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Dementia in Head Injury

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Medical Treatment for Dementia After a Head Injury continued...

Even when family members understand that the person is unable to control his or her behavior, the person's slowness, inappropriateness, and erratic responsiveness can be exasperating or even frightening. Family members become isolated from usual support, especially when the person's impairments are severe, prolonged, or permanent. 

Mental health professionals recommend counseling for family members, especially those in caregiving roles. Ask your loved one's health care provider for a referral to a mental health provider and family support groups. These interventions improve morale and help family members cope.

Social services for head injury and dementia

A trained social worker can help the head-injured person with dementia apply for disability benefits, locate specialized rehabilitation programs, attend to medical problems, and participate in treatment.
 Dementia symptoms such as poor reasoning, impulsiveness, and poor judgment may render the person unable to make medical decisions or to handle his or her own affairs. Social services can help in establishing a guardian, conservator, or other protective legal arrangement.

Medications for Dementia After a Head Injury

Persons with a 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 caused by other diseases. 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.

Antidepressants after a 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 sometimes 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).
  • The antidepressant bupropion (Wellbutrin) is often avoided in patients with head injuries because it may cause seizures.
  • 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 mirtazapine (Remeron) and trazodone (Desyrel).
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