One of the frequent side effects of TBI is depression.
Also known is that the side effects of medication ( SSRIs et al ) can be magnified in such patients, even in small doses.
Subsequent to the development of Prozac, all work on possible alternative supplements to improve serotonin ceased. It was argued, that L-Tryptophan and/or 5HTP did not pass the blood-brain-barrier.
Subsequently, I think that this has been shown not to be the case, and that both can affect an increase in Serotonin levels in the brain.
Are readers aware of any such research to support this view or would like to comment on this contention.
It is true that one of the common sequelae of TBI is mood disturbance with up to 50% of TBI patients experiencing depression within the first year of injury. And yes, the "TBI brain" is more sensitive to side effects of medications, necessitating a slower titration and an attempt to utilize the lowest effective dose. Nonetheless, SSRIs such as citalopram and sertraline have shown some effectiveness in TBI-related depressions, as have SNRI's. The use of TCA's and MAOI's may be more problematic, but we do see lower doses of TCA's used for chronic pain in some head injury programs.
It is also important to keep in mind that depression in TBI is related not only to pathophysiologic changes from the shearing forces of injury, but also can have a psychological component related to--among other factors--the loss of the "old self" and the mourning process secondary to the decline in functioning.
Mike: Interestingly, some newer research is indicating a potentially important role for mitochondrial dysfunction (decreased bioenergetics) in various mood disorders, including depression. What's more, TBI has long been known to result in decreased bioenergetics resulting from mitochondrial dysfunction. It will be interesting to follow this research and see if mitochondrial-targeted treatments can play a role in improving depression and other mood disorders in patients, including those with TBI.
For example, see the article that I provided a link to below:
http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0310-y
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