Academic journal article East Asian Archives of Psychiatry

Antidepressants for Depression Associated with Traumatic Brain Injury: A Meta-Analytical Study of Randomised Controlled Trials

Academic journal article East Asian Archives of Psychiatry

Antidepressants for Depression Associated with Traumatic Brain Injury: A Meta-Analytical Study of Randomised Controlled Trials

Article excerpt

Introduction

Traumatic brain injury (TBI) is extremely common. In the US alone, more than 1,400,000 new cases of head trauma occur every year; over 3 million patients have TBI-related disabilities. (1) The direct medical and indirect costs for head injuries for the year 2000 alone exceeded US$60 billion. (1) The population of brain trauma patients is relatively young with a presumably long life expectancy. (2) In fact, in individuals aged < 45 years, head trauma is the main cause of death and disability. (3)

The psychological difficulties that may arise after a brain trauma vary widely and are of diverse severity. They include mood disorders, generalised anxiety disorder, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder. (4) Approximately 40% of patients with TBI have at least 2 psychiatric conditions, with depressive disorders having the lion's share among them--studies report rates between 16% and 60%. (3,5) Major depression afflicts 24% to 35% of TBI patients, with a prevalence of 61% within the first 7 years post-trauma. (3,6-8) The incidence of head trauma in men is apparently double that in women who nonetheless appear to have double the incidence of post-injury depressive disorders.9 Major and moderate depression, adjustment disorder with depressive symptoms, and dysthymia can persist for (or occur) a long time, often years, after the injury. (10) Such disorders appear to be related to an increased risk of suicide with a study reporting a 15% attempted suicide rate 5 years post-injury. (11) Also, it appears that individuals with milder forms of head injury are at higher risk of depressive disorders. (12-14)

The impact of co-morbid depressive disorders on a patient's quality of life can be severe, with difficulties returning to work as well as enjoying social activities and recreation time, sexual dysfunction, deterioration of general health, and increased caregiver burden. (15,16) Depression can also delay the recovery of several post-trauma physical symptoms, such as headache, neck pain, blurred vision, sleep problems, fatigue and cognitive symptoms, and can lead to prolonged and ineffective hospital stays. (1,17)

Pharmacotherapy constitutes the mainstay of treatment for moderate and major depressive disorders following head injury. The present study systematically searched and meta-analysed the latest pertinent studies in an attempt to determine the best evidence-based antidepressant medication for post-TBI depressive disorders. We also highlighted the gaps in the literature and provided suggestions for further research.

Methods

Study Selection and Eligibility Criteria

This meta-analysis was presented according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines for systematic reviews and meta-analyses. (18) Eligible placebo-controlled randomised controlled trials (RCTs) that compared antidepressants with placebo in adult patients with depressive disorders (major and moderate depression, adjustment disorder with depressive symptoms, dysthymic disorder) following TBI were identified in MEDLINE, SCOPUS, and the CENTRAL Register of Controlled Trials. The following keywords were used in all database searches: "antidepressants", "traumatic brain injury", "depressive disorders", "depression", "brain trauma", "brain injury", "head trauma", "head injury", "selective serotonin reuptake inhibitors", "serotonin-norepinephrine reuptake inhibitors", "serotonin modulators and stimulators", "serotonin antagonists and reuptake inhibitors", "norepinephrine reuptake inhibitors", "tricyclic antidepressants", "tetracyclic antidepressants", and "monoamine oxidase inhibitors". No language or other filters were imposed. Our search was restricted to the period from 1990 to 2017 with the last search performed on 6 August 2017. We also examined the references of all retrieved articles to identify studies that might have been missed by the initial database investigation. …

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