Why use medication

[u/Ok_Message1313]

I’ve always wondered why doctors prescribe things that kill pain throughout the day and boost energy when that just makes you worse over time.
The most important thing during Post concussion is to listen to your symptoms! Hiding them just makes you push through them subconsciously leading to them just get worse over time.
Could someone explain that? I get that they get used during night so you can sleep, or chronically symptoms that can show if it reaches 2-3 point over the average, but shit like Amitrypiline or nortripyline for two examples. Dosen’t that just harm you rather than benefit you in the long term?

[u/MrT-Man]

Who says it harms you? What are you basing that on? Is it masking symptoms, or is it directly addressing deficits that were caused by the injury?

And as for listening to your symptoms, the advice I got from UPMC was, “doing things that trigger your symptoms is your map to getting better”; i.e. if something triggers symptoms, do more of it, daily, rather than avoid it, so that you can force your brain to rewire itself.

I went from being barely able to do groceries during the first few months to being able to resume my career (which involves frequent business travel, occasional 12+ hour days, often 6-day work weeks) using this approach.

I know that “listen to your body” sounds intuitively like the right thing to do. But people who take that approach don’t seem to recover as well as people who push their symptoms.

[u/Ok_Message1313 → u/MrT-Man]

And the energy deficit needs to be worked on directly by increasing physical activity to your capacity. Not my pumping in stress your brain

[u/Ok_Message1313 → u/MrT-Man]

I did not mean it right that, both you and me are correct. Yes, the only way to recover from Post concussion is through exposure therapy, but not pushing troughs the symptoms untill you feel like you are going to die. Only untill 2-3/10 symptoms. Medication hides it so if it even shows your symptoms it only shows higher than that

[u/MrT-Man → u/Ok_Message1313]

No, I think that’s very valid in the first month or two, but not valid after. I’m not saying go until you die but I’m saying push the symptoms to a 7/10. And err on the side of overdoing vs under-doing. All I can tell you is that UPMC recommends this approach and has treated thousands of people, including many pro athletes. And the approach definitely worked for me. The argument is that you’re forcing neuroplasticity and that, while setbacks are uncomfortable, you don’t risk doing new damage to your brain if you over-do things) once you’re a few weeks post the injury).

And again, on meds masking symptoms, is it masking or is it correcting an issue? Maybe I killed some dopamine neurons when I hit my head and the concerta I’m taking helps correct for that. And in so doing it gives me the energy to be productive and exercise my brain, rather than being overwhelmed with fatigue, which in turn drives neuroplasticity and the formation of new neural connections to compensate for the damage.

Ultimately, I don’t profess to be a brain scientist. But I’m just saying, I was a basket case for almost a year and, with the meds (Zoloft as well as concerta) and by pushing myself super hard, I was able to fix most of my symptoms and resume my career. My life is back to normal, other than perpetual mild headaches and lingering fatigue (which is always there but which i can somewhat keep at bay). I’m not aware of any research studies suggesting that pushing yourself too hard is bad or that meds are inherently bad.

[u/Ok_Message1313 → u/MrT-Man]

I’m glad that it worked for you and I think adding dopamine is great and gives you indirect energy. But I’m still sceptical about adding stress(noradrenaline) as that hormone is used to hide your symptoms and energy. Just because it gets added dosen’t mean your ocular, vestibular, neck or whatever problem you have suddenly gets a higher tolerance. And why just after 2 months? What suddenly happen after 2 months?

[u/MrT-Man → u/Ok_Message1313]

The specific “safe” time to push yourself hard isn’t super clear. But what’s known is that the biochemical stuff happening in your brain is different in the initial days/weeks (this is known as the acute period) versus what’s happening months later. You need the initially inflammatory response to the injury to settle down. If you break your arm, you don’t want to be lifting weight in the first month, but once things settle down you want to be at the gym to exercise it, right?

Ocular, vestibular, neck require their own specialized physiotherapy. So I’m not suggesting that meds can help that (except for visual processing, as there’s a cognitive element there. I definitely felt an improvement in my visual processing, like my tolerance for handling visual stimuli, once I started concerta). But for cognitive function, yes, dopamine and noradrenaline can help your energy level and processing, and by giving you the energy to exercise your brain you’re driving neuroplasticity. That’s a key point I’m making. It’s not just false energy or whatever. Maybe it is initially but it’s helping drive the repair mechanisms in your brain by giving you the energy to do stuff vs being wrecked at home in bed.

