Sertraline for Major Depression During the Year Following Traumatic Brain Injury: A Randomized Controlled Trial

Abstract

Objective Major depressive disorder (MDD) is common and associated with impaired functioning after traumatic brain injury (TBI). Few placebo-controlled antidepressant trials exist in this population. We evaluated the efficacy and tolerability of sertraline for MDD within one year of sustaining a TBI. Setting Level I trauma center. Participants Adults with MDD within one year of hospitalization for complicated mild to severe TBI. Design Randomized, double-blind, placebo-controlled trial. Main Measures 12-week treatment response on 17-item Hamilton Depression Rating Scale. We also assessed symptom improvement and remission. Results We randomized 62 participants: 32% sustained a severe TBI, 68% had significant anxiety, 63% had history of prior MDD, 69% had history of alcohol or drug dependence. Depression significantly improved from baseline to 12 weeks in both treatment groups (P<.001). There were no significant differences between the sertraline and placebo groups over 12 weeks on depression severity, response or remission. The sertraline group had significant improvement on speed of information processing compared to the placebo group (P<.006). Conclusion Sertraline monotherapy was not superior to placebo for MDD in people with post-acute complicated mild to severe TBI. Research is needed on the effectiveness of interventions that also address the significant psychosocial needs of this population.

Repetitive Transcranial Magnetic Stimulation with Resting-State Network Targeting for Treatment-Resistant Depression in Traumatic Brain Injury: A Randomized, Controlled, Double-Blinded Pilot Study

“…7,8 Despite this established efficacy, rTMS has not been investigated in the setting of depression associated with traumatic brain injury (TBI), 9 which affects nearly half of TBI patients. 10 While traditional approaches to antidepressant pharmacotherapy and psychotherapy have failed to demonstrate benefit in randomized controlled trials for TBI-associated depression, 11,12 rTMS may hold unique promise due to its structural neurorehabilitative effects. Excitatory stimulation also has been shown to accelerate stroke recovery when applied over the affected cortex.…”

Individualized connectome-targeted transcranial magnetic stimulation for neuropsychiatric sequelae of repetitive traumatic brain injury in a retired NFL player

“…rTMS selectively modulates cortical excitability 4 , which is often affected in traumatic brain injury (TBI) 5 . rTMS has thus been proposed as a potential treatment for patients with TBI-associated depression 6 , especially given that these patients may be less responsive to antidepressant pharmacotherapy 7,8 . While concern for rTMS-induced seizure risk often limits its use in TBI, this risk appears to be elevated primarily in penetrating/hemorrhagic injuries rather than diffuse/multifocal axonal injury 9,10 .…”

“…Individualized functional localization is particularly challenging in traumatic brain injury (TBI), which causes multifocal white matter injury 29 and less-predictable FC changes 30 . However, there is a need for neuromodulatory treatment approaches given the lack of effective antidepressant treatments for TBIassociated depression 8 . Like major depression, TBI can affect FC in anterior cingulate cortex (ACC), DLPFC, DAN, and DMN 31-35 .…”

Individualized Connectome-Targeted Transcranial Magnetic Stimulation for Neuropsychiatric Sequelae of Repetitive Traumatic Brain Injury in a Retired NFL Player

“…rTMS selectively modulates cortical excitability (3), which is often affected in traumatic brain injury (TBI) (4). rTMS has thus been proposed as a potential treatment for patients with TBI-associated depression (5), especially given that these patients may be less responsive to antidepressant pharmacotherapy (6). While concern for rTMSinduced seizure risk often limits its use in TBI, this risk appears to be elevated primarily in penetrating-hemorrhagic injuries rather than diffuse-multifocal axonal injury (7).…”

“…Individualized functional localization is particularly challenging in TBI, which causes multifocal white matter injury (27) and less predictable functional connectivity changes (28). However, there is a need for neuromodulatory treatment approaches given the lack of effective antidepressant treatments for TBI-associated depression (6). Like major depression, TBI can affect functional connectivity in anterior cingulate cortex (ACC), DLPFC, DAN, and DMN (29)(30)(31)(32)(33).…”