A narrative literature review of depression following traumatic brain injury: prevalence, impact, and management challenges

Abstract

Depression is one of the most common conditions to emerge after traumatic brain injury (TBI), and despite its potentially serious consequences it remains undertreated. Treatment for post-traumatic depression (PTD) is complicated due to the multifactorial etiology of PTD, ranging from biological pathways to psychosocial adjustment. Identifying the unique, personalized factors contributing to the development of PTD could improve long-term treatment and management for individuals with TBI. The purpose of this narrative literature review was to summarize the prevalence and impact of PTD among those with moderate to severe TBI and to discuss current challenges in its management. Overall, PTD has an estimated point prevalence of 30%, with 50% of individuals with moderate to severe TBI experiencing an episode of PTD in the first year after injury alone. PTD has significant implications for health, leading to more hospitalizations and greater caregiver burden, for participation, reducing rates of return to work and affecting social relationships, and for quality of life. PTD may develop directly or indirectly as a result of biological changes after injury, most notably post-injury inflammation, or through psychological and psychosocial factors, including pre injury personal characteristics and postinjury adjustment to disability. Current evidence for effective treatments is limited, although the strongest evidence supports antidepressants and cognitive behavioral interventions. More personalized approaches to treatment and further research into unique therapy combinations may improve the management of PTD and improve the health, functioning, and quality of life for individuals with TBI.

The effect of time on cognitive impairments after non-traumatic subarachnoid haemorrhage and after traumatic brain injury

“…However, in our study sample, HADS anxiety or depression scores did not change significantly between the consecutive time points or over the total observation period from 3 to 12 months after SAH or TBI and we observed no obvious correlations between BNIS T scores and HADS scores. At 12 months, approximately one fifth of patients in both groups fulfilled criteria for depression or anxiety, which is in accordance with previous studies (66)(67).…”

Executive (dys)function after traumatic brain injury: special considerations for behavioral pharmacology

“…However, this was only measured at between one and 12 days postinjury ( Markianos et al , 1992 , 1996 ). Although NE has not been a prime target of interest for clinical TBI research, selective NE reuptake inhibitors are a relatively common treatment for depression and anxiety, and may also improve attention, all of which suffer some impairment in TBI patients ( Hibbard et al , 1998 ; Jorge and Robinson, 2003 ; Juengst et al , 2017 ). Thus, further clinical work investigating NE activity following clinical TBI is needed.…”

“…Discrepancies in the nature of such changes in 5-HT metabolite levels may be explained, at least in part, by measurement time points, with 5-HT being elevated during the acute post-TBI phase and reduced during chronic recovery ( Porta et al , 1975 ; Vecht et al , 1976 ; Majchrzak et al , 1979 ; Markianos et al , 1992 , 1996 ). The mood-altering effects of 5-HT have been a primary area of focus, given that the development of mood disorders such as depression and anxiety are prevalent following brain injury ( Hibbard et al , 1998 ; Jorge and Robinson, 2003 ; Juengst et al , 2017 ) and the most common treatment for such disorders are selective 5-HT reuptake inhibitors (SSRIs; Ciuna et al , 2004 ). Although effects have not been assessed directly, it is possible that 5-HT signaling disruption following TBI may also influence executive function ( Cifariello et al , 2008 ).…”

Screening for Traumatic Brain Injury in Prostituted Women

“…We recommend investigation of symptoms of PTSD, depression, and other known psychological consequences of IPV and prostitution (Juengst, Kumar, & Wagner, 2017). The overlap between symptoms of TBI and PTSD is a crucial area for future research because symptoms of TBI are often overlooked because they are perceived as symptoms of PTSD (Barker-Collo et al, 2013).…”