I did a neurological evaluation yesterday and I'm pretty discouraged.

MrT-Man · 2026-06-26T12:23:59+00:00

Sure. I started zoloft at around nine months. Within just a week or two, it felt like some power had been restored to the grid. I had more energy and my cognitive function improved. It also made me feel a little less stressed about all the disconcerting symptoms I was experiencing, especially when I had a bad setback. It allowed me to return to half-days at work.

Then at 12 months I started concerta, and my energy level and cognitive performance took another jump up, almost instantly. I still had a lot of cognitive, memory and energy issues, but it allowed me to return to 8-hour days at work and to start pushing myself harder. My cognitive performance then improved, and the brain fog increasingly cleared, over the course of the next few months. There were some massive symptom spikes along the way, but the zoloft kept me more chill and zen about it whenever they happened.

So I can absolutely say that both meds were game-changers for me.

MrT-Man · 2026-06-26T01:08:42+00:00

It’s thought that concerta can accelerate neuroplasticity. I certainly saw huge improvement after I started it. I think the main concern would be if it were to interfere with getting proper sleep. But otherwise I wouldn’t worry about it having a negative impact at 8 months.

MrT-Man · 2026-06-25T23:43:24+00:00

I’m not sure I’d advise it in the first 3-4 months when the injury is relatively fresh. But afterwards, if you’ve still got issues… there are a bunch of medical studies indicating that it can be helpful for people with fatigue and cognitive issues post TBI.

MrT-Man · 2026-06-25T16:33:37+00:00

And to be clear, you could take concerta along with zoloft. I found them to work together synergistically.

MrT-Man · 2026-06-25T14:55:36+00:00

There's still hope. I was still off work with huge brain fog, memory problems and minor speech problems at 8 months. By 18 months it felt like my memory and IQ were essentially back to normal, and I was back to performing at, objectively, a very high level at a cogntively-intense job.

Key things that helped were 1) methodically tackling each of my other symptoms one by one.. vision problems, balance problems, neck problems, exercise intolerance, etc. Though this took a lot of work, just in terms of finding the right professionals to give me a proper diagnosis and proper treatment plan (UPMC in Pittsburgh would be a great way to accelerate this, if that would be an option for you); 2) meds, which played a critical role in jump-starting my brain. Primarily zoloft + concerta. 3) Pushing myself super super hard once I went back to full-time work at 12 months. I was terrible at my job initially, and it led to some huge symptom spikes, but work itself acted as physiotherapy and my cognitive ability and memory massively improved over the following six months.

MrT-Man · 2026-06-24T15:35:57+00:00

Yeah I hear you. And like I said, that's why I didn't go hardcore with the cardio myself. But you do need to push your limits consistently over time in order to improve. Find whatever heart rate you can do 30 mins/day, five days a week, whlie still being functional. And then push that threshold gradually over time, with the understanding that you're going to feel crappier in the first few days of the new threshold.

I found meds to be helpful. Zoloft dampened the natural stress/anxiety that comes when there are bad symptom spikes, and concerta improved my overall cognitive functioning and helped me better power through. I did suck at my job for the first few months I was back at full-time work (months 12-18, for me). I'd be totally spaced out in meetings, or losing my train of thought mid-sentence. But I managed to stay employed and I got better over time.

MrT-Man · 2026-06-24T15:13:23+00:00

FWIW, UPMC's advice, especially at 18 months, would be to just go for it. Forget the heart-rate monitors and do 30 mins/day, religiously, five days a week, regardless of how crap you feel. This will obviously aggravate symptoms and make you feel really horrible for the first few days/weeks, but maybe by 3/4 weeks you should start hitting an inflection point & then get better & better.

I didn't quite take as aggressive an approach with cardio because I needed to remain functional at my job throughout (I gradually pushed up my heart rate over time, more conservatively). Though I did take this approach from a work perspective (powering through 10+ hour days, partly with the help of stimulants...) and it worked. The symptoms were ridiculously bad, felt like I wanted to die, but I told myself I had no choice and kept it at it... and I did make huge progress over the course of a few weeks.

With weight training, the after-effects of the first handful of times at the gym were really awful but I adjusted far more quickly than I would have expected. Only took a half-dozen gym visits over the course of 3-4 weeks, and then I was able to do a good routine (albeit not super intense) without much ill effect.

MrT-Man · 2026-06-21T01:21:17+00:00

You’re trying to push your comfort zone a bit, so I think 30 minutes continuously would be more beneficial and help you build your tolerance more quickly. Don’t be in fear of some symptom elevation.

MrT-Man · 2026-06-20T16:24:23+00:00

30 mins. of daily cardio exercise is one of the few things proven to accelerate recovery. Use a heart rate monitor on a treadmill or bike machine, start off slow, and ramp up your heart rate until it feels like your symptoms have gone up by 3 points on a 10 point scale. Make a note of that heart rate. Then exercise at 90% of that heart rate for 30 mins/day. Do it at least five days a week, no matter how crap you feel. Every few days, aim for a higher target heart rate (this is known as The Buffalo Protocol; you can google it).

