The Effect of Antidepressants on Depression After Traumatic Brain Injury: A Meta-analysis

Kreitzer, Natalie; Ancona, Rachel M.; McCullumsmith, Cheryl B.; Kurowski, Brad G.; Foreman, Brandon; Ngwenya, Laura B.; Adeoye, Opeolu

doi:10.1097/htr.0000000000000439

Cited by 44 publications

(29 citation statements)

References 57 publications

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“…Depression is a common post-TBI disturbance that is often treated with neuroactive medication. Post-TBI depression is generally managed with selective serotonin reuptake inhibitors (SSRIs), despite only minimal evidence of their efficacy in TBI (Yue et al, 2017; Kreitzer et al, 2018). It is suggested that there may be a causative relationship between depression and dysfunctional adult neurogenesis, with antidepressant medications exhibiting their effects via increases in neurogenesis (Santarelli et al, 2003; Eisch and Petrik, 2012; Yun et al, 2016).…”

Section: The Effect Of Tbi Interventionsmentioning

confidence: 99%

Impact of Traumatic Brain Injury on Neurogenesis

Ngwenya

Danzer

2019

Front. Neurosci.

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New neurons are generated in the hippocampal dentate gyrus from early development through adulthood. Progenitor cells and immature granule cells in the subgranular zone are responsive to changes in their environment; and indeed, a large body of research indicates that neuronal interactions and the dentate gyrus milieu regulates granule cell proliferation, maturation, and integration. Following traumatic brain injury (TBI), these interactions are dramatically altered. In addition to cell losses from injury and neurotransmitter dysfunction, patients often show electroencephalographic evidence of cortical spreading depolarizations and seizure activity after TBI. Furthermore, treatment for TBI often involves interventions that alter hippocampal function such as sedative medications, neuromodulating agents, and anti-epileptic drugs. Here, we review hippocampal changes after TBI and how they impact the coordinated process of granule cell adult neurogenesis. We also discuss clinical TBI treatments that have the potential to alter neurogenesis. A thorough understanding of the impact that TBI has on neurogenesis will ultimately be needed to begin to design novel therapeutics to promote recovery.

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Section: The Effect Of Tbi Interventionsmentioning

confidence: 99%

Impact of Traumatic Brain Injury on Neurogenesis

Ngwenya

Danzer

2019

Front. Neurosci.

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“…This was consistent with the results of previous pair-wise meta-analyses, which addressed the benefits of pharmacologic treatments for post-TBI depressive symptoms. [10][11][12] In addition, based on the frequentist model of network meta-analysis and the SUCRA method, the present network meta-analysis provided further evidence to support the superiority of individual pharmacologic treatments. Specifically, our findings demonstrated that methylphenidate was associated with the best improvement of all pharmacologic treatments.…”

Section: Discussionmentioning

confidence: 70%

“… 9 In spite of the lack of specific pharmacologic guidelines for the treatment of post-TBI depression, several pair-wise meta-analyses have investigated the efficacy of antidepressants, with mixed results. 10 – 12 On the other hand, nonpharmacologic treatments encompass psychotherapeutic approaches such as supportive psychotherapy, cognitive behavioural therapy (CBT) and mindfulness-based CBT. 13 Surprisingly, despite the prevalence and severity of post-TBI depression, there is no consensus on standard therapeutic guidelines.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic benefits of pharmacologic and nonpharmacologic treatments for depressive symptoms after traumatic brain injury: a systematic review and network meta-analysis

Cheng¹,

Tseng

Wu³

et al. 2021

jpn

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Background: Depression is a common morbidity after traumatic brain injury. This network meta-analysis investigated the efficacy and tolerability of pharmacologic and nonpharmacologic interventions for depression after traumatic brain injury. Methods: We extracted randomized controlled trials examining pharmacologic or nonpharmacologic interventions with placebo-or active-controlled designs from PubMed, the Cochrane Library and ScienceDirect, from inception to October 30, 2018. We based study selection and extraction of a predefined list of variables on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, and conducted meta-analysis procedures using random effects modelling. Primary outcomes were changes in depressive symptom severity after pharmacologic or nonpharmacologic treatment; the secondary outcome was tolerability, reflected in overall patient dropout rates. Results: Our analysis of 27 randomized controlled trials (10 pharmacologic, total n = 483, mean age = 37.9 yr; 17 nonpharmacologic, total n = 1083, mean age = 38.0 yr) showed that methylphenidate had significantly superior efficacy compared to placebo or control (standardized mean difference-0.91, 95% confidence interval [CI]-1.49 to-0.33). Sertraline was associated with significantly lower tolerability (i.e., a higher dropout rate) compared to placebo or control (odds ratio 2.65, 95% CI 1.27 to 5.54). No nonpharmacologic treatment was more effective than the others, and we found no significant differences in tolerability (i.e., dropout rates) among the nonpharmacologic treatments. Limitations: Heterogeneity in participant characteristics (e.g., comorbidities), study designs (e.g., trial duration) and psychopathology assessment tools, as well as small trial numbers for some treatment arms, could have been confounders. Conclusion: The present network meta-analysis suggests that methylphenidate might be the best pharmacologic intervention for depressive symptoms related to traumatic brain injury. None of the nonpharmacologic interventions was associated with better improvement in depressive symptoms than the others or than control conditions. None of the pharmacologic or nonpharmacologic treatments had inferior tolerability compared to placebo or controls except for sertraline, which had significantly lower tolerability than placebo.

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“…Selective serotonin reuptake inhibitors (SSRIs) are currently the first-line recommended treatment for depression in patients recovering from concussion [4]. However, despite their widespread use for treating depression in patients with and without neurologic conditions, a recent meta-analysis suggested that SSRIs were actually no more effective at reducing depressive symptoms in mTBI patients than placebo [5]. While caution is warranted in prematurely abandoning the use of SSRIs for this population, given that the benefits may still outweigh potential risks [4], these negative findings should motivate researchers to expand their horizons to identify additional therapeutic options for treating depression following concussion.…”

Section: Concussion and Depressionmentioning

confidence: 99%

Lightening the mood: evidence for blue light exposure in the treatment of post-concussion depression

Killgore

2020

Expert Review of Neurotherapeutics

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The Effect of Antidepressants on Depression After Traumatic Brain Injury: A Meta-analysis

Abstract: This meta-analysis found no significant benefit of antidepressant over placebo in the treatment of MDD following TBI. Pooled estimates showed a high degree of bias and heterogeneity. Prospective studies on the impact of antidepressants in well-defined cohorts of TBI patients are warranted.

Cited by 44 publications

References 57 publications

Impact of Traumatic Brain Injury on Neurogenesis

Impact of Traumatic Brain Injury on Neurogenesis

Therapeutic benefits of pharmacologic and nonpharmacologic treatments for depressive symptoms after traumatic brain injury: a systematic review and network meta-analysis

Lightening the mood: evidence for blue light exposure in the treatment of post-concussion depression

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