Medications for Mood, Concentration & Thinking
This summary describes people’s experiences with medications to improve mood and cognitive function – both positive and negative. Other summaries include information on medications for managing pain as well as other non-medication strategies that people found helpful (See Strategies for Managing Pain & Vertigo; Coping with impacts on memory & cognitive function; Seeking Professional Help for Emotional & Mental Health).
Many of the participants we interviewed talked about being prescribed medications to alleviate cognitive symptoms of TBI – such as problems with concentration and thinking – or to improve their mood or cope with overall feelings of depression, anxiety or post-traumatic stress disorder. Antidepressants, anticonvulsants (such as gabapentin), and stimulants (such as methylphenidate or dextroamphetamine) are used to treat these symptoms of brain injury.
Finding the right medication
Some of the participants we spoke with found medication to be very helpful for improving their concentration and thinking as well as overall mood and energy, even if they were at first skeptical about taking medications. For example, one Veteran said that when he first starting taking Zoloft (an antidepressant), he felt “very odd,” but “…then my body has become adjusted and I’ve started to feel a lot better. I mean I know I’m not at full capacity, but I have my ups and down, you know. So, the medication, I’ve noticed a big change in my attitude and happiness. I think I’m doing a lot better.” Margaret is on a stimulant, which she says has helped with her depression as well as “keep(ing) her mood more focused…with clearer thinking, and feel(ing) a little more energetic.” Jessica has also found stimulants to be helpful, explaining that “I tend to get aphasia at times, really poor word finding, and I’ve found that that’s the biggest thing that’s helped with. And it definitely helps me focus on being able to set tasks and follow through.”
Margaret has found that taking a stimulant medication helps with her mood, thinking, and energy.
Margaret has found that taking a stimulant medication helps with her mood, thinking, and energy.
Uh, I’m on an SSRI now, I take Prozac. And I’ve been on an SSRI for years. And I also take Trazadone, which is an older antidepressant, but it helps with sleep. So those two, and within the last, what is it about five or six years ago, I was placed on a stimulant.
I: Do you recall which one that is?
Yeah, it’s Dextroamphetamine, by, nurse practitioners here as a matter of fact. They helped me with that. One of them brought it up to me a year before I ever agreed to do this. “No way am I ever going to take Dextroamphetamine.” And she’d bring it up again and again and, “all right, fine.” And it’s helped me, a whole lot.
I: What has it helped with?
With the depression. Oh yes. Oh, just tremendously. I’ve told her, I said this has saved my life.
Because I was suicidal at the time, you know. And I do take it, I take it twice a day. I don’t abuse it, because that’s all I need. I wouldn’t want to take any more than that. But it keeps my mood more focused. And I, more focused, with clearer thinking. And feel a little more energetic. Other things that help me deal with the depression are exercise, you know but the, the vertigo can get in the way with that. But that is also a little bit better, so I try to walk. I’m a walker right now.
It was common that people had to try several different types of medication before finding one that worked for them. A few people found that certain medications exacerbated their feelings of anger. Several discussed the “trial and error” of finding the right medication or combination of medications.
Marcus has tried a few different medications – some of which weren’t doing anything - but has had success with Wellbutrin.
Marcus has tried a few different medications – some of which weren’t doing anything - but has had success with Wellbutrin.
Hmm, these medication names. How do I pronounce, Wellbutrin?
I: Wellbutrin?
Yes
I: And have you found that one helpful?
Yeah because I started with, I started…I tried Cymbalta. Whatever those ones… I basically tried all of them. Cymbalta, there was another one that I tried, I just can’t remember it. That’s another thing that I have, the memory issues. I can’t, there’s some stuff that happened, things that happened, my email, sometimes with talk about it with the kids and my family…I can’t even remember it. So, there’s long term memory issue and then there’s even short term memory issues like, I can’t remember these medications. I do remember Cymbalta cause I took different doses, but there were two more before that and I can’t remember. But I do remember there was, I tried three or four of them before the one I am currently taking.
I: Are there things that it makes better, the Wellbutrin? Are there specific things that you can point to that are easier?
I think because it’s a different kind, if I understand correctly, it’s a different kind of medication, it’s in a different class or something, it works different than the rest of those, and I think that’s it, the fact that it works differently. You know I’m taking, I started out at 150 milligrams and I am taking 300 milligrams now, my dose was increased to 300 milligrams. I think the other stuff just, you know, the other stuff just really…I’m still experiencing, what happened with me is for the last six months I been doing going, but for this last year, the six months prior I was just stuck, I just wasn’t feeling good mentally so, and I was trying those medications and they just weren’t doing anything so I was kind of like, I was almost feeling like I was going to topple back down again so this medication here has sort of like brought me back to here, instead of being down there (hand motions down) I want to be there (hand motions up), but I’ll settle for this right now because anything else is just too bad.
After trying a number of different medications, Steven has found that Effexor does the best job at keeping him on an even keel.
After trying a number of different medications, Steven has found that Effexor does the best job at keeping him on an even keel.
