Psychopharmacological advances in neurorehabilitation after traumatic brain injury

PURPOSE OF REVIEW: Pharmacotherapy is widely used to manage neuropsychiatric sequelae that may interfere with neurorehabilitation after traumatic brain injury (TBI), despite limited TBI-specific evidence. This review summarizes psychopharmacological evidence from the past 18 months and proposes a three-step approach: deprescribing potentially recovery-limiting medications, characterizing individual neuropsychiatric symptoms, and selecting symptom-targeted treatments to support cognitive, emotional, behavioral, and functional recovery after TBI. RECENT FINDINGS: Methylphenidate shows the most consistent evidence for selected cognitive outcomes, particularly attention and processing speed. Pharmacological approaches to agitation, sleep-wake disorders, depression, fatigue, and posttraumatic headache have been studied, but TBI-specific evidence remains limited or heterogeneous. Sedative, anticholinergic, and cognitive adverse effects, cardiovascular risks, and dependence require consideration in TBI neurorehabilitation. SUMMARY: No pharmacological treatment is established as disease-modifying after TBI. Given the limited evidence, psychopharmacotherapy should be individualized, symptom-targeted, and integrated into multidisciplinary TBI neurorehabilitation. Continuous medication review and deprescribing should accompany careful treatment selection and monitoring. Future trials should determine whether symptom improvement translates into better rehabilitation participation, functional independence, and long-term health-related quality of life.