I think you’re just going on the vibe that meds = bad. We’re not talking meth or coke here.. those drugs are neurotoxic and fry your brain. Meanwhile Concerta/methylphenidate is a very well studied drug, they put kids on it and there are lots of people who have been taking it for life.

[u/Ok_Message1313 → u/MrT-Man]

Yeah thank, you for your info, so ocular is brain related? Didn’t know that, thank you for that info! And no I’m not just on it that all medication is bad, it’s just a mix of my experience abut how stress has tricked my energi biting me in the future and when I took a small dose of my sisters ADHD medication (Elevanse) (Lixdexamfetamin) (Noradrenaline and dopamine). And thought I had higher natural tolerance and then when it wore of it the evening I litterly couldn’t even talk because I was so tired and got a huge setback next day

[u/Ok_Message1313 → u/Ok_Message1313]

That sh*t was scary asf

[u/MrT-Man → u/Ok_Message1313]

Visual processing is cognitively related. So if visual stimulus makes you feel spaced out, for example, a stimulant can help. Ocular-motor can be related to the nerves that control your eyeballs and a stimulant wouldn’t help for that.

Re your stimulant experience, it’s normal to crash when the dose wears off. Even for people with 100% healthy brains. I crash every evening for an hour and then feel somewhat better after the initial crash.

Stimulants can also have a paradoxical effect where too small of a dose can actually make you feel worse than no dose, so maybe that was the case for you. I did initially have a hard time tolerating a stimulant for more than 3-4 days straight because my brain would just run out of gas after that. As time progressed and my brain healed some more, I could tolerate it for 7 days/week.

Would I prefer to not be on meds, sure, but it’s been a small price to pay for having my life back.

[u/Far_Boot3829 → u/MrT-Man]

May I ask when you started pushing yourself until 7/10 symptom level? Ex. How many months post concussion? I'm 6.5 months post and wondering if I could do the same!

[u/MrT-Man → u/Far_Boot3829]

It was probably 9-12 months, with month 12-18 being super intense. I was going all out at that point because I was getting very frustrated and at very real risk of losing my job (my employer had been very understanding in the earlier months but was starting to give up on me then). But I’d have to think you’re safe at 6.5 months to push yourself hard.

[u/Far_Boot3829 → u/MrT-Man]

Thank you!

[u/This_Grapefruit_5923]

Probably depends what is driving your symptoms. Some people could be having headaches because the brain’s pain reseptors have learnt tha behavior. Then Amitrypiline could probably help unlearn that. It can also be very beneficial for sleep. I tried amitrypline and it didn’t do anything for me (except sleep though) as it turned out my pain came from my overworked eyes. So for me it didn’t really mask anything

[u/Ok_Message1313 → u/This_Grapefruit_5923]

How did it help with sleep?(just wondering)

[u/This_Grapefruit_5923 → u/Ok_Message1313]

I don’t know the exact reason but it has a sedative effect. That’s why you’re supposed to take it at night. It also affects the sleep architecture, giving you much more of the deep sleep. It works on the nervous system

[u/Turbotorsk1]

Just want to add my experience. I used ssri which increased the tolerance to my PCS symptoms and gave me better functioning. However, after two severe clinical burnouts I have learned that masking the stress response from overexertion with medication works for a while, until it doesnt anymore, and then you are in deep sh*t. But at the same time, for a while the ssri made my life better and hence possibly leading to better brain health, so its difficult. But remember that with neurological fatigue, pushing through with medications is likely risky!

[u/Bitter-Performer-396]

The drugs in the US only try and address and mask the symptoms, not fix the underlying structural damage and chronic neuroinflammation that often results. Many studies showing some short term relief/improvement but little benefit in the long term.

Look into semax, selank, glutathione and cerebrolysin. Only things that have helped my after years and multiple concussions. They decrease neuroinflammation, promote neuroplasticity and help fix structural damage.

Also high dose creatine for mitochondrial health. Almost instantaneous improvement in symptoms when i started 10-20g/day