Sherry Chiasson, BSW, MBA/HA
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Disclaimer: This article is for informational purposes only. Please speak with a medical professional before seeking treatment.

What conditions can medications help with?

Treating symptoms associated with PTSD and/or TBI

What are medications?

Medications are substances recommended by a doctor to help you deal with symptoms of PTSD or TBI or both. For example, a doctor might recommend a specific medicine, by prescription or over-the-counter, for headaches, depression, anxiety, balance issues, seizures, or insomnia.

What is the treatment of symptoms of TBI and PTSD with medication like?

Treating the symptoms of TBI or PTSD with medication is similar in many ways to treatment of many other health issues. Many people with TBI or PTSD find great relief from medication, often in combination with other therapies. An antidepressant might calm PTSD nightmares so you can finally sleep soundly and be able to participate in an exposure therapy program. An anticonvulsant medication might reduce TBI-induced seizures.

What can be challenging is the steps you may need to take, in consultation with your doctor, to determine if a particular medication is right for you. You will need to share with your doctor medications you are already taking, and they will make recommendations. Together you will select a medication to try, and at that point you will enter a phase of trial and error. If you are lucky, the first medication at the first dosage will give you relief with little in the way of side effects.

If you’re like a lot of people, you might experience side effects or no relief from the medicine. Then you would need to talk to your doctor and possibly adjust the amount of medication you take, how often you take it, or perhaps the time you take it, as well. That process can be more complicated if your doctor has prescribed multiple medications for you. Often a medication prescribed to treat one problem makes another problem worse. For example your necessary seizure medication might make fatigue worse.

So it can take time and patience to fine tune your treatment with medication. You might find yourself trying multiple medications over the course of a year or so, muscling through some side effects in order to find the meds that bring the most relief. There is almost always another, alternative medication to choose from, especially when it comes to the mood medications. It’s very important to work with a knowledgeable and compassionate health care provider who can help you figure out the right combination for you and your particular symptoms.

Depending on your symptoms, you also might decide that medications are not for you and turn to other approaches to manage your symptoms, such as exercise for depression, meditation for insomnia, or acupuncture to relieve pain.

Why do medications work for treating symptoms associated with TBI or PTSD?

Most of the medications available for the treatment of TBI actually don’t treat the brain injury directly -- the damage to nerve cells. They treat the symptoms. Many people get great relief from medications even though a drug may not have been created specifically for TBI.

For example, headaches are one of the most common consequences of TBI. Under consultation with your doctor, medicines like ibuprofen, Tylenol, or aspirin can provide some relief for TBI headaches. (Ibuprofen and aspirin should not be taken immediately following a brain injury because of the risk of a brain bleed.) Migraine headaches caused by TBI might respond to medications produced for any migraine, not only TBI migraines.

Symptoms of insomnia, anxiety, depression, balance issues, and seizures may all respond to medications created specifically for these symptoms.

Medications to treat symptoms that may be associated with TBI symptoms could include:

  • Anticonvulsant medications (for example, sodium valproate, gabapentin, topiramate, carbamazepine)
  • Antidepressant medications (for example, citalopram, amitriptyline, paroxetine, sertraline)
  • Antipsychotic medications (for example, quetiapine, risperidone)
  • Pain management medications (for example, acetaminophen, cyclobenzaprine, ibuprofen, lyrica, and naproxen sodium, neurontin)
  • Motor system medications (for example, baclofen, cyclobenzaprine, tizanidine)
  • Memory, attention, and cognition medications (for example, donepezil, bromocriptine, modafinil, methylphenidate may be used for early symptoms following severe TBI)

A list of possible side effects: TBI Medication Chart

According to the VA, the medications that have proven most effective at treating PTSD are SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors). They are both types of antidepressants. These medications help relieve some of the symptoms of PTSD -- they are not a cure.

What should I look for when it comes to taking medications for TBI and PTSD ?

You should work with a doctor, whether a primary care provider or one specializing in TBI or PTSD treatment, to help you determine which medications might be helpful for you. Your doctor will consider and discuss with you possible side effects that might make other TBI or PTSD symptoms worse and make sure the drugs you take do not have unsafe interactions. You will also need a healthcare provider who is willing to work with you to determine if medication would be helpful and, if so, what would be the best drug or best combination of drugs for your TBI or PTSD symptoms.

Where can I go to get this treatment?

Health care providers all over the country can provide prescriptions for medications that can treat the symptoms of TBI and PTSD. What may be harder to find is a health care provider who has the experience and expertise to help you select and balance your medications. Look for experts in TBI and PTSD treatment such as a behavioral neurologist or a neuropsychiatrist.

