The Injured Brain + Stimulants: Part 3
Stimulant medications are known to calm an overactive nervous system by increasing the body’s ability to create fluid connection on the dopaminergic receptors. Without proper dopamine production or flawed passage and utilization of dopamine; mood, energy, pleasure, attention, and motivation are all affected. Dopamine is an anticipatory molecule. Humans find themselves seeking and looking for dopamine to feel satisfied. Through dopamine seeking, their attention, concentration, and focus are impeded. This leads to disorganization of the social engagement (ventral vagal) that we need for optimal nervous system functioning. The brain perceives this disorganization as “dangerous” to survival, and at some point, norepinephrine (adrenaline) is activated. When danger is perceived, fight or flight survival mechanisms (sympathetic nervous system) are turned on; and thinking, processing, and problem solving are turned off. Action is on; thought is off.
Mind you, this is a very simple explanation of a very complicated system. However, with brain injuries, dopamine, norepinephrine, and all other mood molecules/hormones are out of balance, even melatonin. Some are overactive and some are underactive, depending on the area of the brain that is affected by injury. Overall, stimulant medications can help produce, regulate, and calm a nervous system that is either overactive or underactive. Stimulants can help bolster energy, improve endurance, and offer a boost to low mood and slower processing speeds. Stimulants also help balance adrenaline and an overactive nervous system, often deescalating tempers, anxiety, restlessness, and sleeplessness. Yes, they can oddly be effective on both ends of this spectrum.
There are only a few negative effects that I’ve seen in my practice and that experts warn about with stimulants and brain injuries. Usually, the problem is related to the right medication and the right dose, rather than the stimulant itself. Most “warnings” are related to increased irritability, risk of sleep disturbances, increased heart rate, reduced appetite, etc. Of course, we must consider patient history and risk of addiction, among other genetic and environmental risks.
All of this being said, it is worth a conversation with your primary doctor, neurologist, psychiatrist, or other providers. The addition of stimulant medications is often met with trepidation from family and friends, but also the medical community. This generally doesn’t have to do with you, personally, but rather the trends of over-use, over-diagnosis, and abuse that stimulant medications are associated with.
One general rule of thumb I like to remind both patients and providers of:
If stimulants allow you to feel closer to your “normal self”, there is a lower risk for abuse. No one strives for “more normal” because what is that? Most brain-injured people are looking for a version of themselves, post brain-injury, that even slightly resembles their pre-injury self. Stimulant medications can very much be a part of this recovery, when prescribed by a professional that understands brain injury.
Medications, therapy, and rehabilitation are the trifecta offering the very best combination of hope and resiliency towards your acceptable new “normal.” It is important to work with a team of professionals that understands all facets of your recovery, including medications. Brain injury recovery requires a unique approach, with a team of professionals that understands the delicate and resilient nature of the brain. Usual “pushing through” can create nervous system disruption, flooding, and other setbacks. Activity that pushes limits of fatigue and symptoms can create setbacks. Not everyone understands, and yes, even in the medical community. But after all you’ve been through, you deserve to work with those that do.
Disclaimer: I am not a doctor. I don’t prescribe, and I am grateful I don’t. There are many behaviors and characteristics to consider that might make stimulants contraindicated for you. Furthermore, medications are not being promoted as the only method of improvement. Brain injuries and post-concussive syndromes require a collaborative approach involving therapies as well. Talk to your medical team; seek your own information; and be informed. You are your own best advocate.
Note: I use “injured brain” as inclusive of all levels of brain injury and post-concussive syndromes.
Written by:
Ashley Olsen, MSW, LCSW
Founder/Owner of The Praxis Group
