IMPROVED AROUSAL AND INITIATION FOLLOWING TRICYCLIC ANTIDEPRESSANT USE IN SEVERE BRAIN INJURY

Three patients with severe traumatic brain injury demonstrated signifi cant improvement in arousal and initiation after administration of tri cyclic antidepressants. The first patient showed improved motor and sp eech initiation in response to amitriptyline following several months of functional plateau. The second patient was minimally responsive 2 m onths after injury and demonstrated improved arousal following the use of desipramine. Both patients deteriorated when the medications were discontinued and improved again when they were restarted. These two ca ses provide strong evidence for a medication effect, The third patient began to verbalize following desipramine administration, despite bein g mute for more than a year after injury. Previous case reports descri be cognitive-enhancing effects, such as improved arousal, attention, m emory, and initiation, of dopaminergic agents, and in the case of tric yclic antidepressants, effects on agitation. The role of norepinephrin e in promoting neurological recovery after brain lesions has been demo nstrated in animals. The cases presented here provide some of the firs t data to show similar efficacy in humans and underscore the need for contolled trials to better determine which patients will benefit. (C) 1996 by The American Congress of Rehabilitation Medicine and the Ameri can Academy of Physical Medicine and Rehabilitation