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Suggest Treatment For Chronic PTSD, Depression And TBI
Question: Hi. In 2010 I suffered both an automobile rollover accident and an aggravated robbery /abduction. Both incidents resulted in skull fractures.
My medical history well-documents that I suffer from:
1) Chronic PTSD
2) Major Depression
3) TBI
I also take painkillers (daily) that include the Fentanyl patch, and for breakthrough pain I am prescribed Oxycodone and Valium. These meds are prescribed because I had 2 recent surgeries on my knee.
So my question is this.... In consideration of the above, could those factors be causing my memory to be seriously impaired? Recently I was en route to an appointment; however, I have no recollection of why I never made it to the appointment, nor do I recall what happened that day.
My medical history well-documents that I suffer from:
1) Chronic PTSD
2) Major Depression
3) TBI
I also take painkillers (daily) that include the Fentanyl patch, and for breakthrough pain I am prescribed Oxycodone and Valium. These meds are prescribed because I had 2 recent surgeries on my knee.
So my question is this.... In consideration of the above, could those factors be causing my memory to be seriously impaired? Recently I was en route to an appointment; however, I have no recollection of why I never made it to the appointment, nor do I recall what happened that day.
Brief Answer:
More than one factor present
Detailed Answer:
I read your question carefully and I understand your concern.
Reading the list of conditions and that list of medications I must say that I tend to agree with your doctor, several factors potentially influencing cognitive functions.
First what I see as the main contributor that is the traumatic brain injury. It means that due to the trauma you have lost some brain cells. Depending also on how much that loss is the remaining brain tries to compensate for it, but as the years go by and we lose more brain cells due to aging (we all do) that compensation becomes more difficult, more difficult to perform, more likely than an uninjured person to manifests decline in cognitive function at an earlier age.
Then there is depression and anxiety. Those condition do influence your cognitive performance as well, they affect concentration and hence the ability to retain information.
Coming to your medication. Benzodiazepines (diazepam) are known to have some effect on several areas of cognition, especially visuospatial memory. Opioids like Fentanyl and oxycodone, while not affecting cognition directly can cause some sedation and mild mental clouding which can affect performance.
So my opinion is that the TBI is very likely to cause a memory impairment, it is the main cause. The other factors can contribute to enhance or exacerbate its manifestations.
I remain at your disposal for further questions.
More than one factor present
Detailed Answer:
I read your question carefully and I understand your concern.
Reading the list of conditions and that list of medications I must say that I tend to agree with your doctor, several factors potentially influencing cognitive functions.
First what I see as the main contributor that is the traumatic brain injury. It means that due to the trauma you have lost some brain cells. Depending also on how much that loss is the remaining brain tries to compensate for it, but as the years go by and we lose more brain cells due to aging (we all do) that compensation becomes more difficult, more difficult to perform, more likely than an uninjured person to manifests decline in cognitive function at an earlier age.
Then there is depression and anxiety. Those condition do influence your cognitive performance as well, they affect concentration and hence the ability to retain information.
Coming to your medication. Benzodiazepines (diazepam) are known to have some effect on several areas of cognition, especially visuospatial memory. Opioids like Fentanyl and oxycodone, while not affecting cognition directly can cause some sedation and mild mental clouding which can affect performance.
So my opinion is that the TBI is very likely to cause a memory impairment, it is the main cause. The other factors can contribute to enhance or exacerbate its manifestations.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Doctor Taka, thank you for the reply.
So if I understand correctly there are multiple medical (be it prescriptions or my noted diagnoses) reasons that plague my memory and consistently cause memory loss. Additionally, it is very possible that my missing the appointment I was en route to was caused by meds or past injuries?
If that is the case, it is a near identical response as my primary care doctor, I just wanted to ask a doctor who specializes in this field.
How can I overcome this and minimize further occurrences? Trying to explain that I missed a wedding, interview or other imperative event is difficult.
So if I understand correctly there are multiple medical (be it prescriptions or my noted diagnoses) reasons that plague my memory and consistently cause memory loss. Additionally, it is very possible that my missing the appointment I was en route to was caused by meds or past injuries?
If that is the case, it is a near identical response as my primary care doctor, I just wanted to ask a doctor who specializes in this field.
How can I overcome this and minimize further occurrences? Trying to explain that I missed a wedding, interview or other imperative event is difficult.
Brief Answer:
Read below
Detailed Answer:
Thank you for your feedback. Yes I think it similarly to your doctor.
Measures can include limiting the use of medication as much as possible. I suppose also that depression and PTSD have been addressed accordingly.
In terms of medication there are some nootropic drugs which may enhance your performance, like Piracetam to name the most well known one. Has a favorable side effects profile as well.
Medication used for Alzheimer's like donepezil or memantin (or both) are often used, but their benefit is limited outside Alzheimer's cognitive impairment.
I hope to have been of help.
Read below
Detailed Answer:
Thank you for your feedback. Yes I think it similarly to your doctor.
Measures can include limiting the use of medication as much as possible. I suppose also that depression and PTSD have been addressed accordingly.
In terms of medication there are some nootropic drugs which may enhance your performance, like Piracetam to name the most well known one. Has a favorable side effects profile as well.
Medication used for Alzheimer's like donepezil or memantin (or both) are often used, but their benefit is limited outside Alzheimer's cognitive impairment.
I hope to have been of help.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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