Post-TBI Apathy

Injury to certain areas within the brain s frontal lobes may produce a syndrome that resembles depression but without depressed mood or a sad affect. Instead, this apathetic syndrome is marked by a lack of motivation, little emotional response, profound psychomotor slowing, and disengagement from social interaction. Antidepressants, stimulants, and medicines that specihcally boost dopamine activity have been tried when treating apathy after TBI (see Table 12.1). 

Antidepressants. As a rule, medicines that increase dopaminergic activity in the brain seem to work best when treating post-TBI apathy. Most antidepressants, however, work primarily by increasing serotonergic and/or noradrenergic activity. 

Medicine Depression Apathy Mania Psychosis Anxiety Delirium Dementia Behavioral Disturbances  

Key 1—first-line treatment 2—second-line treatment 3—may also be considered. 

Consequently, most conventional antidepressant medicines have not proved especially helpful for treating patients who have become apathetic after TBl. 

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Stimulants. Methylphenidate (Ritalin) and dextroamphetamine (Dexedrine) are the most widely used and perhaps the most effective medications when treating post-TBI apathy. They act by enhancing the activity of dopaminergic, noradrenergic and, to a certain extent, serotonergic brain systems. Stimulants act quickly to relieve the core symptoms of apathy, and they may also improve the impairments in attention and short-term memory that often follow TBl. Please refer to Chapter 8 for more information about the stimulants. 

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