My neurologist just said there's a paper which found that sertraline can be helpful for improving the cognitive side post mTBI. I don't know the details, but my GP has put me on it (starting at half a tablet first as I reacted badly to it years ago - woke up with my first panic attack and nausea all day).
Just wondered if anyone else has had help for improving cognitively from sertraline before? Rather than as an antidepressant/for OCD.
Will see how we go, just curious as I fully suspect I'll have several weeks of rubbish side effects first knowing me.
Cheers.
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Ideogram
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My response is completely unscientific and everbody's reactions are different I am told.
About 4 years ago a hospital doctor put me on Mirtazapine, I never really knew why. It made me very miserable so contrary to advice I stopped it and didn't take any notice of the disapproval or nonsense about doing it slowly.
After a couple of months my GP (who I never met or saw) persuaded me to take Sertraline as an aid (I know not what to) at real baby level, 20 mg. I don't think it made any difference but took it anyway as there were no other side effects. After another year I saw a neurologist who thought it might help to increase that to 50 mg daily as I complained again about the permanent headaches. Again zero difference so when I complained again and cornered him about the headaches he switched me to Prednisolone (short course) and Nortriptyline. Sent me doolally emotional so I stopped that. I was supposed to go back to Sertraline but refused.
Basically I don't even like taking an anadin, things have to be pretty unusual or bad for that to happen . I believe all these drugs are basically mind-benders and we are better off without if we can manage it.
As for the headaches, I learnt to ignore and live with them before so just gone back to that.
I have been on Mirtazapine for a while now,and I do find it helps with my anxiety and have a reasonable good nights sleep,also been on and still on amatryptaline since my SAH fir chronic headaches,unfortunately I cannot do without these and take 3 a day but its a small price to pay considering my outcome
I was already taking an effective SSRi (Paroxetine) for depression when I had my ABI. The resident neuropsychiatrist however, insisted I change to Sertraline ; I was in no fit state to argue at that time.
Once discharged, I had my GP re-prescribe the Paroxetine as the Sertraline had badly affected my balance and light sensitivity for over a month. It's all about compatibility with SSRis.
But....what are intolerable for some can be lifesavers for others, so it can be trial & error. Side effects are common in the first weeks whilst the brain adapts to the changes, but should tail off within a few weeks.
I hope you'll strike lucky first time m'love.....
At my follow-up, my surgeon was emphatic about the benefits of SSRis (for plasticity & other technical stuff) and cognition... Cat x
Thank you I know the side effects will be trial and error (unfortunately I react badly to most meds, including this in the past, so I'm starting on quarter tablets - which is a challenge to cut :D) but I was just wary since I couldn't find anything online about it helping cognition, and in fact warnings about it making people more confused. So what your surgeon has said is really reassuring to know, thank you
I had been on the drug for 20 years. Had Severe TBI 6 years ago. Long history of other concussions since childhood. My neurologist wanted me to go off them so there were more options to treat migraine and head pressure. I had check ups with 3 psychiatrist s who insisted I stay on the drug. My GP is useless and had me in maximum dose of 200 mg for years. Every time I tried to discuss my brain injury symptoms with him I was told to “take more Zoloft”, or accused of making up the pain I was in. I was in a bad way last year and ended up in hospital. Got referred to an older experienced psychiatrist who has gradually taken me off the Zoloft gradually. I’m feeling more energetic and clarity. Still getting raging migraines, head pressure, monthly or more.. I feel like I’ve got increased function in life overall.
The psychiatrist said SSRI can cause migraine like symptoms in normal people, so not a good idea to have someone with diagnosed migraine disorder, PCS, TBI, etc on maximum dose. No wonder I was struggling.
I have not looked up any published data on this as yet.
The drug did help me cope with lots during my 20s and 30s.
Just my experience. Hope you get the help you need. Maybe get a second opinion from a psychiatrist that understands or has experience in your specific condition.
Thank you. Sorry you went through that. Seems that I'm basically getting a lot of totally different experiences of it and maybe that's the problem. Just not sure, given how much my symptoms vary from day to day anyway, how I'd tell what effect it was having on me. Will give it a while and see anyway
Extremely tired, no energy at all and pretty dopey - frustratingly I had a neurophysio appt yesterday, the first professional I've actually seen other than my GP since the TBI, and I couldn't follow what she was trying to tell me.
