Sriram Ramaswamy, MD Associate Professor Department of Psychiatry Creighton University School of Medicine Staff Psychiatrist Nebraska Western Iowa VA Healthcare System Omaha, Nebraska
David Driscoll, PhD Health Science Specialist Nebraska Western Iowa VA Healthcare System Omaha, Nebraska
Aleah Rodriguez, PharmD Instructor Department of Pharmacy Practice Creighton University Omaha, Nebraska
Vani Rao, MD Associate Professor Department of Psychiatry and Behavioral Sciences Director, Brain Injury Program Johns Hopkins University School of Medicine Baltimore, Maryland
Disclosures The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
Although commonly used in clinical practice, evidence for their use in TBI is preliminary
Traumatic brain injury (TBI) affects more than 2 million people in the United States each year.1 TBI can trigger a cascade of secondary injury mechanisms, such as inflammation, hypoxic/ischemic injury, excitotoxicity, and oxidative stress,2 that could contribute to cognitive and behavioral changes. Although neuropsychiatric symptoms might not be obvious after a TBI, they have a high prevalence in these patients, can last long term, and may be difficult to treat.3 Despite research advances in understanding the biological basis of TBI and identifying potential therapeutic targets, treatment options for individuals with TBI remain limited.
As a result, clinicians have turned to alternative treatments for TBI, including nutraceuticals. In this article, we will:
provide an overview of nutraceuticals used in treating TBI, first exploring outcomes soon after TBI, then concentrating on neuropsychiatric outcomes
evaluate the existing evidence, including recommended dietary allowances (Table 1)4,5 and side effects (Table 2)
review recommendations for their clinical use.
Pharmacologic approaches are limited
Nutraceuticals have gained attention for managing TBI-associated neuropsychiatric disorders because of the limited evidence supporting current approaches. Existing strategies encompass pharmacologic and non-pharmacologic interventions, psychoeducation, supportive and behavioral psychotherapies, and cognitive rehabilitation.6
Many pharmacologic options exist for specific neurobehavioral symptoms, but the evidence for their use is based on small studies, case reports, and knowledge extrapolated from their use in idiopathic psychiatric disorders.7,8 No FDA-approved drugs have been effective for treating neuropsychiatric disturbances after a TBI. Off-label use of antidepressants, anticonvulsants, dopaminergic agents, and cholinesterase inhibitors in TBI has been associated with inadequate clinical response and/or intolerable side effects.9,10
What are nutraceuticals?
DeFelice11 introduced the term “nutraceutical” to refer to “any substance that is a food or part of a food and provides medical or health benefits, including the prevention and treatment of disease.” The term has been expanded to include dietary supplements, such as vitamins, minerals, amino acids, herbal or other botanicals, and food products that provide health benefits beyond what they normally provide in food form. The FDA does not regulate the marketing or manufacturing of nutraceuticals; therefore, their bioavailability and metabolism can vary.
