Pharmacotherapy for Depression Posttraumatic Brain Injury: A Meta-analysis

Salter, Katherine; McClure, Andrew; Foley, Norine; Sequeira, Keith; Teasell, Robert

doi:10.1097/htr.0000000000000193

Cited by 34 publications

(27 citation statements)

References 44 publications

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“…As far as we can determine, prophylactic pharmacological management to reduce the risk of depression post-TBI has not been considered in clinical guidelines for TBI. Prior systematic reviews and metaanalyses of the pharmacological management of symptomatic depression post-TBI report that pharmacotherapy post-TBI may be associated with a reduction in depressive symptoms; 23,31,32 no systematic reviews could be found that have identified and synthesized the evidence for prophylactic pharmacological management of depression post-TBI.…”

Section: Introductionmentioning

confidence: 99%

Prophylaxis Pharmacotherapy to Prevent the Onset of Post-Traumatic Brain Injury Depression: A Systematic Review

Clay

Hicks

Zaman

et al. 2019

Journal of Neurotrauma

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Background: Depression is a common psychiatric problem following traumatic brain injury (TBI) with reported prevalence rates of 30-77% in the first year post-TBI. Given the negative influence of post-TBI depression on cognition, interpersonal, social, physical and occupational functioning; early initiation of pharmacotherapy to prevent post-TBI depression has been considered. This systematic review will synthesize the available evidence from published studies on the effectiveness and harms of pharmacotherapy for the secondary prevention of post-TBI depression. Method: Studies published prior to October 2018 were eligible for inclusion. Six databases were searched, with additional searching of key additional documents. Studies meeting inclusion criteria were evaluated for methodological quality. Results: Six articles addressing five studies met inclusion criteria. Study designs included three randomized controlled trials (RCT), two retrospective cohorts and one case-control. Prophylactic pharmacotherapy included antidepressants, beta-blockers and statins. In one RCT, the number-neededto-treat with sertraline to prevent one case of depression post-TBI at 24 weeks was 5.9 (95%CI: 3.1-71.1). In a second RCT affected by significant attrition, sertraline had no effect. Prescribing beta-blockers prior to TBI reduced the depression risk regardless of the specific brain trauma. TBI patients with pre-existing hyperlipidemia not treated with statins had an increased depression risk compared to those without hyperlipidemia. Conclusion: Overall this systematic review yielded mixed evidence of prophylactic efficacy and insufficient evidence of harm. In the absence of tolerability data, existing data are insufficient to recommend sertraline prophylaxis. Optimal timing and treatment duration with identification of patients most likely to benefit from prophylaxis require further consideration. Dedicated prospective studies assessing the effects of beta-blockers and statins on post-TBI depression are required.

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Section: Introductionmentioning

confidence: 99%

Prophylaxis Pharmacotherapy to Prevent the Onset of Post-Traumatic Brain Injury Depression: A Systematic Review

Clay

Hicks

Zaman

et al. 2019

Journal of Neurotrauma

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“…We recognize that a systematic review of randomized placebo-controlled trials is the highest level of evidence, but caution clinicians against changing their practice on the basis of the Kreitzer et al [9] study. Clinicians who continue to prescribe will be compliant with practice guidelines [7, 8] and the best available evidence [6, 9, 10]. Selective serotonin reuptake inhibitors (e.g., sertraline or citalopram) are generally recommended as first-line [7, 18, 22, 23].…”

Section: Discussionmentioning

confidence: 99%

“…Prior meta-analyses have concluded that antidepressant medications are effective for depression in a variety of neurological disorders [5], including TBI [6]. Correspondingly, selective serotonin reuptake inhibitors are recommended as first-line treatment for depression in recently published expert consensus clinical practice guidelines for management of TBI [7, 8].…”

Section: Main Textmentioning

confidence: 99%

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Antidepressants for depression after concussion and traumatic brain injury are still best practice

Silverberg

Panenka

2019

BMC Psychiatry

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Background Depression is a common complication of traumatic brain injury (TBI). New evidence suggests that antidepressant medication may be no more effective than placebo in this population. Main body Selective serotonin reuptake inhibitors are recommended as first-line treatment for depression in contemporary expert consensus clinical practice guidelines for management of TBI. This recommendation is based on multiple prior meta-analyses of clinical trials in depression after TBI as well as depression in the general population. The evidence is mixed. A recent clinical trial and new meta-analysis including that trial found no benefit of antidepressants for depression following TBI. We argue that this finding should not change practice, i.e., patients who present with depression after TBI should still be considered for antidepressant treatment, because they may (1) benefit from robust placebo effects, (2) benefit from an alternative or adjunctive medication if the agent prescribed first does not achieve a depression remission, and (3) make improvements that are not captured well by traditional depression outcome measures, which are confounded by TBI sequelae. Patients with mild TBI are especially appropriate for antidepressant therapy because they, on average, more closely resemble patients with no known TBI history enrolled in typical primary Major Depressive Disorder clinical trials than patients enrolled in TBI trials in placebo-controlled trials published to date. Conclusion TBI, and especially mild TBI, is not a contraindication for antidepressant therapy. Health providers should routinely screen and initiate treatment for depression after TBI.

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“…Small open-label and placebo-controlled trials have found sertraline, citalopram, milnacipran, and methylphenidate effective for post-TBI depression (66). In a meta-analysis of randomized controlled trials (67), methylphenidate was also found to be effective for attention deficits after mTBI.…”

Section: Treatmentsmentioning

confidence: 99%

Prolonged Postconcussive Symptoms

Quinn

Mayer

Master

et al. 2018

AJP

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Pharmacotherapy for Depression Posttraumatic Brain Injury: A Meta-analysis

Abstract: Pharmacotherapy after TBI may be associated with a reduction in depressive symptomatology. Given limitations within the available literature, further well-powered, placebo-controlled trials should be conducted to confirm the effectiveness of antidepressant therapy in this population.

Cited by 34 publications

References 44 publications

Prophylaxis Pharmacotherapy to Prevent the Onset of Post-Traumatic Brain Injury Depression: A Systematic Review

Prophylaxis Pharmacotherapy to Prevent the Onset of Post-Traumatic Brain Injury Depression: A Systematic Review

Antidepressants for depression after concussion and traumatic brain injury are still best practice

Prolonged Postconcussive Symptoms

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