Reduction of affective lability and alcohol use following traumatic brain injury: a clinical pilot study of anti-convulsant medications.
OBJECTIVE
A large and under-recognized sub-set of patients suffer both traumatic brain injury (TBI) and alcohol dependence (ADep). This group appears to use alcohol to self-treat affective and anxiety lability following TBI, resulting in new ADep or worsened prior ADep. This study hypothesized that treatment of such patients with mood-stabilizing medications would relieve post-TBI emotional dysregulation and facilitate reduction in alcohol use.


METHODS
This study reported retrospective medical record data from outpatients in the Substance Abuse Treatment Programme who were treated for labile mood. Medications followed clinical indication and were given in non-blind fashion.


METHODS
Subjects included 18 patients who (1) complained of debilitating affective lability following TBI, (2) described drinking alcohol to ease lability symptoms, (3) met DSM-IV criteria for current ADep and (4) were treated with a mood stabilizing medication.


RESULTS
During 6 weeks of treatment, 16 (89%) achieved abstinence from alcohol. All but two (14/16 or 88%) also showed improvement in their affective and anxiety symptoms.


CONCLUSIONS
These preliminary data are limited by the retrospective collection, clinical impression and non-blinded trial. Nonetheless, the results suggest further investigation of anti-convulsants as potentially useful agents in co-morbid emotional lability and ADep following TBI.
Beresford
Thomas P
TP
Denver Veterans Affairs Medical Center, Denver, CO 80220, USA. thomas.beresford@uchsc.edu
Arciniegas
David
D
Clapp
Lori
L
Martin
Brandon
B
Alfers
Julie
J
D000328:Adult; D000437:Alcoholism / Q000188:drug therapy / Q000209:etiology*; D000927:Anticonvulsants / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy / Q000209:etiology*; D001930:Brain Injuries / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D002220:Carbamazepine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000188:drug therapy / Q000209:etiology*; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D014635:Valproic Acid / Q000627:therapeutic use
D000927:Anticonvulsants; D002220:Carbamazepine; D014635:Valproic Acid