Dementia in Head Injury (cont.)
Persons with head injury may require medication to treat symptoms such as depression, mania, psychosis, aggression, irritability, mood swings, insomnia, apathy, or impaired concentration. Headaches may also get better with drug treatment.
Drugs used to treat such symptoms are called psychotropic or psychoactive drugs. They work by changing the way the brain works. Head-injured persons are more sensitive to drug side effects. Doses and schedules may require frequent adjustment until the best regimen is found.
Most people with dementia due to head injury are treated with the same drugs used to treat dementia of other causes. In many cases, these drugs have not been specifically tested in persons with head injury. There are no established guidelines on psychotropic drug treatment after head injury.
These drugs are used to treat depressive symptoms due to head injury.
- Selective serotonin reuptake inhibitors (SSRIs) are the antidepressants of choice because they work well and have tolerable side effects. The goal is to prescribe the drug with the fewest side effects and drug interactions. SSRIs also are used to treat behavior disturbances resulting from head trauma. Examples include fluoxetine (Prozac) and citalopram (Celexa).
- Tricyclic antidepressants are used for people who cannot take SSRIs. They tend to have more side effects than SSRIs. Their advantages include that their levels can be measured in the blood and the dose adjusted readily. These drugs can cause problems with the heart and blood pressure. An example is amitriptyline (Elavil).
- Another group of antidepressants is useful for sleep disturbances in head-injured persons. These drugs are unrelated to other types of antidepressants and are less toxic in overdose. Examples are nefazodone (Serzone) and trazodone (Desyrel).
These drugs increase the amount of a brain chemical (neurotransmitter) called dopamine.
- Increasing the amount of dopamine may improve concentration, attention, and interest level in people who have sustained a head injury.
- These drugs may interact with antidepressants to improve mood swings.
- The most potent of these drugs is levodopa; it also has the most side effects.
- Other examples include bromocriptine (Parlodel) and the stimulant dextroamphetamine (Dexedrine), which increases levels of dopamine and another neurotransmitter called norepinephrine.
These drugs are used to treat psychotic symptoms such as agitation, delusions, and hallucinations.
- Traditional antipsychotics work well at relieving psychotic symptoms but are more likely to have side effects that may worsen cognitive function. These include haloperidol (Haldol).
- New antipsychotics (eg, risperidone [Risperdal], olanzapine [Zyprexa], quetiapine [Seroquel]) may be safer for demented patients than the traditional drugs. These drugs may work particularly well for the agitation and other psychotic symptoms common in head-injured persons.
These drugs often work well in behavior disturbances (aggression, agitation) that occur as complications of head injury. They work by stabilizing mood. Examples include carbamazepine (Tegretol) and valproic acid (Depacon, Depakene, Depakote).
Like some antiepileptic agents, the drug lithium (Eskalith, Lithobid) is a mood stabilizer. It is helpful in calming explosive and violent behavior. Lithium also decreases impulsive and aggressive behavior.
These drugs quickly relieve agitation or violence in dementia. They have other uses, such as treating insomnia and relieving anxiety. Because they can worsen cognitive problems, they are not recommended in head-injured persons with dementia except to as needed to calm a person rapidly. Examples are lorazepam (Ativan) and diazepam (Valium).
These drugs work well in treating aggression in some people with head injury. They also reduce restlessness and agitation. An example of these drugs, which are most widely used to lower high blood pressure, is propranolol (Inderal).
Nestor Galvez-Jimenez, MD
Francisco Talavera, PharmD, PhD
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