title: The use of bupropion in the treatment of restlessness after a traumatic brain injury.
abstract: The occurrence of restlessness after a traumatic brain injury (TBI) is common. Severe restlessness can be a barrier in the multidisciplinary treatment of patients with TBI. The following case describes a patient with restlessness after a head-on motor vehicle accident. The patient was tachycardic, diaphoretic, demonstrating decerebrate posturing and a Rancho Los Amigos Stage II--III. Significant left lower leg restlessness was severe enough to cause bruising and ulceration. A multidisciplinary look was taken at the effects of using different neurotransmitter modulators in the treatment of restlessness after a TBI. Current biology treatment options include the use of medications that either modulate dopamine or noradrenaline alone. Bupropion effects both the dopaminergic and noradrenergic pathways. In the following case, the patient's restlessness was resistant to almost every medication employed. The only medication that proved to be effective in significantly reducing the patient's restlessness was bupropion. The evidence for the use of bupropion in the treatment of restlessness after a TBI has never been discussed previously, aside from anecdotal accounts. It is hoped that this case will prove insight into another treatment option for patients who have severe restlessness.
authors.affiliation: Department of Psychiatry, St. Michael's Hospital, University of Toronto School of Medicine, Toronto, ON, Canada.
authors.forename: C J
authors.initials: CJ
authors.lastname: Teng
authors.forename: S
authors.initials: S
authors.lastname: Bhalerao
authors.forename: Z
authors.initials: Z
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Farber
authors.forename: H
authors.initials: H
authors.lastname: Morris
authors.forename: T
authors.initials: T
authors.lastname: Foran
authors.forename: W
authors.initials: W
authors.lastname: Tucker
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016642:Bupropion / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications*; D006801:Humans; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D016642:Bupropion