Dementia in Head Injury
Medications for Dementia After a Head Injury continued...
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) andtrazodone (Desyrel).
These drugs increase the amount of a brain chemical (neurotransmitter) called dopamine, which may improve concentration, attention, and interest level in people who have sustained a head injury.
Dopamine enhancers may interact with antidepressants to improve mood swings.
The most potent of these drugs is levodopa, but it also causes the most side effects. Other drugs 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 delusions, hallucinations, agitation, and disorganized thinking and behavior.
Traditional antipsychotic drugs work well at relieving psychotic symptoms, but are more likely to have side effects that may worsen cognitive function. These include haloperidol (Haldol).
Newer antipsychotic drugs (such as risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel) may be better tolerated. These drugs may work particularly well for the agitation and other psychotic symptoms common in head-injured persons.
Keep in mind that all antipsychotic drugs carry a "black box" FDA warning describing an increased risk of death from all causes when given to elderly patients with dementia-related psychosis. When prescribed, they must be administered cautiously and with the informed consent of individuals who are designated to make health care decisions if the patient himself cannot.