Use of depo-provera to control sexual aggression in persons with traumatic brain injury

Objective: To determine the effectiveness of medroxyprogesterone acetate (Depo-Provera) treatment in conjunction with psychological counseling on the hypersexual behavior seen in individuals with traumatic brain injury. Design: A retrospective review of the use of Depo-Provera in adult male patients who sustained a traumatic brain injury from blunt trauma and subsequently exhibited hypersexual behavior. All individuals were treated with a combination of weekly Depo-Provera injections and psychological counseling; the latter was educational/behavioral in nature and took into account such problems as deficits in awareness and empathy, poor memory, concreteness, and rigidity. Follow-up examinations were done every 3 months for at least 2 years and every 6 months thereafter. Setting: Individuals were seen in outpatient treatment and reside in community environments. Patients: Eight males (average age = 17.5 years at the time of head trauma) who developed problematic hypersexual behavior approximately 3 years later. These individuals were consecutive referrals to a psychiatric practicc with expertise in the treatment of hypersexual behavior. Intervention Weekly intramuscular Depo-Provera injections were used in conjunction with counseling. Main Outcome Measures Incidence of hypersexual behavior; change in testosterone level. Results: In all cases, cessation of the unacceptable sexual behavior was noted while the men received treatment (mean duration = 42 months). Three individuals remain on Depo-Provera, and two have successfully discontinued treatment for 2 and 10 years, respectively, with no further problems. The remaining three reoffended when medication was discontinued, a decision made unilaterally by their families. Conclusions: The use of Depo-Provera in conjunction with counseling may offer an opportunity to control aberrant sexual behaviors after brain injury. However, only a minority of individuals stay in good control after discontinuing Depo-Provera.