Treatment and Interventions For CTA, Depression and Impulsivity

By David M. Reiss, M.D.

(Editor’s Note: The following article is excerpted from the February issue of Concussion Litigation Reporter. To see the full article, visit

Issues related to identifying and preventing CTE (Chronic Traumatic Encephalopathy) during athletic competition have been appropriately gaining extensive medical coverage, even including, during a recent interview, mention and discussion by President Obama of risks related to playing football.

The questions of how CTE can be treated and how secondary effects of CTE can be prevented or treated have received less attention, despite the high-profile and tragic events that have been possibly related to CTE and the very large number of school, amateur and professional athletes who are probably suffering possible CTE-related difficulties (ranging from mild and subtle to severe).  However, the absence of discussion of intervention and treatment is not particularly surprising in that to a significant extent, clinically, we are in uncharted waters.

CTE has only relatively recently been recognized as a specific and significant condition. Thus, research regarding treatment is in its very early stages. Not all that long ago, it was considered that only “severe” or “major” head injuries were problematic and deserving of medical (and mental health) attention. We are now aware that pathology caused by repetitive “minor” concussive forces to the brain may contribute to a greater extent to later difficulties than less-frequent “major” injuries. CTE is caused by the jostling of the brain within the cranial vault – trauma caused by the brain being shaken and making contact with the skull. This can occur in the absence of any injury to the skull itself and this can be experienced subjectively as a “minor ding” rather than as a “concussion” or significant “injury.” The problem is exacerbated by the false impression that helmets are protective against minor head injuries – helmets protect against injuries to the skull, but helmets are far less effective in preventing the trauma caused by internal concussive forces that lead to CTE (some argue that the hard-helmet is more dangerous when frequently used on the field of play as a “weapon” than it is protective).

I am not a neurologist or neuro-psychiatrist, and I defer discussion of specific neurological interventions, treatment and rehabilitation to experts in that area. However, as a psychiatrist, I recognize that both due to physiological factors and on a psychological basis, changes in cognition, attention, mood stability and impulsivity that may be attributable (at least in part) to CTE are significant problems for which some interventions are available and additional preventive and treatment protocols need to be developed…

(To read the full article, visit

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