USE OF DEPO-PROVERA TO CONTROL SEXUAL AGGRESSION IN PERSONS WITH TRAUMATIC BRAIN INJURY

Objective: To determine the effectiveness of medroxyprogesterone aceta te (Depo-Provera) treatment in conjunction with psychological counseli ng on the hypersexual behavior seen in individuals with traumatic brai n injury. Design: A retrospective review of the use of Depo-Provera in adult male patients who sustained a traumatic brain injury from blunt trauma and subsequently exhibited hypersexual behavior. Ah individual s were treated with a combination of weekly Depo-Provera injections an d psychological counseling; the latter was educational/behavioral in n ature and took into account such problems as deficits in awareness and empathy, poor memory, concreteness, and rigidity. Follow-up examinati ons were done every 3 months for at least 2 years and every 6 months t hereafter. Setting: Individuals were seen in outpatient treatment and reside in community environments. Patients: Eight males (average age = 17.5 years at the time of head trauma) who developed problematic hype rsexual behavior approximately 3 years later. These individuals were c onsecutive referrals to a psychiatric practice with expertise in the t reatment of hypersexual behavior. Intervention: Weekly intramuscular D epo-Provera injections were used in conjunction with counseling. Main Outcome Measures: Incidence of hypersexual behavior; change in testost erone level. Results: In all cases, cessation of the unacceptable sexu al behavior was noted while the men received treatment (mean duration = 42 months). Three individuals remain on Depo-Provera, and two have s uccessfully discontinued treatment for 2 and 10 years, respectively, w ith no further problems. The remaining three reoffended when medicatio n was discontinued, a decision made unilaterally by their families. Co nclusions: The use of Depo-Provera in conjunction with counseling may offer an opportunity to control aberrant sexual behaviors after brain injury. However, only a minority of individuals stay in good control a fter discontinuing Depo-Provera.