STANLEY L. GOODMAN, M.D. – Qualified Medical Examiner #962948
Diplomate, American Board of Psychiatry & Neurology
in Forensic, Child, Adolescent, Adult, Addiction, and Geriatric Psychiatry
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YEARLY AND LIFETIME MEDICATION COSTS
FOR TREATMENT OF TRAUMATIC BRAIN INJURY (TBI)
Treatment of patients who have sustained Traumatic Brain Injury is necessary in order to restore
to the patient a sense of peace of mind, return the level of fulfillment which he/she had prior to
being injured, and reduce his/her feelings of hopelessness which have pervaded his/her
existence since the injury.
These patients often will also develop significant cognitive dysfunction with resulting inability to
function as they once did -- such as precluding them from returning to their former avocation or
rendering them mentally unable to care for their family -- and this loss of their previous
functioning ability often causes permanent depression. Treatment will also help restore some
hope in the patient that they may be able to work again in some fulfilling capacity.
Therefore, the Traumatic Brain Injury patient will need psychotherapy and also perhaps
psychotropic medication, i.e., anti-depressants. Cost for such treatment/medication is detailed
1. Psychotherapy: The patient would benefit from a one-hour psychotherapy session with a
Board Certified psychiatrist experienced with patients suffering from Traumatic Brain Injury.
Cost per hour is $200.00. 50 sessions per year = $10,000.00.
2. Treatment of Post-Traumatic Stress Disorder: Post-Traumatic Stress Disorder often
accompanies Traumatic Brain Injury. According to the most recent lecture given by Andrew
Pollack, M.D., Associate Professor of Psychiatry, these symptoms of Post-Traumatic Stress
Disorder need to be treated with maximal doses of anti-depressants and with symptomatic
use of medication for anxiety.
3. Psychopharmacologic Treatment of Post-Traumatic Stress Disorder: I would consider
prescribing Zoloft (sertraline) 50mg., two twice per day. Zoloft has been shown to decrease
the intensity of the recurrent, intrusive traumatic thoughts associated with Traumatic Brain
Injury. Cost of each 50mg. Zoloft tablet is $2.35. Cost of 4 tablets daily, 365-days per
year = $3,431.00.
4. Psychopharmacologic Treatment for Anxiety: For anxiety, a reasonable choice would be
Buspirone, since benzodiazepines might further reduce the patient's memory. I would
recommend Buspirone be given in a daily dose of 60mg.-80mg. Cost of each 10mg.
Buspirone tablet is $1.38. Cost of 6 tablets daily, 365-days per year = $3,022.20.
5. Psychopharmacologic Treatment for Sleep Disturbance: Remeron, an anti-depressant,
is non-addictive and can be used for an extended period of time. The usual daily nighttime
dose is 30mg.-40mg. Cost of each 15mg. Remeron tablet is $2.42. Cost of 2 tablets
daily, 365-days per year = $1,839.50.
6. Psychopharmacologic Treatment of Mood Lability Associated with Depression and
Anxiety: Mood lability is common subsequent to Traumatic Brain Injury. I recommend
Lamotrigene (Lamictal), which is currently used for treatment of mood or affective disorders
and mood instability. (Maximum Time: 5 years.) Cost of each 25mg. tablet of
Lamotrigene (#60) is $1.60. Cost of 3 tablets daily, 365-days per year = $1,752.00
7. Couple Counseling: The patient and his/her significant other should be given Couple
Therapy with a therapist experienced with Traumatic Brain Injury. I feel they would need 10-
20 sessions per year for the next 3-4 years. Estimated cost of such therapy is $150.00.
Total cost bi-monthly Couple Counseling = $3,600.00 per year ($14,400.00 for 4 years).
Psychotherapy: .......................... $10,000.00
Psychopharmacologic Management: ....... 10,044.70
Couple Therapy: ............................ 3,600.00
Yearly Total: .......................... $23,644.70
LIFETIME COST (25-Years): ........................... $591,117.50
General Discussion of Medication Costs:
All parties concerned should recognize that a drug company will spend close to $250,000
today, to develop a new medication and these costs are passed-on to patients in the form
of increased costs. For example, for schizophrenia or other psychoses, the drug
olanzepine -- which is now starting to be used in treatment-refractory cases -- costs $9.60
Therefore, it is possible that pharmacologic costs listed above may be significantly underestimated,
given the possibility that costs could double for newer antidepressants which may
be prescribed in the future.