I went through a, a battery of them. I went through, they first had me on Zyprexa. Then Citalopram. Then Wellbutrin, which made me a raging asshole, excuse my language. I’ve never even seen that kind of rage come out of a person. It’s just like, I got mad and started throwing things. And it’s like, I like to think that, you know, I can control my anger enough to where I wouldn’t hurt anybody, you know. But it scared the crap out of me. And I said, “I got to get this thing under wraps,” and stuff. So, then I went back and they, then they started me on Venlafaxine, Effexor. And Effexor, so far, has kept me on an even keel. And I take seventy-five milligrams now. And then I take Ambien for sleep and what’s the – Prazosin for nightmares and everything.
After an unsuccessful trial of Wellbutrin, which exacerbated his feelings of anger, Peter’s doctor suggested he try Provigil
After an unsuccessful trial of Wellbutrin, which exacerbated his feelings of anger, Peter’s doctor suggested he try Provigil
When my son was much younger, you know I would get, I would get angry and frustrated at him and yell at him. And you know I never, I never hit him. Although I did, I did kick a hole in a kitchen cabinet one time, you know when he wouldn’t eat his breakfast, which was clearly an overreaction. And so I guess, I guess you know I try to pay attention to that too and not do it. And so my doctor had prescribed the VA’s TBI medication protocol for this sort of thing, I guess starts with, I guess they, they have some of the SSRIs and some other things that they make you try. And so I tried, recently I tried Wellbutrin and we noticed that that, that seemed to have a negative effect. Like it, it made my, you know and I was on it for, like long enough for – you know that’s, that’s one of those ones with a really long half-life, so it takes a while to get to the low that they want you to have - and when I got there, I was having some, I, my temper got worse for sure. And so I just quit taking it and I figured whatever else it was doing for me, it certainly wasn’t worth aggravating that. And so the next thing that my doctor wanted to try was Provigil. And so she wrote a prescription for that, but then I guess it required some multi-step approval because it’s non-formulary. And so, so I’m waiting for that.
I think I mentioned earlier on the, some of the symptoms that I think I have seem to be potentially on the same spectrum as, you know, like undiagnosed ADHD or sleep apnea. And so I mean I don’t know a whole lot about it, honestly. But I do know that, you know, the way my doctor explained it to me, there are a few medications that the VA, the VA has some sort of protocol which I actually have not ever seen written out anywhere or note. And it seems like the front line of these things are to try some of the ADHD-type medications. The other reason why they weren’t totally excited about trying me on those, like Adderall for example, is that I’m a heart patient. I had a heart attack, so giving me stimulants is maybe not necessarily the best idea. So that’s sort of another reason – the Provigil’s a little bit different apparently than some of those.
Refusing or discontinuing medications
Some people said they eventually stopped taking medications because they didn’t like the side effects – “I just didn’t feel good” - or the way they made them feel – one person told us that she “couldn’t stand” herself” on them. A few said they stopped taking antidepressants, like Zoloft, after experiencing sexual side effects, explaining that it “was really hard for me to accept that, my virility got taken away from me,” which is something that is “really big for guys.”
Jason tried taking medication, but eventually stopped because he “couldn’t stand himself on it.”
Jason tried taking medication, but eventually stopped because he “couldn’t stand himself on it.”
I became an alcoholic. Especially because I didn’t, when you’re isolated and you don’t have anyone to talk to that, even if you don’t have anyone to talk to that can understand, somebody that’s been there and done that, just being in the same environment as them, really is kind of a huge thing. I started drinking heavily. I didn’t know why I wanted to. I didn’t know why I was, you know, depressed or why I got angry or why some, why days I couldn’t, I wouldn’t be able to get out of bed. And then I started, or I, then I came to the VA and they were prescribing various forms of medication. And that was probably the worst thing for me, because a lot of things, a lot of the problems that I have with my head, I was kind of, I was low on serotonin, which kind of helps, which, it stabilizes your mood in a little bit, and kind of helps you I guess, have a flavor, I guess, where everything doesn’t feel like, tasteless, I guess. So, I started taking that and it actually inhibited more than what I was needing so.
A funny thing about serotonin, is that when you have too much of it you start hallucinating. When you actually have too much of it going through your system, you can have very vivid hallucinations and and have different things that go on. I think it’s, I think it’s actually LSD that actually helped, actually releases a lot of, or a serotonin, and that’s part of why people have hallucinations during, or during a trip, or as the effect of, a lot of the effect of serotonin. I didn’t learn this later until I was, you know, you know a couple years later, but, I realized that, you know, I was, you know, wasn’t sleeping, wasn’t, you know, I was, I lost a ton of weight. I was down, probably, 30, 40 pounds from what I, you know, what I was. I was like 180, 190, I was like a solid 220, you know, 215, 220. I, you know, I eventually just stopped taking it because I couldn’t, and I didn’t, I couldn’t stand myself on it, because it was, it would, I would have, I would grind my teeth and it would, I would have twitches and…
I: Which one was it, do you know?