At night I'm tossing a bit trying to sleep (not too bad) but then waking up after three hours and then every hour or two after that, until lunchtime when I just feel like I want to sleep forever. (I've always been a night owl but since the TBI I've been going to sleep about 3-4am and getting up around lunchtime or early afternoon. This isn't easy to shift due to OCD.)
Then in the day I'm a zombie. Not left my flat for a couple of days. Today I suddenly felt like doing a tiny bit of cleaning but the effort of walking downstairs and back up again had me needing to lie down.
I'm on 12mg (about - I have to quarter the tablets, which is difficult!) and had been taking them mid evening but will now try mid afternoon instead.
Fingers crossed this helps my cognition... So far it's definitely doing the opposite, but I know it's pretty early days yet! Struggling with anger at yet another thing making me feel totally out of control though - any progress I may have been making with the brain is going to be completely undone /plastered over for the next 6 weeks or so with these I suspect. (At which point my full sick pay runs out, but I can't go back to work like this...)
I suspect I'm a bad case as I don't seem to tolerate meds at all, and I have started it while I'm premenstrual so hard to tell what I'd be like anyway (this is normally one of my worst weeks). Don't mean to put anyone else off, but trying to write these things to keep a record (and give me a chance to vent - talking to non-BI'd folks just invite a lot of well-meaning but maddening platitudes).
Going to try to get a mate to walk me later as I really need some fresh air, even if I have no energy to actually move my legs.
Don't know how the f I'm going to manage Easter staying with family like this...
Now wondering how on earth I'm supposed to function like this. I need to catch a couple of trains to visit my family for Easter this weekend. I don't know how the hell I'm going to get out of bed, catch three modes of transport, and remember where I'm going. I'm currently lying on the sofa feeling kind of disassociated from my body (a bit like when you've had anaesthetic before you go under), getting this weird panic like I'm scared I'm going to forget to breathe. This is on 12mg. I can't have coffee or anything to pep me up.
Fuck this is bleak. How are you supposed to survive living alone like this??
Advice on any meds post brain injury is 'start low and go slow' because we can be overly sensitive to them. If you feel rough after a week of starting them you probably need to quickly talk to your GP and stop them. Don't hang on too long if something disagrees with you.
There is research that shows that SSRIs and SNRIs can apparently help with the disturbance in the white matter following a MTBI - the brain apparently can't tell the difference between the disturbance of the white matter from depression and that from an MTBI. Taking them at a low dose for 18 months - two years can help iron out the disturbance. The trouble is the side effects of these drugs seem to vary a great deal person to person. Don't take one that doesn't agree with you - but bear in mind you might get some benefit from one that doesn't give you side effects. (They don't work for everyone , and they can affect your sexual responses- but if they do work, they can be very helpful).
Duloxetine helped me (along with everything else that I did) it lifted the appalling anxiety - which I wasn't even aware of till it went away. The neuropsychiatrist used it in particular because it is used for fibromyalgia for pain relief - because my headaches were a nightmare. I tapered off it without problems with the help of the neuropsychologist at nearly two years. I preferred feeling sharper without it, but was a bit more headachey, and a little bit more anxious from time to time, but it was manageable. Haven't gone back on them.
I suspect they're a better option than the oft-prescribed amitriptyline which is anticholinergic - and which, according to my neuropsychiatrist, under modern day standards of testing, all its therapeutic effects apparently just derive from its sleep inducing properties.
If you can go on these without side effects, it's apparently likely that you can also eventually wean off them without side effects - certainly that was my experience.
Thanks. Everything I've read seems to suggest that these side effects are normal and I should push through - but definitely will say something if it's more than a week. As I say it's hard to tell what's them and what's also starting them during what would normally be pmdd.
Amitriptyline was appalling. Worse than this. Never again!
Oh that's tricky on starting sertraline. Wonder why they default to sertraline automatically - there's plenty of different SSRIs and SNRIs out there. Good advice I had on meds generally from a doctor friend was that there is always another drug out there to do the same job if the one you're on has side effects you can't tolerate, it's always worth asking for a rethink. (Amitriptyline made me quite zombie like when I took it, and have me an awful dry mouth, which annoyingly lhas never gone away. It made virtually no difference to my headaches either ( which I was logging on the migraine buddy app) but I did sleep better on it when I took it at night - weird dreams though. Plus anticholinergic drugs really aren't a good idea if you're older. )
I was told that the cognitive benefit was specifically sertraline and not other SSRIs. I've tried looking it up but very hard to delve past all the research discussing it as an anti-depressant rather than for cognitive benefit. Anyway I don't think I can Google any more without self-combusting and stressing myself out further so will just see how I go. Ta.
