither. Find a specialist in Physical and Rehabilitation Medicine. Do a bit of research to find the Rehab Doctor who is good with mild traumatic brain injury.

The neurologist is only good if he understands MTBI. Most do not. If they cannot image it with CT, MRI, or EEG, they say it should go away without any intervention.

The Rehab doctor has a focus at getting you better if possible.

My neurologist prescribed anti-inflammatories, an anti-histamine (for insomnia), and other useless things. He even discounted the natural remedies (B vitamins) that I take.

If the Rehab specialist thinks you should see a psych, neuro-psych or neurologist, then go.

The neurologists who prescribe anti-depressants do it to get your anxiety level down so you do not keep calling and coming back. Plus, the anxiety can sometimes make your symptoms worse. But the chemical effects of the anti-depressants can also be bad for a healing brain. Anti-depressants have been the cure-all for our screwed up health care system since the early 1990's.

Anti-depressants should be reserved for Psychiatrists and Neuro-Psychiatrists to prescribe, not GP's, PCP's, Internists, gyno's, nor neuro's.

I must have a really good neurologist. I actually asked for the antidepressants because I have a history of being on and off them my entire adult life.

My neuro schedules me for a follow-up every 90 days and is always willing to listen to what's going on and re-adjust my meds as necessary.

My first head injury showed on an MRI, so maybe that's why mine is more proactive than most?

I just wanted to let folks reading this thread know that there ARE good neurologists out there. I've built my entire doctor network around her. I got a recommendation for a PCP from her, my PCP recommended my *cardiologist and so on.

*finally figured out that the fainting which caused three major head injuries is cardio related.

RisibleGirl,

Your neurologist is one out of a thousand. As you say, "He listens to you." This is not the norm. I have been seen by many different neurologists and not found one like you have. The various brain injury support web sites also report this situation. RisibleGirl, you have been blessed with this neuro.

The Physical Medicine specialists have been better. Two out of three have this willingness to listen to me. But then, I did research to find the two that listen.

I had a PCP that was good at listening but she did not have the good referral lists to work with.

Monday, I start occupational and speech therapy for the first time since my injury 8 years ago. Hope I can afford all of the co-pays.

I think your question is, "between a psychiatrist or a neuropsychiatrist, which should I see? Do I have that right?
If so, definately see a neuropsychiatrist!
They specialize in tbi, and pcs.

I went to one of the best rehab hospitals in philly, (Magee), and the doctor who is the one who is the "Director" of the hospital saw me, for intake.
He directed me immediately to a neuropsych.
I got the full regimen of testing and evaluation, and was seen out patient for about a year. (Of course, I can get back into this any time I need).

I agree also with what Mark said, as that's what I did.

Neurologists, by and by, are a lot who "wanted to be doctors, but not get their hands dirty". (That's just my take).

Mine is great! He's also a Ph.d, so that tells you.
I would never waste my time with a plain neurologist again.

As I understand your question, a Neuropsych is the way to go, over and above any plain psychiatrist. But, you'll probably find the best at a Rehab hospital as Mark has said.....

Pete
Asb

Thanks for the replies. I was seeing a psychologist within a rehab medicine clinic every two weeks for biofeedback and relaxation techniques. She then referred me to a chronic pain group this summer. I don't feel like I need a chronic pain group. I went to a "fair" last week where there were lots of rides, lights, sounds. I couldn't go to work the next day because I had such a headache. I didn't sleep at all the night of the fair. I was wide awake and I think overstimulated. Why is this stuff happening? We have a family vacation planned this summer for Utah and the kids are really looking forward to the mountain slides and the zip lines down the ski slopes. I can't even imagine doing something like this, but having two active kids and having once been active is really hard for me. Do I try things and then suffer the rest of the week or do I wait until the last day and it doesn't affect me and I have wasted the whole week? My neurologist is seeing me because of a seizure disorder, not a head injury. When I call about questions, her nurse tells me to take ibuprofen and the headache will go away in the few days. I feel there is something "wrong" with the right side of my brain and I'm not being heard by anyone. I have just recently (within the last couple of weeks) noticed that I lose my balance to the left quite frequently and when I walk I tend to walk to the left. I feel like I'm at my wits end.

People with PCS need to understand the different specialties.

Psychologists are usually Ph.D. or Psych.D trained. They are not medical school trained. They usually try to put a psychological cause to every diagnosis. Their treatments are limited to psycho-therapy. They may refer to an MD who will prescribe drugs at their recommendation.