Sertraline, that was one of them. I did try to take Lunesta. I tried, I want to say it was Ambien, and then there was another one that I took, which, none of the stuff really helps, as far as, as far as like trying to normalize it, normalize my, my levels of serotonin. I eventually just got to the point where I was like, can’t take this. I can’t take this medication anymore. It, it’s changed me into somebody I don’t like to be, and then I kind of went back into, because I, you know it made me happy, you know it made me feel, you know, feel happy, but it was like overly happy, it was, too almost a panicky happy. It was, it was weird, so yeah I did, I stopped using that.
Alan talks about his experience with different medications.
Alan talks about his experience with different medications.
For a long time I was on Concerta, I was on Ritalin for the ADHD, and of course I’m still on a high dose of Prozac, 200 mg, I take two tablets a day. But I’m not on the other, the Ritalin. And it’s like ah I feel really focused, but it’s kind of weird, I just didn’t like that feeling. And then I haven’t taken it, I got off of it after my heart issue.
I: How long had you been on the Ritalin?
How long had I been on it? So probably from 2001 to 2006, and I would go back between Ritalin and Concerta, which is the delayed, it’s delayed you only take it once a day, and then Ritalin I would take twice a day.
I: And what was the reason that they prescribed?
Well it was, and this is through a civilian psychologist that diagnosed me with ADHD, which science or medicine isn’t…
I: What kind of symptoms did you have that sort of led her to that?
I couldn’t keep focused on stuff. You know obviously lists really help. And follow-though is still a struggle.
I: And was the Prozac sort of at that same time, were you prescribed that as well?
Yeah, well initially I did Zoloft and then I went to Prozac. But I have been very religious about taking it, and also heart medications after 2007.
I: So, did you notice a difference when you stopped taking the Ritalin, like did you miss it, and how have you coped with that or what kind of differences have you noticed first of all?
I felt less edgy. I felt like, it was almost like a little bit of withdrawals as I was parting ways with it, maybe in that regards. I have never had a substance other than alcohol; there was a time when I was drinking a lot. So, I try to just have one to two beers or a glass of wine in the evening. I don’t have that when I’m at the fire station. But I think I’ve gotten better at decreasing that.
I: So, what prompted you to want to stop with the Ritalin?
It just made me feel like not good. I didn’t feel good.
Jeremy describes having a grand mal seizure after going off one of his medications; now the only medication he uses is marijuana.
Jeremy describes having a grand mal seizure after going off one of his medications; now the only medication he uses is marijuana.
No, I’m not taking any medications at all. I mean, I recreationally use marijuana. I mean, and it helps way more because the medications they were giving me kept giving me seizures. Remember the seizure I was talking about? It was the medications I started, they didn’t know. They diagnosed me being bipolar. They kept giving me all these medications. Well, it wasn’t till I stopped taking them I stopped having seizures. Well one day, it was like, “Come again because I want to advise you that you should be taking them.” And I had a grand mal seizure, like big one, big one. And my girlfriend at that time had to put a pencil in my mouth so I would stop chewing my tongue and stuff so I could breathe. And I was chewing my tongue pretty good, it was gnawed off. So, I took myself up to the hospital and stuff and in the end the only thing they told me was, “Well whatever you do, just don’t stop taking your medication.”
So, the first second I just throw those things out the window. You know, smoke some weed. It has never happened again. I never had any of the side effects and anything that would – I mean, as you can see, I’m a fully functional person. So, I mean, I definitely know that maybe marijuana use substitutes for any kind of medical use. And so, I don’t need any of that. I mean, it’s there for me if I need it. Like, I’ve broken a few fingers and the emergency room’s been there. And that’s amazing. But I, I just stay away from artificial drugs ever since then because it almost killed me. I was smart enough to know that it almost killed me. Smart enough to know what I didn’t take before and I didn’t grow up having seizures. You know? I don’t need anti-seizure medication. I’m having seizures because the medication.
Some told us that that their memory issues made it difficult to manage medications.
Joseph talks about how his memory issues make it difficult to manage his medications.
Joseph talks about how his memory issues make it difficult to manage his medications.
Medications are a bit of a problem when you’ve got memory disorders. Not just on taking them daily - that, you get in the habit. But then getting the refills before you run out, and then making it to the primary care in the middle of nowhere West, West Lynn. To get the refill put into the system, it’s – and PTSD meds, depression meds, it’s – the, the withdrawal symptoms are bad. It got to the point where I basically had to simply quit because I couldn’t take going through another bit of withdrawal from them. It wasn’t like the addictive stuff, but it was like - it was basically the variable range of how bad everything was. I would rather be like, you know, like this, you know, up and down. You know, imagine you’re like this when they’re in your system reliably, you know? Without, without them completely clean of your system, you’re, you’re varied in this area. The withdrawals, like you’re out to here, up and down, start, get them fresh in your system again, it’s…
A few of the people we talked to preferred not to even try taking medications. As one Veteran explained, “they’ve wanted me to, and I don’t want to. Like because I don’t think I need that. That’s just like a personal thing. I mean I know those medications help a lot of people, but like I’m a little sketched out about it.” Another said that he has opted for a more natural approach to medications, taking “vitamins and supplements that are supposed to help you with your memory and things.
See also Strategies for Managing Pain & Vertigo; Coping with Impacts on Memory & Cognitive Function; Seeking Professional Help for Emotional & Mental Health.