Considerations in the Choice of Drug Intervention

An in-depth discussion regarding commonly used drugs in the treatment of various MTBI symptoms is too complex for this forum. However, medications for headaches, musculoskeletal pain, or depression/anxiety must be carefully prescribed to avoid the sedating properties, which can have an impact upon a person's attention, cognition, and motor performance.

Some of the criteria to be considered in the choice of drug intervention are:

  • Reduction of symptoms
  • Enhancement of rehabilitation performance
  • Avoidance of impairment to attention and cognition

 

Precautionary Steps

  • Provide appropriate therapeutic drug trials and allow adequate time for one drug to clear out of the person's system before changing to another medication
  • Allow adequate time for any drug trials
  • Rule out other causes of symptoms/behaviors; know the person's history
  • Know all the medications the person takes and their possible interactions
  • Evaluate the person's potential for addictions
  • Check for non-compliance in taking medications that could be either intentional or due to poor memory
  • Inform all those who are treating the person of his/her current medications and any medication changes

 

Therapists are typically seeing the person more frequently than the physician. Therapists may observe changes in the person's behavior or performance level from day to day. These changes may be related to medications, medication changes, and/or dosage changes. They should provide feedback to the physician about the person's response to medications. This should help in making better drug choices, and enhance rehabilitation.

Medications to Consider for MTBI Symptoms

Anxiety and depression occur in varying levels of intensity in the MTBI population. Anxiety may respond to such serotonin enhancers as trazodone (Desyrel), buspirone (BuSpar), or sertraline (Zoloft). Depression may respond to such selective serotonin reuptake inhibitors (SSRI's) as Prozac, Paxil, Zoloft, or Effexor or anticonvulsants, such as carbamazepine (Tegretol). Counseling should be involved.

Sleep disturbances should be evaluated for the root cause. Sleep apnea, nocturnal seizures, and pain should be ruled out, as there are other treatments for these disorders. Poor sleep initiation that is related to anxiety may respond to trazodone. Difficulties with sleep maintenance may respond to nortriptyline (Pamelor).

Chronic fatigue with related decreased attention, concentration, and memory problems, may respond to moderate use of caffeine or short-term trials of methylphenidate (Ritalin) or amantadine (Symmetrel). There can be several contributors to fatigue so possible causes should be identified and addressed.

Poor emotional control or lability may respond to carefully monitored doses of selective serotonin reuptake inhibitors, psychotropics, or anticonvulsants such as carbamazepine (Tegretol) or valproate (Depakote).

Pain must be carefully evaluated for its underlying cause before medications for relief are carefully prescribed. The most effective drugs include nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressant-like drugs, or muscle relaxants such as cyclobenzaprine (Flexeril). Appropriate physical therapy treatment should be used in conjunction with medications.

A physician's choice of medication may be dictated by experience with the drug or for other reasons. The person should always be educated in the use of these medications (e.g., expectations of when the drug will reach therapeutic levels) and encouraged to report his/her reactions to any medications.

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