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Tricyclic antidepressant in TBI
109
DEPARTMENTS
Letter to the Editor Tricyclic Antidepressant in TBI We are encouraged by the case reports of Reinhard et al in “Improved Arousal and Initiation Following Tricyclic Antidepressant Use in Severe Brain Injury” (Arch Phys Med Rehabil 1996;77:80-3) and wish to point out that our earlier report of 8 cases is in agreement with their findings.’ We should also point out that Reinhard et al’s statement, “The cases presented in the current paper represent the first reports of functional recovery in the TBI population in response to tricyclic antidepressant administration,” is not accurate. As reported in our 1993 publication, protriptyline, a strongly noradrenergic tricyclic antidepressant, achieved results strikingly similar to those of Reinhard et al, using amitriptyline and desipramine. We wholeheartedly concur with the authors’ theorization, as well as other accumulating literature, regarding the potentially crucial role of norepinephrine in enhancing neurologic recovery after brain injury. We also strongly agree with the potential for adverse effects, especially seizures associated with the administration of tricyclic antidepressants.2
As we have reported in the protriptyline paper, however, and as the Reinhard report alludes, some patients appear to respond only to strongly noradrenergic agents, like tricyclic antidepressants, rather than “dopaminergic” type drugs. In light of the significant available literature, the risk-to-benefit equation may favor trials of noradrenergic tricyclic antidepressants, especially protriptyline and desipramine. As noted by Reinhard, further controlled, prospective studies are warranted. Bruno
Wroblewski, MS, Pharm Anthony B. Joseph, MD Greenery Rehabilitation Center Boston, MA 02135
References 1. Wroblewski B, Glenn MB, Comblatt R, Joseph AB, Suduikas S. Protripytline as an alternative stimulant medication in patients with brain injury: a series of case reports. Brain Inj 1993;7:353-62. 2. Wroblewski B, McColgan K, Smith K, Whyte J. The incidence of seizures during tricyclic antidepressant drug treatment in a brain injured population. J. Clinical Psychopharmacology 199O;lO: 124-8.
Arch
Phys
Med Rehabil
Vol78,
January
1997
DEPARTMENTS
Letter to the Editor Tricyclic Antidepressant in TBI We are encouraged by the case reports of Reinhard et al in “Improved Arousal and Initiation Following Tricyclic Antidepressant Use in Severe Brain Injury” (Arch Phys Med Rehabil 1996;77:80-3) and wish to point out that our earlier report of 8 cases is in agreement with their findings.’ We should also point out that Reinhard et al’s statement, “The cases presented in the current paper represent the first reports of functional recovery in the TBI population in response to tricyclic antidepressant administration,” is not accurate. As reported in our 1993 publication, protriptyline, a strongly noradrenergic tricyclic antidepressant, achieved results strikingly similar to those of Reinhard et al, using amitriptyline and desipramine. We wholeheartedly concur with the authors’ theorization, as well as other accumulating literature, regarding the potentially crucial role of norepinephrine in enhancing neurologic recovery after brain injury. We also strongly agree with the potential for adverse effects, especially seizures associated with the administration of tricyclic antidepressants.2
As we have reported in the protriptyline paper, however, and as the Reinhard report alludes, some patients appear to respond only to strongly noradrenergic agents, like tricyclic antidepressants, rather than “dopaminergic” type drugs. In light of the significant available literature, the risk-to-benefit equation may favor trials of noradrenergic tricyclic antidepressants, especially protriptyline and desipramine. As noted by Reinhard, further controlled, prospective studies are warranted. Bruno
Wroblewski, MS, Pharm Anthony B. Joseph, MD Greenery Rehabilitation Center Boston, MA 02135
References 1. Wroblewski B, Glenn MB, Comblatt R, Joseph AB, Suduikas S. Protripytline as an alternative stimulant medication in patients with brain injury: a series of case reports. Brain Inj 1993;7:353-62. 2. Wroblewski B, McColgan K, Smith K, Whyte J. The incidence of seizures during tricyclic antidepressant drug treatment in a brain injured population. J. Clinical Psychopharmacology 199O;lO: 124-8.
Arch
Phys
Med Rehabil
Vol78,
January
1997