Neuro-psychologists are still just Ph.D or Psych.D trained with a residency in Neuro-Psychology. This allows them to administer full battery neuro-psych assessments and interpret the data. Remember that they are interpreting the data, not scoring it. There is a serious need to read between the lines when sinterpreting neuro-psych assessment scores. They also have a bias toward psychological causation and treatment. They cannot prescribe medication. Their treatments are limited to psycho-therapy. They may refer to an MD who will prescribe drugs at their recommendation.

The above are often members of the APA, the American Psychological Association which has much lower standards for specialization that medical boards.

Psychiatrists are MD trained with a residency in Psychiatry. They can order blood and other lab work, prescribe drugs and also provide psycho-therapy. Their training in the chemistry of pharmacology provides a much better opportunity for proper medication therapies. Some are more prone to drug therapies with minimal or no psycho-therapy. Some are more prone to psycho-therapies with drug adjuncts. Their neurology training does not necessarily go beyond the basics. The Board that certifies psychiatrists is the same Board that certifies neurologists. Each certification is different.

Neuro-psychiatrists are MD trained with a residency in Psychiatry with further study and residency in neuro-psychiatry. They can order blood and other lab work, prescribe drugs and also provide psycho-therapy. Their training in the chemistry of pharmacology provides a much better opportunity for proper medication therapies. They usually have a more scientific approach to how the brain functions. They may be dual certified by the Board of Psychiatry and Neurology.

GP or PCP M.D's do not usually have much training in psychiatry beyond basic med school. They get their drug information from the drug companies and the drug representatives who try to get them to prescribe drugs. Their experience with anti-depressants is usually limited to what the drug companies told them and a bit of anecdotal information from their patients. They do not see psychiatric drug patients on a regular basis with their focus being a medicine review. Their medication review will often be limited to a general "How are you feeling" without any specific questions into the various side effects or other issues that come with psychotropic drugs.

Even run of the mill Neurologists do not usually have a broad understanding of psychotropic drugs. They may be good with anti-epileptics and movement disorder drugs or drugs for stroke victims but their knowledge of psychotropics can be haphazard. Their in-depth expertise is usually limited to those disorders that can be imaged with CT, MRI, PET, EMG, EEG, etc. The invisible injuries such as concussion leave them taking shots in the dark.

The most important issue to consider is the Continuing Medical Education (CME) that keep the physician up to date with current research. Some pursue improving their skill and knowledge set with CME. Others are content to go to Hawaii to play golf and get their CME hours credited.

The doctors who have established good multi-disciplinary approaches by combining the other specialties through good and open communication with the other specialties are often the best. Beware of those who try to keep you in their care only. They usually are less helpful. Their egos are usually much bigger than their skill and knowledge sets.

So, when it comes to Doctors, whether M.D., Ph.D. or Psych.D., it is always caveat emptor, Let the buyer beware.

Just because there are lots of letters after a name does not mean they are any better. I have seen M.D.'s with Ph.D's that were in Public Administration or Public Health. These extra degrees are worthless to a patient.

Don't let the white lab coats and extra diplomas blind you to your true needs.

So, just a little update. I went to see a psychiatrist today on my family physician's suggestion. I really liked him, seemed knowledgeable, etc. Within the first 1/2 hour, he was pretty much convinced that I was not depressed. He said that the "even" feeling I am experiencing is because I have reached the "poop out" effect from my Prozac. He is going to gradually ween me off of it in hopes that I won't even need it anymore. He said sometimes family docs seem to think that increasing your meds will make everything all better when in fact, it contributes to the problem. He told me there is a razor thin line between being depressed (with a little d) and being majorly depressed. He said that typically general practitioners just don't ask the right questions. So starting today, I am dropping my level by 20 mgs. and will check in with him in 5 weeks. Also starting today, I am going to rethink my life and get used to the fact that I have daily headaches and all the other good stuff that comes with PCS. I am too young to let this take over my life. Time is short and I have a lot to live for. I think that I am finally moving on in the stages of grief and have gotten to the acceptance level.

Sheds,

Sounds like you found a good psychiatrist. He agrees with my perception about GP's over-prescribing anti-depressants. Wean of the Prozac very slowly.

A 20 mg drop might be a bit fast. If you notice problems, you might consider only a 5 mg reduction. Do this 5 mg reduction in steps once every 2 to 3 weeks. When you get to 5 mgs, reduce to 2.5mgs for three weeks.

The withdrawal symptoms can be worse than the supposed depression the SSRI is supposed to treat.

Paxil can be even worse at getting off. I am on 60 mg/day. It will take quite a while for me to get off.

Regarding the headaches, ibuprophen is not a good idea to take when you are taking an SSRI like Prozac. Acetaminophen is ok though. It works well for my headaches.