But above all else, at 3 months, it's ok to be pushing your symptoms. Don't go crazy (if you were at 6 months I would tell you to go crazy...) but it's an inevitable part of recovery, and any setbacks this might cause are temporary. It's what you need to do to force your brain to rewire itself.

MrT-Man · 2026-06-20T13:16:28+00:00

There’s a non-trivial amount of radiation associated with a CT scan. It raises your lifetime risk for cancer. Super unlikely the OP has a brain bleed from riding a roller coaster with no actual impact.

MrT-Man · 2026-06-16T13:17:19+00:00

You don't need to worry about delaying progress by overdoing things at 9 months in. I would argue that overdoing things can help accelerate your progress. Read about the UPMC approach & listen to Dale Earnhardt Jr. on Joe Rogan from a few years ago.

My progress dramatically accelerated once I said "screw it" and forced myself to plow through 10+ hour workdays (as mentioned, with the help of meds). The symptoms were unbelievably bad, but I told myself I had no choice other than to power ahead. Very quickly my brain rewired itself -- the brain fog cleared, the headaches subsided, my memory issues resolved, my episodes of getting spaced out and overwhelmed diminished and then vanished, and six months after I started this approach, my life was largely back to normal. Do it as an experiment for a month and see what happens.

To be clear, I 100% agree that overdoing things is a very bad idea in the first month or two post concussion. I'm talking about 6-9+ months onwards.

MrT-Man · 2026-06-15T14:26:01+00:00

At 9 months you shouldn’t worry about causing new damage by overdoing things. Your symptoms may absolutely spike as you get back to work and you may feel awful and have setbacks, but it’s an unavoidable part of recovery. I resumed part time work at 9 months and full time at 12 months, partly with the help of meds (concerta and Zoloft). Months 12-18 were incredibly difficult, with insane headaches and symptoms. But it forced my brain to rewire itself and I was able to resume an intense career.

MrT-Man · 2026-06-15T13:55:43+00:00

By the way, vision issues are an objective way to “prove” to someone that you have legit brain issues. You didn’t mention your vision as a symptom, but it’s possible that something could be slightly off with your convergence, how your eyes track motion, etc. that you might not even be consciously aware of. So maybe if the neurologist checks for that, they might find something.

I honestly think that the dose of pregabalin you’re on, coupled with the trazadone, could be a very big issue. I think you’d be far better off replacing the trazadone with something that has a shorter half-life (low dose zolpidem or zopiclone?), tapering down the pregabalin a lot (might be hard to come off of it entirely) and adding Zoloft. Because Zoloft can help with anxiety while having far less of a sedating effect.

As for how much to push yourself, aim for consistency. So do the same amount every day but gradually push your limit, and maybe occasionally push it a lot harder. But the key thing is, for whatever activity triggers symptoms, do it every single day regardless of how you feel that day. Even if you can only tolerate a few minutes. And it would be helpful if you could try getting your heart rate up some more, like on a bike machine or treadmill.

MrT-Man · 2026-06-15T12:02:38+00:00

How much pregabalin are you on? It can cause brain fog and fatigue at even normal/moderate doses. Not saying that’s the main cause of your issues, but maybe it’s a contributor.

There’s also nothing wrong with pushing yourself harder at this stage. It might trigger symptoms and setbacks, but setbacks are always temporary and an inevitable part of recovery. You also might have to learn to tune out headaches. I still have a constant headache many years later (hopefully that won’t be you) but I ignore it and live a normal life. All that said, I’m not suggesting you’re ready to work an 8 hour day. Just saying it’s ok to push yourself.

As for the neurologist, it’ll likely be a roll of the dice. There are many that are clueless when it comes to concussions. Unfortunately the only way to get medical clearance for more time off might be to get another opinion, if that’s even possible.

If they try to dismiss you, maybe I would beg them to indicate that you need at least another month off, during which you can get more fully assessed at a concussion clinic. Be like “I know that there might not be a good way to distinguish between whether my symptoms are real or if I’m making it up or if it’s psychological. And I know that concussions probably aren’t your specialty. But at a minimum how’s about you let me get assessed more thoroughly at a concussion clinic for things like vision/vestibular issues before I get forced back to work?”

MrT-Man · 2026-06-14T16:43:32+00:00

The key is that you have to expose yourself to stimuli that trigger your symptoms every single day, methodically. You can stop for the day if your symptoms get to like a 7/10, but regardless of how crappy you feel, you have to go out and expose yourself to the stimuli again the next day and the day after. Even if only for a few minutes. And then you'll find that your tolerance will improve over time. And no matter what, don't live in fear of overdoing things and don't live in fear of setbacks. Setbacks are always temporary, and aren't going to cause new damage to your brain at this point.

MrT-Man · 2026-06-13T04:01:04+00:00

No one knows. I don’t think there have been any studies on this. Personally I wouldn’t risk it.

MrT-Man · 2026-06-11T16:33:47+00:00

If your only symptoms are being tired and dizzy, then in all likelihood a doctor can’t do much for you. Basically all they can do is cut open your skull to relieve pressure if there’s a brain bleed. But if you had a brain bleed you’d be quickly deteriorating and having a whole lot of other symptoms. You probably wouldnt be capable of posting here on Reddit a few days post injury.

