Medical Treatment and the Traumatic Brain Injury
One of the most essential facets in the treatment of a traumatic brain injury is medical management. Medications play a crucial role in both the immediate and long-term prognosis of a head or brain injury. Drugs are used to treat not only the symptoms of brain injuries but also their potential complications. Some of the clinical issues that could be treated with medications following a severe neurological injury include:
- Intracranial pressure
- Breathing disorders
- Blood pressure issues
- Emotional distress
- Psychosis including hallucinations and delusions
One of the biggest challenges of treating any of these disorders following a TBI is that they might not occur separately. Many of these disorders and problems are similar. This makes it difficult for medical providers to tell exactly where the issues are coming from.
Furthermore, even with proper treatment, it is difficult to completely control the symptoms of these clinical disorders. The mental health complications that arise following a TBI are often the most challenging to treat. For this reason, treating neuropsychiatric disorders usually requires a different approach when compared to common medical problems. Without a doubt, the treatment of mental health disorders following a TBI is just as much an art as it is a science.Assessing Mental Health Disorders Following a TBI
Often, the most challenging step of treating mental health disorders following a TBI is the first step. The evaluation of an individual with mental health problems following a traumatic brain injury can be challenging. It is important to identify precisely what is most bothersome to the individual. While they might have more than one symptom, the most effective therapy targets whatever is most distressing to the individual. Some of the possible reasons why someone might seek help for a mental health issue following a TBI include:
- Difficulty sleeping at night
- Trouble engaging in the activities that they used to find enjoyable
- Anxiety related to school or work
- Strained relationships with family members or friends
- Difficulty focusing or concentrating
It is essential for all providers to be both compassionate and understanding, allowing individuals the space to talk through their problems. This will help build a trusting, working relationship with the individual. After this, the doctor needs to discuss the possibility of medical management. Patients and their loved ones are going to have concerns about starting a new medication. Some of the topics that need to be discussed include:
- The benefits of the various drugs
- The possible side effects of the medications
- How long the treatment should be expected to last
- Any severe complications of the medicines
- The timetable during which results might appear
Doctors need to make sure that the individual knows that he or she is in control when it comes to the choice of medication. This control will help allay and calm the patient’s concerns. Most importantly, for individuals on multiple medications, stopping an unnecessary medication could be more effective than starting a new one.Choosing the Medication: Optimizing the Drug Selection
When it comes time to select a specific medication, there are going to be multiple options available. For example:
- The treatment of depression has numerous options. The two major classes are SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Selective Norepinephrine Reuptake Inhibitors). Even within these two classes, there are multiple options.
- The treatment of psychosis has both typical and atypical antipsychotics. Typical antipsychotics, such as Haldol, have been around much longer. Atypical antipsychotics, such as Aripiprazole, are newer.
Choosing the right medication for an individual can be a challenge. Some of the factors that everyone should consider include:
- How easy the drug is to use
- How the patient has done with prior medications
- The current research and evidence regarding the various medication options
- The possible side effects
- Financial considerations, such as cost and insurance coverage
Most of the medication options are going to have side effects. Certain side effects are more manageable to some people than others. In addition, medications that only require once-a-day dosing are easier to manage than those that need to be taken three or four times a day. Furthermore, some medications will require repeat doctor visits to measure the levels of these medications in the blood. This could be another barrier to treatment and could hinder patient compliance.After the Treatment Has Started
Once the treatment has begun, it is important to gradually work up on the dose. This is important for seeing how the individual will react. Some of the tenets include:
- Start low and go slow.
- If changing something in the treatment plan, change one thing at a time.
- Reassess the treatment plan regularly.
- Watch closely for any drug-drug interactions in individuals taking more than one medication.
Keep in mind that those who have suffered a TBI are going to be more sensitive to changes in their medication regimen. Therefore, smaller doses and smaller increases in the medication dose could lead to more substantial effects. While there are studies on the effectiveness of these various medication options, few of these have been performed in individuals with a TBI. Therefore, it is crucial for everyone to keep a close eye on TBI patients who are being treated for a mental health disorder.Side Effects and Alternatives
One of the most common side effects to watch for is seizures. While many medications do not increase the risk of seizures in those with epilepsy and those who have suffered a TBI, tricyclic antidepressants (TCAs), Bupropion, and Clozapine (an atypical antipsychotics) have been shown to increase the risk of seizures. Seizure worries could lead patients to explore alternative options such as:
- Taking medications in an off-label fashion.
- Looking for “alternative” medicine treatments, such as supplements.
- Stopping the use of medicines.
It is important to note that all of these could be harmful to the health of an individual. All changes in the medication regimen need to be discussed with a trained healthcare provider. This provides patients and their families with the highest chance of witnessing a successful recovery. Prescribing a medication for an individual who has suffered a TBI can be a challenge. Therefore, all treatment plans must be a continuous, ongoing discussion between the individual and their doctor.
The animated video below discusses some of the side effects of medications and why it's important to always consult with your doctor before taking them.
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