I'll see if I can find something and pop it on here - I remember the endless research very well ...The neuropsychiatrist explained it to me as being any SSRi / SNRI - and I found d the research and asked him about it, but perhaps more had been done more recently.
Cheers. I thought when I was looking over my GP's shoulder it was on something like psychology online but all I've found suggests the opposite. Oh well. Please don't trouble over it too much
I will say the headache has been a lot better today, but it's almost like all everything is a bit sedated so maybe I just can't feel it, if that makes any sense (?!).
All the stuff I've read on sertraline seems to suggest that it's normal to feel like this (and I know I tolerate it badly hence very small dose) but maybe the difference is living alone makes it feel scarier. Or maybe I just don't tolerate it. Adding this to a baseline of fatigue etc from brain injury isn't feeling fun at the moment. I'll see how I'm feeling tomorrow.
I'm definitely not going to the psych ward.
I agree the support I've been getting has been maddeningly minimal but my GP is very good at listening and now has me referred to neuropsych and the local brain injury rehab team which I've been pushing for.
I think where I've probably had a different experience to others is by not being deemed to be 'bad' when I went to A&E (I got the impression that because I only went there two days later they thought I couldn't be serious, which clearly isn't correct) so didn't get a CT or referral to any neuropsych help, then being told by GPs that it would pass with rest for the first three months. But this definitely hasn't been from a lack of pushing. Regardless at almost 1am after 8 hours in hospital, 6 of which on my own in A&E, concussed, with only 10% left on my phone wondering how I was going to get myself home, I was in no state to argue for a CT - and since my previous concussion was a 24 hour job I had no reason to argue (in fact I nearly left the hospital because waiting 6 hours without being able to go to the loo or even having had lunch was a lot!).
I might ask my GP about the CT. I understood they were for bleeds on the brain and I would have presented with that by now (MRI was fine) but may be worth discussing for peace of mind when I next see her.
Should add that I deliberately asked my. GP if this was definitely being suggested for cognition, not depression, and she said yes. I don't think she is playing me along at all (other than in hindsight wish she'd got me referred earlier) - she was the one who told me I had long COVID after years of feeling gaslit by the consultants I saw. Anyway, will definitely check in with her again if needed as she and I are both aware I might react badly to these (I did years ago, but on a higher dose).
I found a couple of meta analyses which included many small studies where the results were very mixed - not a great deal of data to support using Sertraline just it was the most studied SSRI.
This 2023 paper( another meta analysis ) is really long - but in conclusion it basically says that though post TBI depression is a thing, the jury is out on whether meds help or not.
Interesting that your GP thinks it addresses cognition. I think that is in line with the white matter plus SSRi/ SNRI thing that my neuropsychiatrist came up with - albeit a few years ago.
Lots going on here and I'm trying to think through this without the clearest head so please bear with me.
So this morning I've actually found by chance that I have access to the emails between my neurologist (it was his suggestion) and the GP via the NHS app.
He said a neurorehab colleague found sertraline sometimes helped post TBI - 'not just with depression but also cognitive symptoms'. This was the paper he was referring to. I'm too tired to go through it now - another night of awful sleep since being on these.
I will go back and ask my GP about this if I don't feel any better after a few more days. I don't mind tolerating side effects if I know they're going to help but I'm not as convinced now, particularly as I've now found that my neurologist at first thought my symptoms were all just migraine, despite me going to A&E with concerns about concussion (I think my notes there may have been a bit muddled - they reported pain but no confusion, which isn't accurate about how I was feeling at all, but I was probably trying to be as articulate as possible given I was on my ruddy own trying to get seen!).
My neurologist has agreed with the PCS definition but "maybe functional overlay as well". I don't know what that means in this context.
I believe my GP is doing her best for me (and has been very helpful for me on other things where others haven't) but she is not an expert in this, so has reasonably turned to my neurologist for advice, and I just need to see someone who ruddy well is.
