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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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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

per pill.

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.

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