Hi folks there are discussions about antidepressants and brain injury on this site. There was a professor on the Nicky Cambell show this morning who is setting out to research sertraline and brain injury because no realistic research has yet been done.
I did not have depression or take antidepressants during my brain injury although many doctors told me my symptoms were caused by depression and they wanted me to take antidepressants.
It's good that open discussions surrounding brain injury issues are made available to the general public, but disappointing that both Sertraline and Traumatic brain injury were singled out.
Most lasting after-effects are common to both TBI and ABI, but stroke, tumour, haemorrhage and other acquired injuries weren't mentioned ; so an unfortunate omission for listeners with no knowledge of brain injury.
Also, Sertraline is so often singled out as the SSRi despite many people's intolerance to it, and the fact that any other SSRi will aid progress and treat potential depression.
At my 3 month review, my surgeon asked how I was getting on with the Sertraline prescribed by their neuropsychiatrist. I explained how, once discharged, my GP had re-prescribed my previous SSri owing to the Sertraline's lasting, disabling side effects.
He admitted it was just the standard drug used after brain injury but, that if I was already using a compatible alternative, he couldn't understand the need for changeover.
Sorry if this looks picky, but just those couple of points stood out for me personally.
Thanks for all your good work and diligence Richard... Cat 😑
I was just pointing out that there has been no definitive research into this antidepressant in regards to brain injury. Some people are being told by their GPs and neurologists that this drug can increase cognition after brain injury. There are some research papers that say it does and there are just as many that says it does not. However, the NHS guidelines say it should be prescribed but on what basis are they saying that because as the professor who will lead up the research says no realistic research has been done yet. This research is however only to see if sertraline can prevent depression if it is prescribed early after brain injury even if the patient does not even have depression. I find this odd because only 28% of people with TBI and 35% of people with strokes report depression and the side effects experience by many people on sertraline are worse that the brain injury symptoms themselves.
The professor also said that they are starting to listen to patients, but I don't think they are from the patients perspective. They have just asked questions from the medical point of view and those questions are biased towards what the health profession think.
An interesting question they might like to ask someone with depression after brain injury would be "How much of a factor does having no realistic rehabilitation play in the development of depression?" In other words if the health system acknowledged people had a brain injury in the first place and set out a plan for high quality rehabilitation after would less people get depressed because it removes the sense of hopelessness in peoples lives.
I think hopelessness from a dysfunctional health system and DWP system that persecutes people has more to do with creating depression than the brain injury itself does.
You are right to be picky because you are telling a truth from your perspective. If more people stood up and started telling their truths the system might change. The system only works by consensus but unfortunately the voices of people with any brain injury are not really considered so the 'experts' who could not possibly understand the experience of what a brain injury is like are making the decisions.
I'm lucky because after six months or so after my injury I realized none of the doctors or medical experts actually knew what they were talking about, so I went on my own alternative recovery journey.
"How much of a factor does having no realistic rehabilitation play in the development of depression ?"
......spot on Richard.
I was taking an SSRi long before my brain injury and the depression has been under control since the late 90s. But a couple of years post Bi the disillusionment from lack of aftercare did threaten that stability.
I guess, like many others, the curtain of brain fog and fatigue obscures the slippery slope somewhat, but anger takes its place.
It's a joy to know we have a competent & fervent ally amongst us. Thanks for all you do...
Cat..
Thanks Cat
This subject has been heavily discussed in the news in recent days so it must be getting traction somewhere. The articles I saw talked about not waiting for the onset of depression and using Sertraline to treat it, but rather to pre-empt depression and start giving Sertraline straight away which improves some cognitive ability due to depression not being a factor influencing speed of recovery. There have been a few studies, a couple linked below. Effectively you are removing depression as a limiiting factor in recovery. Sertraline doesn't physically treat a TBI and improve cognitive brain function however according to studies.
Hi PVThanks for this
I also really resonate with you pointing to the link between no realistic rehab and depression.
