Pharmaceuticals
Classic Stimulants: Cognitive Enhancing Agents
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Neurostimulant medications are some of the most commonly utilized, and probably the most widely studied medicines for the treatment of problems following traumatic brain injury. Examples of this class of medications include methylphenidate (Ritalin, Concerta, Methylin, Metadate), and dextroamphetamine (Adderall, Dexedrine). The use of these medications is probably best known for their use in children with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder. Neurostimulant drugs are generally very safe and well-tolerated, as well as being very effective in helping with some of the cognitive problems following TBI.
There are several reasons why a neurostimulant medication may be used following TBI. Most commonly, it is used to help patients pay attention to their environment. Many patients with TBI are extremely distractible, which makes it hard for them to interact effectively with others, and as a result, may affect their ability to participate in rehabilitation therapies. Additionally, use of these medications may subsequently result in improvements in memory, as attention is a primary component of memory formation. Early in the course of recovery following traumatic brain injury, stimulant drugs are often prescribed to try to help individuals recover more quickly, as it is thought that the stimulant effect may help patients emerge from coma sooner. These medications may also be prescribed to patients who are awake, but are exhibiting slow cognitive processing. Sometimes they are prescribed to help combat fatigue that is commonly seen after brain injury, or to help regulate the sleep-wake cycle. Lastly, and probably most importantly, there is some evidence that the neurostimulants may have a beneficial effect on helping the brain to recover following TBI, by helping the nerve cells reconnect to other nerve cells in the brain.
The way these medications specifically work is unknown, but it is thought that these medications work by increasing the amount of stimulant neurotransmitters available in the brain, specifically norepinephrine and dopamine. Common side effects include fast heart rate, elevation of blood pressure, and loss of appetite. In some cases, they may cause sleep problems, but this is not usually a problem if the medicines are taken at the prescribed times. They may make agitation worse. Use of neurostimulant medications should be approached with caution in patients who have seizures, as it is possible that they can worsen a seizure disorder, although recent evidence actually suggests that they may actually have a protective effect against seizures. These stimulants do have a high abuse potential, and are classified as Schedule II narcotics under the Federal Drug Enforcement Agency’s guidelines, so that it is important for the patient to see their doctor prior to the expiration of the prescription, as they cannot be “called in” to a pharmacy. Usually, if taken as prescribed, neurostimulant medicines are very safe and are tolerated well.
These medications are generally prescribed in a twice-daily dosing schedule, once first thing in the morning and again at lunchtime. For some patients, a third dose is added. The older versions of the medications are fairly short acting, with effects lasting from 3 to 4 hours. Now, several longer acting forms are available, which make once-daily dosing schedules possible. The actual dose prescribed depends on the brand of medicine used, and the patient’s needs.
www.mentalhealth.com/p30.html - lists numerous medications with pharmacology, indications, warnings, dosages, research, etc.
Dr. Ripley joined the staff of The Shepherd Center in August of 2001, and assumed responsibility as Medical Director of Brain Injury Research and Medical Director of Post-Acute Services. He serves as Co-Medical Director of the Georgia Model Brain Injury System (GAMBIS). Prior to this, he held a position on faculty of Emory University School of Medicine with a primary appointment in the Department of Rehabilitation Medicine, where he served as Medical Director of Brain Injury Services.