Psychopharmacological issues in the treatment of TBI and PTSD.

Recognition of the frequency of the co-occurrence of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) is a relatively recent development in both fields. As a result there has been little work on effective treatment strategies for those with both conditions. In fact studies of PTSD treatment often exclude those with a history of TBI, and studies of the treatment of TBI sequelae have often excluded participants with psychiatric disorders such as PTSD. Thus although evidence-based approaches for the treatment of PTSD and for the sequelae TBI are emerging, little is known about the use of psychotropic medications to treat individuals with co-morbid TBI/PTSD. The growing cohort of military personnel with high rates of exposure to TBI and concurrent PTSD calls attention to the need for improved treatment strategies, and for clarification of whether medications currently used to treat PTSD or the sequelae of TBI are effective in the co-morbid condition. In the absence of informative treatment studies, clinicians are faced with uncertainty about whether to use conventional approaches, alter these approaches in some way, or to shy away from these interventions for fear of exacerbating symptoms of the other condition. This situation is further complicated by the fact that many clinicians tend to be more familiar with medication approaches in one disorder or the other. This paper reviews the use of medications for the treatment of PTSD, the neuropsychiatric sequelae of TBI, and the co-morbid condition. General principles are suggested and particular attention is directed to situations where the use of medication for one condition might exacerbate symptoms of the other disorder. Directions for future research are suggested.