With therapy I realized what my triggers are. Through that, and medication, I’m a lot better today.

James Dantzler, Veteran, U.S. Marine Corps

What should you consider before asking a doctor about medication?

TBI and PTSD are two different diagnoses, but they can have overlapping symptoms.

If you have been diagnosed with TBI and/or PTSD, your symptoms may come and go. They may also stick around. Symptoms can occur immediately or over time. They can bother you a little or a lot. Symptoms can be physical, mental, or emotional. You could feel pain or something vague, as if something is not quite right.

Depending on your situation, a variety of treatments might be helpful, including medication. Talk to your healthcare provider about what is best for you.

Things to consider:

  • Medication might reduce or prevent your symptoms.
  • You might need a prescription or “over-the-counter” medicine.
  • Some medications produce negative side effects.
  • New medications might interact with other things you take, such as other prescriptions or over-the-counter medications and supplements.
  • Dosage varies from person to person.

Tell your healthcare provider if:

  • You have any side effects after starting a new medication.
  • A new medication does not seem to work as expected.

What can I do to manage medications most effectively?

Take medications exactly as directed by your provider. To keep on track:

  • Take everyday medications at the same time each day.
  • Stay organized by using reminders or prepackaged doses.
  • Keep a medication log. Write down all the drugs taken, dosages, dates, side effects, and problems.
  • Take advantage of refill reminders from your pharmacist.

These resources may help you manage your medications, especially if your injury has affected your memory:

Where can I find more information?

American Psychological Association - Medications for PTSD

National Center for PTSD - Medications for PTSD

Center of Excellence for Medical Multimedia - Traumatic Brain Injury (TBI) Medication Chart

Medicine Assistance Tool (MAT) - PhRMA’s Medicine Assistance Tool (MAT) is a search engine designed to help patients, caregivers and health care providers learn more about the resources available through the various biopharmaceutical industry programs. MAT is not its own patient assistance program, but rather a search engine for many of the patient assistance resources that the biopharmaceutical industry offers.

What do patients say?

With therapy I realized what my triggers are. Through that, and medication, I’m a lot better today.

— James Dantzler, Veteran, U.S. Marine Corps

 

So I’ve learned if you don’t like the depression medicine you’re on it’s okay to ask to try another one. They do different things, and this is the one for me now. I started 150 milligrams ten days ago with the current accident and I bumped up to 300, only because I told the doctor I would. I didn’t think I needed it; but since I have, I quit crying every day, so I guess doc knows best.

— Michelle Kauffman, TBI survivor

What do experts say?

Antidepressants are not addictive, and they do often take several weeks to get their full effect. What we usually do in people with a brain injury or any other kind of injuries to the brain like a stroke or other injuries is that we usually try to start at relatively lower doses and go up at a slightly slower pace than what we would do with people without a brain injury. And when you do that, what we would call start low, go slow, people generally do tend to tolerate the medications pretty well.

There are a number of patients who would prefer not to take an antidepressant, partly because they’re already on a lot of medications. Sometimes people who have had a brain injury are on pain medications, sometimes even seizure medications. So, it’s understandable that some people might not want to take another medication and would prefer counseling, for example.

— Jesse Fann, M.D., University of Washington

 

[With PTSD] what the medications do is, with time, decrease the amount of depression, improve your mood, so you can do the things that make you feel better. So they take a while to work, and they’re kind of a pain because you have to take them every day. And you can’t miss the medication doses. In order for them to be helpful, you really have to be consistent with them.

— Dr. Alauna Curry, Psychiatrist

References

PTSD: National Center for PTSD: Medications for PTSD. (2021). U.S. Department of Veterans Affairs.

Traumatic Brain Injury - TBI Medication Chart. (2021). Air Force Center of Excellence for Medical Multimedia.

VA Staff Contributor. (2020, April 14). New treatment for Veterans’ old headaches. VAntage Point.

Williamson, D. R., Frenette, A. J., Burry, L., Perreault, M. M., Charbonney, E., Lamontagne, F., Potvin, M. J., Giguère, J. F., Mehta, S., & Bernard, F. (2016). Pharmacological interventions for agitation in patients with traumatic brain injury: protocol for a systematic review and meta-analysis. Systematic reviews, 5(1), 193.

Disclaimer: This article is for informational purposes only. Please speak with a medical professional before seeking treatment.

 

Reviewed by Amy Shapiro-Rosenbaum, PhD, Lyndsay Tkach, MA, CBIS, and Michelle Neary, March 2021.

The BrainLine Treatment Hub was created in consultation with TBI and PTSD experts.