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So back in march i had a bad car accident. I have been having issues since then. Now finally ramped up badly. Lots of doctors, therapies etc..................but due to all this my anxiety and depression has ramped up. I was doing great back in march. But now i need a med tweak. Anxiety is awful. Depression fluctuates, im definitely depressed, and some days i have that black hole dont wanna be here kinda day. I know its due to some life circumstances. But my concussion team want me in to see pdoc. They think i need an adjustment. So Heres what Im on:

Meds: Seroquel 150IR, trazadone 100mg, Lithium 900 ER,, Klonopin 1mg mg PM,, Wellbutrin XL 300mg, vyvanse 40mg, melatonin 3mg

Any suggestions??

one fantastic individual suggested:

adding lexapro or

upping seroquel(i dont like that idea never seemd to help depression) or

decrease klonopin.

 

anyone else?

@argh

@notloki

@mikl_pls

i know there are more med guys around

 

thanks in advance

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@looking for answers, it's very common after a concussion for depression and anxiety to ramp up, so your concussion is most likely the cause of this. You are already on the correct meds (stimulants help with post-traumatic depression in post-concussive syndrome, and the Vyvanse and Wellbutrin should have that covered). Melatonin is a wonderful idea because it is an antioxidant and free-radical scavenger for oxidative stress in the brain. Supposedly combining low-dose BuSpar with low-dose melatonin can cause neurogenesis, but I imagine an antidepressant or an antipsychotic would do the same thing unless its something idiosyncratic about BuSpar's chemical/molecular nature.

Lexapro would be a good addition, really almost any SSRI or SNRI. The more stimulating, the better, generally speaking.

You could decrease the Klonopin and increase the trazodone, as it would help both with sleep and anxiety via 5-HT2A antagonism (although Seroquel does that too).

I think I read that the acetylcholinesterase inhibitors, which are used in dementia, can be used for post-traumatic depression if nothing else responds, but don't hold me to that.

Namenda, another dementia drug and an NMDA receptor antagonist, is supposed to be good for concussions because when you get a concussion, glutamate levels rise far above normal levels and can cause neuroexcitotoxicity; Namenda blocks the receptors glutamate binds to and protects from neuroexcitotoxicity.

I hope this helps.

I'll tag @browri in here too.

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7 hours ago, mikl_pls said:

@looking for answers, it's very common after a concussion for depression and anxiety to ramp up, so your concussion is most likely the cause of this. You are already on the correct meds (stimulants help with post-traumatic depression in post-concussive syndrome, and the Vyvanse and Wellbutrin should have that covered). Melatonin is a wonderful idea because it is an antioxidant and free-radical scavenger for oxidative stress in the brain. Supposedly combining low-dose BuSpar with low-dose melatonin can cause neurogenesis, but I imagine an antidepressant or an antipsychotic would do the same thing unless its something idiosyncratic about BuSpar's chemical/molecular nature.

The OP was taking Trintellix at one point in time which has been shown to increase dendritic branching in the brain similarly to what you're describing. Although he would have to decrease or discontinue bupropion to take it in any dose higher than 5mg

@looking for answers the anxiety and depression aside, how is your sleep? Are you falling asleep easily and sleeping through the night?

7 hours ago, mikl_pls said:

Lexapro would be a good addition, really almost any SSRI or SNRI. The more stimulating, the better, generally speaking.

I was just thinking escitalopram because escitalopram+bupropion make a good pair. Escitalopram is a strong SRI but it also binds as a negative allosteric modulator on the transporter as well making it comparatively more potent than most SSRIs. It may also have some 5HT2C antagonism although that may be restricted to citalopram. Not sure. It could help though.

7 hours ago, mikl_pls said:

You could decrease the Klonopin and increase the trazodone, as it would help both with sleep and anxiety via 5-HT2A antagonism (although Seroquel does that too).

Yeah at that rate I would say talk to your pdoc about decreasing the Seroquel back down to 100mg and upping the trazodone to 200mg. Then slowly work your way off the clonazepam. Hard to say though. Post-concussive depression/anxiety is so much harder to treat really.

7 hours ago, mikl_pls said:

I think I read that the acetylcholinesterase inhibitors, which are used in dementia, can be used for post-traumatic depression if nothing else responds, but don't hold me to that.

Namenda, another dementia drug and an NMDA receptor antagonist, is supposed to be good for concussions because when you get a concussion, glutamate levels rise far above normal levels and can cause neuroexcitotoxicity; Namenda blocks the receptors glutamate binds to and protects from neuroexcitotoxicity.

I hope this helps.

I'll tag @browri in here too.