The good news is that I've now been referred to neuropsych and the brain injury rehab team (I had to tell the GP the latter existed when it's two minutes' walk from the surgery!).
Interestingly I also saw a neurophysio the other day who thinks I have BPPV and nystagmus, odd as noone else has said that, but tbh that's probably my least important symptom.
Gah.
I really, really miss coffee and real ale this week.
I think what I'm finding so maddening is the assumption that we must all have depression. I have had it in the last, but tbh, four months of being off work has actually done my mood no end of good!!
Other than date and bias why do you say not methodologically realistic? I don't really have the means to critique it myself at present, but my faith in him has diminished since I found out that at first he thought this was all migraine. (Though that may be the fault of the A&E notes as I told them 'I don't know what is this was the migraine I was suffering at the time').
Still very curious about that 'functional overlay'.
PV -The paper you provided the link to here, endorses the use of SSRIs after MTBI, particularly Sertraline. While amitriptyline and other tricyclics are contra indicated. The view taken is the same as the paper Ideogram posted, that by alleviating depression after TBI, cognition can improve because the likely depression is alleviated.
Thanks. I was sold this as helping cognition independently of depression (at least that's how I understood it). Since I don't particularly have depression, I'm uncertain of the benefit. Anyway, I've stopped taking it for this weekend and felt most like myself (and actually slept, to some degree) for the first time in days so will revert to the GP next week.
My comment is also non-scientific! I had a major haemorrhagic stroke in 1997. Medics tried a pharmacopoeia of medicines for a couple of years, but after the (mild, in my case) side effects settled Setraline (ultimately at the maximum dose) has been the only thing that helped. After a while, I asked for and tried a reduction in the dosage. Mistake! 20+ years later, I still take it and have been more or less ok. Even re-took my law degree, with a view of qualifying as a solicitor.
It clarified my mind, so that I acquired a better law degree than my first (I got that in 1984 - by 2001 it was a totally different subject - law degrees become outdated after about 6 years). I hadn't thought that I'd be able study at degree level after the stroke, but as my brain and mind healed, I managed to do much better than before my TBI.
As an aside, it also brought me back from the brink of my severe clinical depression, which was causing me obsessively to contemplate doing something drastic.
I had tried other SSRI’s before arriving at Sertraline.
After the initial period post TBI when I thought the world and everyone in it was wonderful ( a known side effect of Brain Injury) , when reality started to hit hard, I was under a Psychiatrist and so the medication began.
After some more potent stuff, I eventually got to Sertraline.
I don’t know whether it does what you are asking, but I can only tell you what it does for me.
If I don’t take it, I tend to be extremely tearful, angry and can be violent.
If I take too large a dose I become too isolated and uninterested.
Taking the right amount reduces the tears to negligible and I’m much less angry. This amount helps me greatly get through the days and function as normally as possible.
Underlying issues still are there which I don’t share with those around me.
But I will with you on here.
I feel very isolated from people, because I know they don’t have my problems coping with normal things nor can they understand.
This feeling is gradually getting worse and I feel like an outsider.
I don’t have anyone I can really talk to .
So. Sertraline does help me but it doesn’t solve anything either.
I'm sorry to hear you feel like this, but definitely relate to those feelings.
I didn't mean to suggest in any of the above that it doesn't have a very valid role to play in anxiety and depression - I have multiple friends who are on it for that reason and it seems to have done them some good.
So if it works for you to help with your mood I'm glad you've found it.
Hi Idiogram, listen to the Nick Cambell show from today. Listen to the professor talking about antidepressants and brain injury. No realistic studies so far have been done.
Yeah, I've just woken up to three different people sending me that BBC article. It does seem to rather suggest that people who have brain injuries actually get some healthcare as well... I just don't know what to think for the best.
Well at least after you listen to the program you will know your neurologist and GP have not told you the truth or maybe they don't really know and are just fobbing you off.
And today, ironically, I really feel depressed. In pain all day from another (unrelated) condition but I'm not supposed to take painkillers much because of the headaches. Not that they make much difference anyway.
Head had felt a lot clearer the last few days after coming off sertraline, though I did get very fatigued quickly. Today it's awful - even when it's not actively hurting I somehow feel really *off*, don't want to read a book, got tired and fed up trying to follow long conversation and even turn to look at a relative. Just couldn't.
