Mental fatigue is a common post-concussion symptom that is multifaceted and post-concussion survivors will often experience varying degrees of fatigue. Among this, the severity of mental fatigue among post-concussion survivors  is related to other factors such as mental health, the level of social support available, and the presence of other medical conditions.

The Relationship Between Mental Fatigue and Concussions

According to researchers, more than 60% of concussion survivors suffer from mental fatigue. Fatigue is generally a long-term symptom in this setting and individuals frequently report that fatigue significantly impacts their lives and recovery. Moreover, many studies have found that concussion patients suffer from higher degrees of fatigue in comparison to regular individuals. Consequently, it is clear that fatigue is a debilitating symptom that must be addressed during concussion recovery. 

What Causes Mental Fatigue?

Reduced Energy

• After a concussion, the brain has a depleted energy bank. Therefore, the brain has to work harder to do basic activities, which can cause fatigue. 

Environmental Causes

• External stimulants can disrupt sleep (e.g. noise or light), thereby causing fatigue.
• Environmental distractions in work environments (e.g. loud voices) can cause fatigue as concussion survivors in these environments must use more energy to concentrate during work.

Emotional and/or Mental Causes

• Constant worrying during recovery
• Stress 
• Anxiety 
• Depression
• Being unable to shut off the brain when trying to sleep 

Physiological Causes

• Chronic health conditions
• Poor nutrition e.g. micronutrient deficiencies 
• Some medications taken during concussion recovery can cause fatigue as a side effect 

Stimulants Used to Treat Mental Fatigue

Stimulants work by affecting neurotransmitter systems. These neurotransmitter systems are responsible for cognitive, attentional, motor, and perceptual functions. When deemed appropriate by a medical doctor, prescribed stimulants can be used to treat and improve concentration and fatigue among concussion survivors. Common prescription stimulants include Ritalin (methylphenidate) and Alertec (modafinil).

Modafinil

Modafinil is a stimulant that promotes wakefulness in patients. Specifically, modafinil can reduce sleepiness and fatigue, thereby helping patients stay alert and awake during the day. In addition, one study concluded that modafinil may be effective at reducing fatigue and improving motivation and reaction time. These potential benefits of modafinil may be helpful for those who must return to work or other responsibilities, following a concussion. Nonetheless, modafinil may also be beneficial for those who struggle with everyday tasks. Some common side effects of modafinil can include headache or nausea. 

Ritalin

Ritalin can be used to modify neurotransmitters in the brain to help increase concentration, focus, and attention. This is ideal for those suffering from fatigue as many patients report that it is difficult to focus, concentrate and pay attention, while simultaneously suffering from fatigue. One study analyzed the long-term use of Ritalin over a 5.5 year period and found that Ritalin can potentially improve mental fatigue, cognitive function and emotional distress. The study however did not include consequences associated with long-term Ritalin use, which would need to be assessed on an individual basis , as concussion recovery may be a long journey for some survivors. Some common side effects of Ritalin can include headache, insomnia, anxiety, or reduced appetite. 

As mental fatigue is complex and unique among all concussion patients, it must be stressed that different medications may work differently for different people. 

For comprehensive information on stimulants, please consult your physician or your pharmacist. 

Written by Dorothy Dinh

 

References

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Healthlink BC. (n.d.). Methylphenidate. https://www.healthlinkbc.ca/medications/fdb0094 

 

Healthlink BC. (n.d.). Modafinil. https://www.healthlinkbc.ca/medications/fdb7094 

 

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Johansson, B., Andréll, P., Rönnbäck, L., Mannheimer, C., Institute of Neuroscience and Physiology, Institute of Medicine, Department of Molecular and Clinical Medicine, Göteborgs universitet, Gothenburg University, Sahlgrenska Academy, Sahlgrenska akademin, Institutionen för medicin, avdelningen för molekylär och klinisk medicin, & Institutionen för neurovetenskap och fysiologi. (2020). Follow-up after 5.5 years of treatment with methylphenidate for mental fatigue and cognitive function after a mild traumatic brain injury. Brain Injury, 34(2), 229-235. https://doi.org/10.1080/02699052.2019.1683898

 

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