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Pharmacological Therapies For The Neurobehavioral Sequelae Of TBI by Charles Watson


Posted on March 27, 2020

The use of pharmacological agents to treat neurobehavioral disorders after TBI is diverse and varies from patient to patient. Behaviors such as agitation, irritability, hostility, anger, aggressiveness, anxiety, depression, verbal and physical violence, impulsiveness, apathy are common after TBI. These behaviors can be treated by psychological interventions, along with medications.

Latest research suggests using beta-blockers, antiepileptics, antidepressants, benzodiazepines, Amantadine and neuroleptics and other drugs to treat these behaviors.  

New treatment option for TBI patients suffering from aggression

Aggression and anger are the most common behavioral and emotional symptoms that TBI patients experience and that often negatively affects rehabilitation outcomes. It also affects the patients’ relationship with family and friends and their ability to lead an independent life and steady employment.

Researches have reported that a drug that was developed in the 1960s, originally as an antiviral medication is showing promising result in treating aggression among TBI sufferers. 100mg. of Amantadine twice daily is beneficial in decreasing aggression and specifically improves alertness, initiation and motivation in patients with TBI. 

Treatment options for “clinically depression” after TBI

The most common antidepressants following brain injury that are least sedating include Prozac (fluoxetine hydrochloride), Paxil (paroxetine), Zoloft (sertraline), Norpramine (desipramine) and Wellbutrin (bupropion). Antidepressants work by increasing neurotransmitters (chemical messengers that are required to allow communication from one nerve cell to another) to return to more normal levels. A decrease in neurotransmitters following a brain injury seems to be the underlying cause for difficulties in concentration, initiation and mood swings. 

However, it is important to assess if the depression is of the more serious form, namely “major depression” characterized by at least a 2 week period of feeling sad/depressed accompanied by four or more of these symptoms; 

  • insomnia or sleeping too much
  • fatigue or loss of energy
  • motor agitation
  • decreased concentration
  • indecisiveness
  • significant weight change
  • feelings of worthlessness and/or suicidal thoughts 

In the absence of the use of any illicit drugs or alcohol, or physical problems, a depressive episode of this magnitude requires psychiatric counseling along with medications.

Drugs that can be used other than those mentioned include Serzone (nefazodone), Effexor (venlafaxine), Tofranil (imipramine), Elavil (amitriptyline) and Pamelor (nortriptyline). All of these antidepressants probably increase the risk of seizure, so it is advisable to use a lower dose of the antidepressant as an injured brain may probably be more sensitive to the effects as the side effects of the medication. Also, once a patient has stabilized on a specific dose of the antidepressant, it can be continued for at least 6 months to a year. 

What is ‘emotional lability’? What drugs can be used to cure it?

Emotional lability can be sudden, often frequent and unexpected mood changes that occur after a brain injury but are not solely related to the injury. In post-stroke patients, it has been formally studied and also referred to as ‘emotional incontinence’. A milder version can be seen as irritability, whereas if it accompanied by crying, then the patient needs to be evaluated for ‘clinical depression’. Manic depression (bipolar illness), delirium and dementia also involve emotional lability. 

Medications that are effective include antidepressants, benzodiazepines and antipsychotics. The length of treatment will depend on the patient and the recommendation of the therapist. Moreover, no medicine should be left abruptly without the consent of your physician.