Completely woozy and exhausted trying to hang up washing. Got fed up that others didn't help. Making tea was exhausting.
Suspect a good amount of this is the pain but I'm not sure what I can do about this; was referred to a specialist ages ago who was a bit of an eejit and very dismissive. Referred back to another one 18 months ago but not heard anything. GP tells me to chase up. Getting the energy to do so is difficult.
Tried lounging in the living room (visiting family) so not in bed all day, but TV is too loud so I'm back in bed, in pain, dreading tonight not being able to sleep. Only thing that helps is hot baths but I've already had comments at bathing too often.
Today is just awful, and wish the pain would do one. Mostly not PCS as I say but the brain seems to have flared up at the same time.
If I do briefly manage a tiny nap something or someone wakes me up.
I can't face the snarky comments about me getting up late. Thought staying with family for a few days would be a relief from living alone but it's difficult being around other people who mean well but just don't get it. I don't want to have to keep justifying myself.
Wonder if I should be on bloody antidepressants but hell knows.
I really hate being so dependent on one friend (other than family, who live a £100 multiple train journey away) and feel guilty and anxious about it - it's not entirely healthy - but what can you do?
So, so angry that my healthcare is all put on me when I'm the worst placed to try to make decisions or advocate for my own health.
Now to get up and try and get yet another hot water bottle...
Hi Ideo, It is really tough being on your own, and dealing with the weird world of post concussion. I think your accident was only about four months ago ( have I got that right?) So all the symptoms you mention can spring directly from your TBI, and it's still very early days for you. It won't always be this bad though. Don't forget you can carry on ringing Headway for support when you feel floored by it.
I live on my own, and with the benefit of hindsight, it's been a help and not a hindrance overall. You have total control of your environment, and how and when you eat. It's tricky when you can't move to even get a glass of water, but if you want to cook a large stew and live on it for days, in or out of the freezer, you get to choose, without any questions from anyone else. My flat has resembled a quiet dimly lit cave for many years now. Particularly early on I found other people's environments way too loud and bright. And I think I would have found it hard to explain to other people the things I have to do to adapt ( a new friend commented on my endless lists the other day, but at least had the insight to realise it's what I need to do to cope - though it was a little hard for me to face up to how I cope compared to my neuro normal peer group.) I'm still not sure how I'd manage watching a TV programme right through - I still pause these a lot - though because I'm on my own that's perfectly ok.
I do think my glitches are much more minor these days. Because the thing is I do cope now, and have an interesting life and new friends, and fatigue is microscopic compared to my own four month point. I had a rough time after my first bout of Covid last year, and it was depressing for months, but I seem to have finally bounced back, and feel pretty normal ( I had two complete days on my feet doing flower arranging for church last week - so much more physically taxing than it sounds - it is always a 10,000 step day - I ache like anything afterwards) plus a family do, and am in pretty good shape right now for example (ok mainly reading and eating chocolate this morning.. but that's not exactly unacceptable) But a family thing would have knocked me sideways for a week afterwards in the past on its own.
What you're experiencing is tricky to unravel. A lot of the symptoms of PCS overlap with the symptoms of depression, plus dealing with all the stuff of coping with the PCS, can trigger depression anyway. But stuff like fatigue is invariably just part of the normal sequelae of BI even if it's easily mistaken for depression.
The trouble with PCS is that it's often the longest any of us have to deal with a period of ill health and that's difficult to process all on its own, both for us and for other people.
Staying with other people can give us much needed social interaction and deal with regular stuff like meals, but can be fatiguing in itself. You might need time to recover when you do go home.
Be kind to yourself and keep talking on here, and I'm glad your GP is onside, that's great x
Thanks. Yes on balance I think I'm very lucky to rent my own place (as much as I'd like it to come with my own driver:D) and particularly not to have any caring responsibilities.
I think the crux over the last few days is other health conditions really flaring up so I'm in almost constant pain and those aren't easily treatable, but hopefully when they eventually subside things will feel a bit brighter.
Appreciate having this place to sound off, even if it is in danger of becoming the one woman monologue show.
It is hard when you can't do the things that usually cheer you up though, right? Again today I don't even think I can really manage a walk.
Anyway. Best try and go make myself eat something that didn't come out of an Easter egg packet...
Actually I say I have no caring responsibilities - I really ought to go and find the tortoise...
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