Amitriptyline for agitation in head injury.

Agitated behavior is frequently associated with traumatic closed head injury. Proactive behavioral intervention is often not successful, and psychopharmacologic agents may result in increasing the targeted behavior through sedation. We describe a 32-year-old woman who developed severe agitation after frontal lobe closed head injury. After failing conservative behavioral management, a therapeutic trial of amitriptyline was initiated. Within two weeks, aggressive outbursts nearly ceased and attention span improved. Serial neuropsychologic assessment before and during amitriptyline therapy documented preservation of cognitive indices along with improvement in Trailmaking tasks. This case suggests that a trial of amitriptyline or other tricyclic antidepressant may be helpful in diminishing agitation associated with frontal lobe damage without impeding cognitive recovery.