Buspirone Treatment of Traumatic Brain Injury in a Child Who Is Highly Sensitive to Adverse Effects of Psychotropic Medications

Abstract

Traumatic brain injury can produce various neuropsychiatric impairments and a high susceptibility to adverse effects of psychotropic medications. A 6-year-old boy developed symptoms of ADHD after head trauma at age 30 months. Three different psychostimulants, three tricyclic antidepressants, clonidine, bupropion, fluoxetine, and propranolol were either ineffective or produced adverse effects. Side effects mainly consisted of organic mood syndrome (despite the lack of apparent genetic or organic mood disorder), sympathomimetic intoxication, and sympathomimetic hallucinosis. Buspirone (10 mg q.i.d.) produced significant improvement in impulsivity and hyperactivity, but not in attention deficits. Methamphetamine (5 mg every morning), added to the buspirone, was effective in treating the remaining attentional symptoms. These treatments were readily tolerated, and the child has remained stable for 2 years on buspirone and methamphetamine. The symptoms of mood disorder were present only during stimulant or antidepressant treatment, and therefore the diagnosis of organic mood disorder did not apply. Apart from medication side effects, the child appeared to have an "organically-based pharmacological vulnerability to mood disorder" and postinjury ADHD (although comorbid neuropsychiatric conditions might have contributed to the complex clinical picture). This single case study was uncontrolled, did not involve drug withdrawal design, and used clinical observations rather than standardized measures. Further study is needed before buspirone can be viewed as safe or effective for treating TBI, but buspirone may be an attractive alternative for managing certain behavioral problems following brain injury, especially in patients sensitive to adverse effects of psychotropic medications.