Managing depression in brain injury rehabilitation: the use of an integrated care pathway and preliminary report of response to sertraline

Turner-Stokes, Lynne; Hassan, Nibras; Pierce, Katherine; Clegg, Frances

doi:10.1191/0269215502cr489oa

Cited by 50 publications

(38 citation statements)

References 21 publications

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“…41,42 Despite their relative effectiveness, TCAs may not be as well tolerated as the newer SSRIs and are used much less frequently. [43][44][45] In the current study, SSRI use was associated with a somewhat larger, positive treatment effect than TCA use, although both effects were significant. Lee et al 33 noted that methylphenidate, when used for the treatment of depression, may be as effective as an SSRI in improving depressive symptomatology while also having a beneficial influence on cognitive recovery and daytime alertness.…”

Section: Discussioncontrasting

confidence: 50%

“…34 Although authors of existing guidelines for the use of antidepressant medication after acquired brain injury have recommended a treatment duration of 6 months (following a period in which the appropriate treatment and optimal dose are determined), there may be relatively little published research evidence to support this recommendation, particularly within the specific population of individuals with TBI. 45 In the present review, most identified trials reported the provision of short periods of treatment, ranging from 4 to 10 weeks. This may have been insufficient to optimize the dose of antidepressant given and observe the treatment potential of pharmacotherapy.…”

Section: Discussionmentioning

confidence: 97%

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Pharmacotherapy for Depression Posttraumatic Brain Injury: A Meta-analysis

Salter

McClure

Foley

et al. 2016

Journal of Head Trauma Rehabilitation

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 97%

Pharmacotherapy for Depression Posttraumatic Brain Injury: A Meta-analysis

Salter

McClure

Foley

et al. 2016

Journal of Head Trauma Rehabilitation

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“…Despite possible links with the serotonergic system, there is a paucity of data concerning efficacy and adverse effects for selectiveserotonin reuptake inhibitor (SSRI) treatment in depressed TBI patients. Only two randomized controlled trials [13,14], one single-blind trial [15] and four open-label trials [16][17][18][19] have examined SSRI treatment in this patient population and those studies reported a significant improvement in depressive symptoms. More recently, in an open-label citalopram treatment study mg/day for 6-10 weeks) on 65 patients with TBI and MDE (54 with major depression due to TBI and 11 with depressive features), a 28% response rate was observed [20].…”

Section: Introductionmentioning

confidence: 99%

Genetic predictors of response to treatment with citalopram in depression secondary to traumatic brain injury

Lanctôt¹,

Rapoport

Chan³

et al. 2010

Brain Injury

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Objectives-To determine which serotonergic system-related single nucleotide polymorphisms (SNPs) predicted variation in treatment response to citalopram in depression following a traumatic brain injury (TBI).Methods-Ninety (50 M/40 F, aged 39.9, SD = 18.0 years) post-TBI patients with a major depressive episode (MDE) were recruited into a 6-week open-label study of citalopram (20 mg/ day). Six functional SNPs in genes related to the serotonergic system were examined: serotonin transporter (5HTTLPR including rs25531), 5HT1A C-(1019)G and 5HT2A T-(102)C, methylene tetrahydrofolate reductase (MTHFR) C-(677)T, brain-derived neurotrophic factor (BDNF) val66met and tryptophan hydroxylase-2 (TPH2) G-(703)T. Regression analyses were performed using the six SNPs as independent variables: Model 1 with response (percentage Hamilton Depression (HAMD) change from baseline to endpoint) as the dependent variable and Model 2 with adverse event index as the dependent variable (Bonferroni corrected p-value <0.025). Results-MTHFR CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptConclusion-Results suggest that polymorphisms in genes related to the serotonergic system may help predict short-term response to citalopram and tolerability to the medication in patients with MDE following a TBI. KeywordsTraumatic brain injury; serotonin receptors; serotonin transporter; brain derived neurotrophic factor (BDNF); methylenetetrahydrofolate reductase (MTHFR); tryptophan hydroxylase (TPH)

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“…• Improvement in symptoms of depression or lability is often reported, [15][16][17][18][19] but actual gains in function or quality of life are harder to demonstrate. 20 • Selective serotonin re-uptake inhibitors (SSRIs) appear generally to be about as effective as tricyclic antidepressants (TCAs), but have fewer reported side-effects, 21 and are probably therefore cost efficient despite the slightly higher drug costs.…”

Section: The Evidence For Use Of Antidepressants In People With Abimentioning

confidence: 99%

Use of antidepressant medication following acquired brain injury: concise guidance

Turner-Stokes

MacWalter

2005

Clinical Medicine

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Introduction and aimsAcquired brain injury (ABI) -whether due to stroke, trauma or any other cause -is frequently complicated by depression, which can interfere with rehabilitation, leading to poorer outcomes. The use of antidepressants in the treatment of depression following ABI is increasingly widespread. Because it may not be practical to involve a psychiatrist in all cases, first line management is usually undertaken by general clinicians. However, at present, many people are given antidepressant medication as a matter of routine -often without their knowledge and without any clear treatment plan.The aim of these guidelines is to provide the general physician, GP or other clinician with a safe approach to managing minor to moderate depression in the context of rehabilitation or recovery from ABI, and to identify those individuals who require referral to mental health services.The guidelines focus on the use of antidepressant drugs, but these are by no means the only way to manage depression following ABI, and it is important in any event to consider other contributing factors before reaching for the prescription pad. Alternative interventions may include simple measures to address environmental or other factors which contribute to low mood (such as missing their home and family, or worries about life outside hospital), and non-pharmacological interventions, such as 'talking therapies' , for patients who have the cognitive and communicative abilities to engage successfully.The guidelines have been prepared in accordance with the principles laid down by the AGREE Collaboration (Appraisal of Guidelines for REsearch and Evaluation). 1 A summary of the guideline development process is given in Table 1. Although developed specifically with brain injury in mind, the main principles applied here may also be applicable in other conditions, especially where the person's ability to interact is impaired.I CLINICAL GUIDANCE 268

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Managing depression in brain injury rehabilitation: the use of an integrated care pathway and preliminary report of response to sertraline

Cited by 50 publications

References 21 publications

Pharmacotherapy for Depression Posttraumatic Brain Injury: A Meta-analysis

Pharmacotherapy for Depression Posttraumatic Brain Injury: A Meta-analysis

Genetic predictors of response to treatment with citalopram in depression secondary to traumatic brain injury

Use of antidepressant medication following acquired brain injury: concise guidance

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