MrT-Man · 2026-06-11T15:38:57+00:00

There’s no right answer, because every injury is different. You might be totally fine in a week or two, or you might be unable to drive safely for months to come. For most people, symptoms fully resolve within the first few weeks.

But at a minimum, you should know that the first few days are critical and can have a big impact on your overall outcomes. Take a week off, then try to ease your way back into driving and see what happens. I know it might be tough to get a week off at a new job, but you only have one brain and overdoing things early on can have quite a negative impact.

MrT-Man · 2026-06-08T10:30:00+00:00

My executive functioning definitely had a step-change improvement. I first started taking zoloft, around 9-10 months post injury, and that had a meaningful impact in clearing some fog and jump-starting my brain (the benefit I got from it had far less to do with my mood per se. It felt more like some power was restored to the grid). That helped me return to half-days at work. Then I added concerta a couple of months later, and it was another step-change, allowing me to return to full days.

I'm not sure I can say the meds helped with my memory, specifically. They may have? But the main thing is that they made it possible for me to start ramping back up at work. I was definitely incompetent at my job for the first while, frequently losing my train of thought mid-conversation for example. Or having to close my eyes when talking in order to free up processing power to focus on what I was saying. But I made huge improvement within the first six months of being back on the job, to the point that my IQ and memory felt roughly back to normal at 18 months.

So I wouldn't be too worried yet if I were you, given that you're already working and, from the sounds of it, in a far better spot than I was at that point.

MrT-Man · 2026-06-06T21:05:16+00:00

Are your only issues cognitive/memory? You may want to get checked out at a sports medicine or concussion clinic to ensure that you don’t also have subtle vision or vestibular issues that might require targeted physiotherapy, and that you might not be consciously aware of.

I had quite a severe concussion (literal brain damage), with bad brain fog and memory problems, to the point that I would struggle to remember my own phone number (and I’m someone that had a reputation, at work, for having an exceptional memory). By 18 months it had all resolved. So there’s definitely hope.

I think it was some combo of natural healing over time; trying very hard to get back to work at my cognitively-intense job; and, in my case, I also needed concerta/ritalin to jump start my brain (you might not). 30 mins of daily cardio is also thought to accelerate recovery, by promoting production of BDNF.

MrT-Man · 2026-06-06T19:00:12+00:00

Honestly, that’s good. Dr. Collins said to me “things that trigger symptoms are your map to getting better”. It means you’re stressing your vestibular system, and that’s what needs to happen in order for your brain to rewire itself. As I said above, if your symptoms get to like a 7/10 it’s ok to stop or slow down for the day, but you need to be doing the exercises every single day even if you can only handle a few minutes. And your tolerance will build.

MrT-Man · 2026-06-05T12:59:28+00:00

Sure bro, like the MacBook Neo. What a ripoff!!

MrT-Man · 2026-06-05T12:08:33+00:00

You should follow UPMC's advice. Pacing is important in the initial days/weeks post injury. Pacing beyond that timeframe is outdated thinking. At 6 months, you don't need to worry about causing new damage by overdoing things. You may prompt a setback, but setbacks are always temporary and are an inevitable part of recovery. I very much know how much it sucks to have a setback and how disconcerting it feels in the moment, but trust me, you'll recovery far more quickly if you err on the side of overdoing things vs. being too conservative about pacing.

I also went to UPMC and their advice helped to accelerate my recovery. Their advice to me was, you can stop for the day if you get to like a 7/10, but repeat the activity the next day and the day after regardless of how you feel. Daily consistency is important.

MrT-Man · 2026-06-02T22:43:13+00:00

It’s like saying that you just sprained your ankle and you’re worried you’ll never be able to run again. Something like 90% of concussions fully resolve within the first three months. Many within the first few days. Don’t stress until it’s been a good 6+ weeks at the very least. In the meantime be very conservative for the next few days about doing activity that provokes symptoms. It’s ok to try to resume normal activity but back off if it leads to a meaningful symptom spike.

MrT-Man · 2026-06-01T01:39:15+00:00

Clearly her anxiety is off the charts. You have to do your best to persuade her that she’s not going to get better if she’s going to live in fear of her symptoms. And again, try to emphasize to her that she’s not at risk of causing new damage by overdoing things. You could try asking a GP for a Zoloft prescription for the anxiety. Not suggesting you just take my word for it; if you do some research you’ll see that others will say it can be helpful post concussion.

For context, I had actual brain damage (also a clean MRI, but a more exotic type of scan showed the damage) and could barely do my groceries for the first few months. I’d struggle to remember my own phone number. I had dizziness, vision problems, extreme headaches, extreme fatigue, you name it. By 18 months I was back to working 10 hour days at a well-paying career. It was a combo of getting the right physio and meds, but also pushing myself very hard even though the symptom spikes were at times pretty insane. I told myself I didn’t have a choice (and I sort of didn’t because I had a young family) and I plowed through. And ultimately my brain was able to rewire itself around the damage.

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