Efficacy of stimulants for psychiatric symptoms in individuals with traumatic brain injury.

BACKGROUND: The objective of this systematic review is to summarize data from published randomized controlled trials (RCTs) on the efficacy of stimulants for psychiatric symptoms in individuals with traumatic brain injury (TBI).

METHODS: A literature search was conducted of 5 major databases (PubMed, MEDLINE, PsycINFO, Embase, and Cochrane Collaboration) that identified RCTs on the use of stimulants for human patients with a diagnosis of TBI.

RESULTS: A total of 176 articles were identified, of which 18 matched the inclusion criteria and were reviewed in their entirety. The majority (17) of studies assessed methylphenidate (MPH), 1 assessed dextroamphetamine and MPH, and 1 assessed modafinil. One study showed significant improvement in depressive symptoms with MPH. Seven studies showed significant improvement in reaction time, whereas 4 studies showed significant improvement in accuracy with MPH compared with placebo. Of the 2 studies that included follow-up, only 1 found significant differences in disability ratings, attention-concentration, and motor memory at 30 days but not 90 days between the stimulant and placebo groups. The majority of studies demonstrated significant treatment effects immediately (ie, within minutes to hours) after first-time stimulant administration. Five of the 18 studies (3 adult, 2 pediatric) did not find benefit for stimulants when compared with placebo. Two studies that evaluated self-reported side effects found no significant difference between treatment groups, although 1 study showed a significant increase in mean arterial pressure in the stimulant group.

CONCLUSIONS: There is limited evidence to suggest efficacy of stimulants for psychiatric symptoms in individuals with TBI. However, stimulants appear to improve attention after first-time administration and for short time periods in these individuals.