If mild/moderate
Consider management by local health care professional
If severe
Consider combination of pharmacological and non-pharmacological therapy Refer to a psychiatrist, psychologist, or neuropsychologist
Non-pharmacological Treatment
Non-pharmacological Treatment
Pharmacological Treatment*
General Measures
Support and psychoeducation:
- proper sleep hygiene, good diet, regular social and physical activity Psychosocial Interventions Evidence-based Psychotherapy:
- Cognitive-behavioural therapy (CBT) Other Psychotherapy Interventions:
- Depending on availability
Psychosocial Interventions
Evidence-based Psychotherapy:
- Cognitive-behavioural therapy (CBT)
Other Psychotherapy Interventions:
- Depending on availability
Was the treatment successful?
(minimum 8-10 sessions, symptoms not worsening)
General Measures
Support and psychoeducation:
- proper sleep hygiene, good diet, regular social and physical activity Psychosocial Interventions Evidence-based Psychotherapy:
- Cognitive-behavioural therapy (CBT) Other Psychotherapy Interventions:
- Depending on availability
Psychosocial Interventions
Evidence-based Psychotherapy:
- Cognitive-behavioural therapy (CBT)
Other Psychotherapy Interventions:
- Depending on availability
Anxiety/Mood Disorders
- •SSRI, mirtazepine, TCA
PTSD
- •SSRI
PTSD & Sleep Disorder
- Trazadone, mirtazapine, prazosin
*These medications are used “off-label”
Adapted from Guideline for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms, Third Edition Acronyms: Post-traumatic stress disorder (PTSD); Selective serotonin reuptake inhibitors (SSRI); Tricyclic antidepressants (TCA)