Namenda could be a good option, but from what I've read from the OP so far, his pdoc sounds conservative and won't think outside the box the way some pdocs do.

My question would be if there are concerns with the use of lithium in post-concussed patients.

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13 hours ago, looking for answers said:

So back in march i had a bad car accident. I have been having issues since then. Now finally ramped up badly. Lots of doctors, therapies etc..................but due to all this my anxiety and depression has ramped up. I was doing great back in march. But now i need a med tweak. Anxiety is awful. Depression fluctuates, im definitely depressed, and some days i have that black hole dont wanna be here kinda day. I know its due to some life circumstances. But my concussion team want me in to see pdoc. They think i need an adjustment. So Heres what Im on:

Meds: Seroquel 150IR, trazadone 100mg, Lithium 900 ER,, Klonopin 1mg mg PM,, Wellbutrin XL 300mg, vyvanse 40mg, melatonin 3mg

Any suggestions??

one fantastic individual suggested:

adding lexapro or

upping seroquel(i dont like that idea never seemd to help depression) or

decrease klonopin.

 

anyone else?

@argh

@notloki

@mikl_pls

i know there are more med guys around

 

thanks in advance

I know you're asking a med question here, but has anyone addressed the possibility of ptsd from the accident as adding to your symptoms? I had a couple of accidents in quick succession some years ago in which I easily could have died, and it definitely brought on ptsd symptoms for me, and huge amounts of anxiety/panic related to driving and being in cars that persists today. Just wondering if anyone's considered that as part of the equation for you along with the concussion and life circumstances.

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1 hour ago, browri said:

The OP was taking Trintellix at one point in time which has been shown to increase dendritic branching in the brain similarly to what you're describing. Although he would have to decrease or discontinue bupropion to take it in any dose higher than 5mg

@looking for answers the anxiety and depression aside, how is your sleep? Are you falling asleep easily and sleeping through the night?

sleep with the melatonin in is BETTER than before, never great, but better

1 hour ago, browri said:

I was just thinking escitalopram because escitalopram+bupropion make a good pair. Escitalopram is a strong SRI but it also binds as a negative allosteric modulator on the transporter as well making it comparatively more potent than most SSRIs. It may also have some 5HT2C antagonism although that may be restricted to citalopram. Not sure. It could help though.

 

1 hour ago, browri said:

Yeah at that rate I would say talk to your pdoc about decreasing the Seroquel back down to 100mg and upping the trazodone to 200mg. Then slowly work your way off the clonazepam. Hard to say though. Post-concussive depression/anxiety is so much harder to treat really.

wonderful ':-(

1 hour ago, browri said:

Namenda could be a good option, but from what I've read from the OP so far, his pdoc sounds conservative and won't think outside the box the way some pdocs do.

My question would be if there are concerns with the use of lithium in post-concussed patients.

what would be the concern with lithium? no ones mentioned it so far

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1 hour ago, Unstrung Harp said:

I know you're asking a med question here, but has anyone addressed the possibility of ptsd from the accident as adding to your symptoms? I had a couple of accidents in quick succession some years ago in which I easily could have died, and it definitely brought on ptsd symptoms for me, and huge amounts of anxiety/panic related to driving and being in cars that persists today. Just wondering if anyone's considered that as part of the equation for you along with the concussion and life circumstances.

they havent. And actually i had a car accident in december 3 months earlier.............and the kicker.........no lie

same exact road, same spot, same dead stop, making the same turn, same rear end except worse

ive read some things on aricept, celexa, elevil as well

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28 minutes ago, looking for answers said:

they havent. And actually i had a car accident in december 3 months earlier.............and the kicker.........no lie

same exact road, same spot, same dead stop, making the same turn, same rear end except worse

ive read some things on aricept, celexa, elevil as well

That's bizarre that they both happened in the same exact place and circumstances. Well, I would consider the PTSD. I remember having flashbacks for months over my second accident, and it brought on driving panic which has never really gone away for me, though I have never specifically been treated for PTSD.

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6 minutes ago, Unstrung Harp said:

That's bizarre that they both happened in the same exact place and circumstances. Well, I would consider the PTSD. I remember having flashbacks for months over my second accident, and it brought on driving panic which has never really gone away for me, though I have never specifically been treated for PTSD.

i can bring it up later today when i go thank you. oddly i have been ok driving.

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3 hours ago, looking for answers said:

the namenda for cogniton im assuming just like aricept? they suggested ametadine initially and pdoc said he would prescribe it but didnt think it would do much

Yes the Namenda would be for cognition, but also to prevent neuroexcitotoxicity from the concussion. It would help normalize your glutamatergic neurotransmission.

