Emotional disturbances following traumatic brain injury

Abstract

Mood disturbances are common sequelae of traumatic brain injury (TBI), but the scientific database for such disorders is very limited in descriptive, prognostic, and treatment data. Post-TBI symptoms often cross diagnostic boundaries and include cognitive loss, amotivation, psychosis, mood, changes, or other domains. The treating physician must be mindful that clear diagnostic boundaries may not exist. Premorbid level of functioning commonly affects post-TBI level of functioning. When setting treatment goals, this must be considered. Patients who had lower levels of psychosocial functioning before the injury may not fare as well afterwards. Treatment of post-TBI mood symptoms should proceed after a full diagnostic work-up including imaging and electroencephalographic (EEG) studies, neuropsychologic testing, and physical and laboratory examinations. Once the diagnostic picture is established, treatment should then proceed with a multidisciplinary team (physician, social worker, neuropsychologist, and others). For the medications, consider both target symptoms and side effects; start medications with low doses and raise slowly, give full therapeutic trials before switching or adding second agents, avoid benzodiazepines if possible, limit anticholinergic or antidopaminergic agents, and avoid providing large quantities of lethal medications. When starting medications for the treatment of mood disorders following TBI, several general principles of treatment in this population should be considered, including: balancing treatment of target symptoms with the potential for adverse effects; making use of side effects to treat comorbid problems when present (ie, relatively antidepressant for depression and marked insomnia); using a "start low, go slow" approach; continuing dose escalation to full therapeutic levels (ie, completing therapeutic trials) before switching or adding augmenting agents; avoiding agents with predictable and functionally important adverse effects (ie, benzodiazepines, strongly anticholinergic or antidopaminergic agents); and avoiding prescription of large and potentially lethal quantities of medications.

Pharmacotherapy for Depression Posttraumatic Brain Injury: A Meta-analysis

“…It should be noted, however, that TCAs are known to reduce seizure thresholds, 46 and while adverse events were not systematically reported in the identified studies, one trial did describe the occurrence of more serious adverse events 29 including seizure activity, mania, and action tremors for some individuals assigned to the treatment group with relatively high doses of desipramine. Overall, reported adverse events such as dry mouth, nausea, constipation, diarrhea, decreased libido, sedation, agitation, and headache were described as mild and of no clinical significance by study authors.…”

Diagnostic and treatment challenges in traumatic brain injury patients with severe neuropsychiatric symptoms: insights into psychiatric practice

“…The prevalence of mood disorders post-TBI and the importance of mood stabilization are consistent with other studies. 21 , 22 Of course, diagnosing a patient with depression after TBI can be challenging. Certain symptoms used as diagnostic criteria for a depressive episode are not uncommon in people with a history of TBI.…”

Relationship between competency in activities, injury severity, and post-concussion symptoms after traumatic brain injury

“…It has been detected that emotional problems have been underestimated by both professionals and the next-of-kin (18). Emotional and interpersonal competency is essential for people's ability to maintain family life and employment (32). These skills may also influence leisure activities, and in the long run influence the person's self-esteem and quality of life (33).…”