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How This ADHD Medication Can Help Manage Traumatic Brain Injuries | by heidi


 


After Anne*, a 28-year-old who lives in Los Angeles, sustained a traumatic brain injury three years ago, she lived with severe brain fog and exhaustion on a day-to-day basis. Three to four months after her injury, a psychiatrist prescribed her methylphenidate—a central nervous system stimulant typically used to treat symptoms of attention deficit hyperactivity disorder (ADHD)—to help her manage her symptoms.



“I'm able to at least like make it through a reasonable number of hours of work,” Anne, who noted that she still sleeps more than she did before her injury, told Verywell. “It would be a lot harder without [this medication].”


 What Everyone Should Know About Traumatic Brain Injuries

Anne still takes methylphenidate, taking small doses twice a day. “At least it's like I sign up for four hours of time, and I can make that decision,” Anne said about sometimes deciding to not take a second dose to work through the afternoon on days when she should take a break.



Brain Injury Awareness Month, which occurs in March every year, aims to promote awareness about the challenges people with brain injuries face. And experts are increasingly examining how medications like methylphenidate can help.


Open dialogue between people with traumatic brain injuries and friends, family, and even health professionals can be difficult in part due to the shame that some people with injuries may experience. Stigma about traumatic brain injuries and their possible symptoms highlight the importance of awareness of treatment options.1


Traumatic brain injuries can have a wide range of symptoms depending on the severity of the injury and what parts of the brain are impacted. A September 2019 review article suggests that methylphenidate could be helpful in managing cognitive dysfunction for people who have traumatic brain injuries, but more research is needed.2



“In traumatic brain injuries, due to injury to the brain tissue itself, dopamine and norepinephrine effect may be diminished, and methylphenidate can help this,” Heidi Fusco, MD, assistant professor in rehabilitation medicine and the assistant director of the traumatic brain injury program at New York University, told Verywell.



A clinical trial on whether methylphenidate can help people with brain injuries replenish dopamine was submitted to ClinicalTrials.gov in September 2021, but the results of this trial have yet to be released to the public.3  



Patients’ Experiences Should Guide Care 

To understand how traumatic brain injuries affect patients, neurologists, psychiatrists, and other health professionals who help people manage life after the injury need to listen to patients about how their symptoms affect their lives. 


“We know that it is important to both quantify and qualify those signs and symptoms that are problematic to the patient, personally, interpersonally, as well as functionally in their activities of daily living,” James J Giordano, PhD, MPhil, professor of neurology and biochemistry and the chief of the neuroethics studies program at Georgetown University Medical Center, told Verywell. 


 The Most Common Types of Traumatic Brain Injury

Methylphenidate is far from the only medication that can be used to help people manage their symptoms. For example, if someone mentions they have trouble falling asleep, it may be beneficial to prescribe medication to help aid them. 


“There are many medications that can target specific signs and symptoms, rather than just providing sort of a generalized or blanket approach,” Giordano continued.


The Importance of Managing Symptoms

Santosh Kesari, MD, PhD, neurologist at Providence Saint John’s Health Center and the regional medical director for the Research Clinical Institute of Providence in Southern California, regularly helps people with different types of brain disorders. In addition to traumatic brain injuries, Kesari has also prescribed methylphenidate to some patients with brain tumors who experience similar symptoms.


“It’s more thinking about what exactly is the problem that's causing the symptoms,” Kesari told Verywell. “Dopamine is one of the big transmitters in the brain, and low dopamine causes problems.”


 Research Shows Sleep Is a Critical Part of Traumatic Brain Injury Recovery

Giordano also encourages other health professionals to consider treatments for attention deficit issues, like ADHD, if another condition, like a brain injury, is causing attention deficit.


“If there is attention deficit as a consequence of head injury, well, then absolutely the drug should be considered,” Giordano said. 


Research also suggests that traumatic brain injuries could lead to some people developing ADD or ADHD after the injury. A March 2019 study found that, “youths with traumatic brain injury reported greater ADHD symptom severity compared with those without traumatic brain injury.” Genetic predispositions to ADHD do not appear to have an effect on whether or not someone has acquired ADHD or related symptoms after a brain injury.4


What This Means For You

If you or a loved one have a traumatic brain injury that is characterized by cognitive dysfunction—which can include symptoms like brain fog—you can ask a healthcare professional if trying methylphenidate might be helpful.


Methylphenidate Might Not Help Everyone

One benefit to methylphenidate is that both the patients and their health providers should be able to tell quickly whether or not the medication is effective, in order to continue prescribing it or stop it to pursue a different treatment plan. 


“Within days, two weeks, we’ll know whether the patient has any clinical benefit or not in order to consider continuing to use it,” Kesari said. 


Fusco has reservations about prescribing methylphenidate to people over the age of 65, who have cardiac issues, agitation, anorexia or poor eating, or severe anxiety due to possible side effects of this medication. 


“There is no silver bullet medication for treating cognitive and functional impairments after TBI, and the clinician must always identify what is the problem symptom the patient is having and what are the possible causes,” Fusco said.

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