Treatment for depression following mild traumatic brain injury in adults: A meta-analysis

Abstract

Primary Objective: Development of depression after TBI is linked to poorer outcomes. The aim of this manuscript is to review evidence for the effectiveness of current treatments.Research Design: Two meta-analyses were undertaken to examine the effectiveness of both pharmacological and non-pharmacological interventions for depression after mild -TBI Method and Procedures: PubMed, Medline, PsychInfo, Web of Science, and Digital Dissertations were searched and 13 studies located. Meta Analyst Beta 3.13 was used to conduct analyses of pre versus post effects then to examine treatment group versus control group effects. Main Outcomes and Results:Studies using a pre-post design produced an overall effect size of 1.89 (95% CI 1.20-2.58, p<.001), suggesting that treatments were effective, however the overall effect for controlled trials was 0.46 (95%CI -0.44-1.36, p<.001), which favoured the control rather than treatment groups. Conclusions:This study highlights the need for additional large well controlled trials of effective treatments for depression post-TBI.

Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand

“…There remains a lack of evidence on the use of pharmacological and nonpharmacological treatments after mTBI, although early information and advice has been found to have beneficial effects on recovery. 35,36 Overall, this study has highlighted that, although some people recover well after TBI, nearly half continue to experience significant persistent symptoms 1 year after mTBI. The impact of these symptoms on people's ability to function in everyday life suggests that early intervention is needed and can improve longer-term outcomes to facilitate the resolution of symptoms.…”

Telephone and In-Person Cognitive Behavioral Therapy for Major Depression after Traumatic Brain Injury: A Randomized Controlled Trial

“…[23][24][25] Clearly, more research is needed to examine the efficacy and potential mediators of 54 FANN ET AL.…”

“…Recent reviews of depression treatment literature in people with TBI conclude that serotonergic antidepressants and cognitive behavioral therapy (CBT) appear to be the most promising approaches to treating depression following TBI; however, there is an absence of high quality depression treatment trials and no published psychotherapy trials for MDD. [23][24][25] Important theoretical and preliminary work has described how CBT could be adapted for people with TBI. [26][27][28][29] Structural equation modeling has shown that post-TBI depression is consistent with cognitive behavioral theory, 30 and preliminary CBT trials have been promising for decreasing depressive symptoms.…”

Amantadine preserves dopamine level and attenuates depression-like behavior induced by traumatic brain injury in rats

“…Depression is the most commonly reported psychiatric consequence, with studies suggesting that up to 28.6% of TBI patients develop major depression within 1 year following injury [34][35][36]. However, the present treatment of post-TBI depression is far from satisfactory [37]. Hence studying its treatment is clearly essential.…”

“…Nevertheless, unfavorable outcomes in clinical trials have limited their clinical application. A recent meta-analysis showing the overall effect of anti-depression drugs used in post-TBI depression suggests that active treatment is no more beneficial than placebo [37]. Methylphenidate was the only drug superior to placebo [57].…”