Amantadine is related to Namenda (memantine), and is also a NMDA receptor antagonist in high doses (and so would have the same benefits as Namenda, except not quite as potent), as well as a dopaminergic agent (it also has stimulant properties). It would probably be worth a try, but it can have some anticholinergic side effects.

2 hours ago, looking for answers said:

they havent. And actually i had a car accident in december 3 months earlier.............and the kicker.........no lie

same exact road, same spot, same dead stop, making the same turn, same rear end except worse

ive read some things on aricept, celexa, elevil as well

That's terrible! I'm so sorry to hear that!

Be careful with Elavil as it's a TCA and for some reason TCAs aren't great for post-concussive syndrome (at least I read anyway... It didn't go into any details. Of course there may be articles FOR using Elavil or another TCA...)

Aricept would be a good med too. Supposedly it helps depression in certain populations.

 

5 hours ago, browri said:

Namenda could be a good option, but from what I've read from the OP so far, his pdoc sounds conservative and won't think outside the box the way some pdocs do.

That's true... I forget that not all pdocs are like mine... lol

5 hours ago, browri said:

My question would be if there are concerns with the use of lithium in post-concussed patients.

I think I read an article promoting the use of lithium in concussion patients because it's pro-cognitive and promotes neurogenesis. I could be wrong though...

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3 minutes ago, looking for answers said:

Thanks guys walking in now 

Good luck!

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26 minutes ago, looking for answers said:

Thanks guys walking in now 

So how'd it go?

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9 hours ago, looking for answers said:

No changes. Said I’m on too many meds. And they don’t make concussion drugs. Need to stop negative thoughts , get in more therapy. Butbtherapy is booked

Unbeknownst to your pdoc, he has already prescribed you a "concussion med," Vyvanse, as stimulants have been shown to benefit concussions in many aspects.

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Posted (edited)
16 hours ago, looking for answers said:

No changes. Said I’m on too many meds. And they don’t make concussion drugs. Need to stop negative thoughts , get in more therapy. Butbtherapy is booked

@looking for answers Sorry to hear this...don't underestimate the fact that sometimes a very small med "tweak" can make a difference in stability. There are plenty of people that increase/decrease meds at times depending on symptoms. Maybe a seroquel increase could help....

Maybe even some supplements could provide a bit of a protective cushion or subtle boost? Do you take Omegas or NAC, Tyrosine? Melatonin or Trytophan at night? Maybe something else that is neuro protective? Just a random thought, nothing to lose. i know @notloki takes some of these.

Edited by Blahblah

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9 hours ago, mikl_pls said:

Unbeknownst to your pdoc, he has already prescribed you a "concussion med," Vyvanse, as stimulants have been shown to benefit concussions in many aspects.

He actually mentioned the Wellbutrin an vyvanse

2 hours ago, Blahblah said:

@looking for answers Sorry to hear this...don't underestimate the fact that sometimes a very small med "tweak" can make a difference in stability. There are plenty of people that increase/decrease meds at times depending on symptoms. Maybe a seroquel increase could help....

Maybe even some supplements could provide a bit of a protective cushion or subtle boost? Do you take Omegas or NAC, Tyrosine? Melatonin or Trytophan at night? Maybe something else that is neuro protective? Just a random thought, nothing to lose. i know @notloki takes some of these.

I have taken things butbwith little to no effect for myself

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7 hours ago, looking for answers said:

He actually mentioned the Wellbutrin an vyvanse

I have taken things butbwith little to no effect for myself

While I know it’s super frustrating, in the aftermath of a huge shake-up, stability might be the best way to go, if possible, to see if things get back to equilibrium. Now if you weren’t on the vyvanse/ Wellbutrin combo, that would be different. Like someone said above, the post concussion stuff is hard to treat, so since you’re already on some appropriate meds, it might be the lesser of two evils to try and lock things down to see what’s what before a huge change 

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3 minutes ago, Iceberg said:

While I know it’s super frustrating, in the aftermath of a huge shake-up, stability might be the best way to go, if possible, to see if things get back to equilibrium. Now if you weren’t on the vyvanse/ Wellbutrin combo, that would be different. Like someone said above, the post concussion stuff is hard to treat, so since you’re already on some appropriate meds, it might be the lesser of two evils to try and lock things down to see what’s what before a huge change 

I agree to an extent. Concussion was 4 months ago

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Posted (edited)
3 minutes ago, looking for answers said:

I agree to an extent. Concussion was 4 months ago

Ah- so have symptoms plateaued?

I’m sorry, for some reason I forgot when March was

also, If he thinks you’re on too many meds, did he give a plan/suggestion to work on that? Cuz presumably you might need one In the future If you do a tweak 

Edited by Iceberg

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