ADHD Drug May Be Effective Treatment For TBI and PTSD

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A drug commonly prescribed to treat attention-deficit hyperactivity disorder (ADHD) shows potential to also help individuals with traumatic brain injury and post-traumatic stress disorder (PTSD), according to a recent study published in the journal Neuropsychopharmacology.

The study showed that methylphenidate improved PTSD symptoms overall, but also showed promise for treating depressive and postconcussive symptoms in individuals with PTSD and/or TBI. The drug also improved cognition in both groups.

In contrast, galantamine, a drug commonly used to treat patients with Alzheimer’s and was also tested, only improved episodic memory with no effect on trauma-related symptoms.

“These findings are of particular interest given anecdotal reports of widespread prescribing of methylphenidate by clinicians working with veterans and military personnel with PTSD, and highlight the pressing need for additional research to determine the utility and safety of this drug (or other drugs with potentially overlapping mechanisms of action, such as atomoxetine) in this patient population,” the investigators, led by Thomas W. McAllister, MD, chair of the Department of Psychiatry, Indiana University School of Medicine, in Indianapolis, write.

“In folks with mild brain injury, whether it’s a military cohort or civilian cohort, cognitive complaints are very prominent,” he said. “People will report that they have trouble with reading, attention, concentration, and the like, and, in fact, you can usually measure small deficits in these domains,” Dr. McAllister told Medscape Medical News.

“What’s less widely appreciated is that people with posttraumatic stress have similar complaints, so they’ll report difficulties in attention and concentration. They may also report problems with memory. They have too much memory for traumatic events and not enough memory for common, day-to-day events, so they feel somewhat impaired by their cognitive complaints as well.

“So we thought that maybe this would be a good place to start, and the idea was that if we could help people with their cognitive complaints, and even maybe cognitive performance, then that might have some positive downstream effects in terms of mood and psychological health in general.”

For the study, the researchers conducted a 12-week, randomized, double-blinded, placebo-controlled study with 32 individuals with a history of PTSD, TBI, or both. The participants were administered galantamine or methylphenidate.

The majority of the participants were veterans or active duty military personnel, however 15 were civilians with no record of military service. The researchers say the distribution of PTD, TBI, or both were approximately even among both groups, as was the distribution of military and non-military participants. The results were compared to a control group given placebo.

As the researchers predicted, the results indicate methylphenidate performed significantly better than a placebo in terms of cognitive improvement and a measure of attention. However, the researchers did not expect to see that methylphenidate was associated with large reductions in postconcussive symptoms, as well as significant improvements in depressive symptoms.

However, Dr. McAllister expressed caution about the results, saying the study is “very small, so all the usual caveats apply.”

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