I would go further and add in the harmful way people with BI get treated as a factor. I imagine my experience is typical and I got accused of malingering when I couldn't even walk very well and ended up throwing up in a consultant's office - I got told 'no one needs to throw up - just stop that'. Someone I met had been labeled a psychiatric case and had lived with that 20 years before she got a proper diagnosis. Someone else I met got told he didn't have a bi because the doc told him to go to the waiting room down the hall, which involved a couple of turns, and the doc said of he really had a bi he wouldn't have been able to do that.
My point being the way people get treated is truly often lacking basic standards of dignity.
A survey to that regard would be helpful. My understanding is it is not uncommon for folks with a bi to have the bipolar label slapped on them, my guess is done to changes in their emotional responses. At least, I understand this is common where I live as a case manager at the local society I am involved with told me - of course this person can say nothing that would contradict a doctor - however has a background in both mental health and substance addiction - so speaks from experience.
I also guess that depression , over and above for situational reasons, is over diagnosed for various reasons - people are tired, Ativan is an rx that is used and for some it gives depression like symptoms (does for me,anyway) , there may be other drugs that do the same because bi people tend to be more sensitive to drugs. (And are often forced by insurance companies who will threatened to cut them off for not complying with therapy.) Plus, since the brain is no longer acting as expected they don't always know what is going to happen.
And, of course, as Cat mentioned we are more prone to a host of other conditions . We are unlikely to be told never mind given any advice about prevention.
The bright spot is the research you have done, PV, with yourself as your first science experiment. I await further releases on your website.
And, there are some.carung docs out there that do listen, even if you really have to hunt them down.
Leaf
That article made me so cross. Why do we always have to reinvent the wheel to put money into the major drug companies pockets? New is not always better. My daughter had a major tbi last October. After 2 months she started talking but with the worst PTA symptoms (swearing and then expressing suicidal thoughts, etc). I was surprised when she was given (temporarily) the lowest dose of diazepam (1mg a day) but the change was miraculous. I realize a sample of one is not scientific evidence but am just saying that it worked for her and she is now happy and well on the road to recovery, diazepam-free.
Diazepam was the happy pill of choice in the 1970s and there is a huge body of evidence about its benefits and side effects (mainly addiction if given for too long but sertraline is similarly addictive). Diazepam went out of favour when the patent held by Roche, its developer, ran out. This meant that all the generic drug companies could make much cheaper copies so Roche stopped making big money on it. So Roche stopped pushing it to the medics. So it went out of favour.
I am not a medic. I was a development chemist at a generic drug company and I wrote product license applications to the Medicines Agency during the 1970s. Drugs are big business; altruism is not involved.
There are plenty of alternative rehab options but this would take time, money and expertise. I suspect finding the 'magic pill' that cures everything is the cheapest option, but of course they will never find it!
Hi Hermother
Yes, some drugs do happily help some people quite a lot.
Whoever rx'd it seems to be aware bi people do better on very small doses of things.
I am so happy it worked for her.
Drug companies are out to make money and that does not always fit with altruism.
I take a medication that used to cost 90 for 3 months and now costs 150 because only 1 place makes it now. (I live in Canada and we don't have the same rx model the UK has.)
I went to a lecture years ago where a medical chemist, who had developed chemo without nausea, was completely disgusted- the major company who bought the patent never used it - they made more selling the old style ones and the anti nausea drug too.
There are trends and standards of practice and docs do seem to stick to the same ones.
This is partly why a good pharmacist is worth their weight in gold. They can tell you if a drug is in the same family as one that either worked or bothered you before, or talk to the doc with suggestions, and tell you side effects or if supplementation is useful.
I know a couple that are really good and I do run things by them a lot.
The things to watch out for are ones that destroy your kidneys or liver over time, and also those that cause dry mouth and eyes - they can ruin your teeth and harm your eyesight in the long run.
Leaf
Good morning pinkvision
Link for Nicky Campbell podcast I found on BBC last night looking for news article that aired through the day yesterday.
bbc.co.uk/sounds/play/p0hn9zq2
I wrote to local and national Headway as well as my local Brain Injury Service about this yesterday evening. Both Dr Pam Martin-Forbes of latter and Marie Peacock, head of Network at Headway replied this morning with link to article.
bbc.co.uk/news/health-68557769
Apparently Headway CEO was involved.
Best wishes
Michael
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