Treatment for Depression after Traumatic Brain Injury: A Systematic Review

Abstract

The aim of this systematic review was to critically evaluate the evidence on interventions for depression following traumatic brain injury (TBI) and provide recommendations for clinical practice and future research. We reviewed pharmacological, other biological, psychotherapeutic, and rehabilitation interventions for depression following TBI from the following data sources: PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar. We included studies written in English published since 1980 investigating depression and depressive symptomatology in adults with TBI; 658 articles were identified. After reviewing the abstracts, 57 articles met the inclusion criteria. In addition to studies describing interventions designed to treat depression, we included intervention studies in which depressive symptoms were reported as a secondary outcome. At the end of a full review in which two independent reviewers extracted data, 26 articles met the final criteria that included reporting data on participants with TBI, and using validated depression diagnostic or severity measures pre- and post-treatment. Three external reviewers also examined the study methods and evidence tables, adding 1 article, for a total of 27 studies. Evidence was classified based on American Academy of Neurology criteria. The largest pharmacological study enrolled 54 patients, and none of the psychotherapeutic/rehabilitation interventions prospectively targeted depression. This systematic review documents that there is a paucity of randomized controlled trials for depression following TBI. Serotonergic antidepressants and cognitive behavioral interventions appear to have the best preliminary evidence for treating depression following TBI. More research is needed to provide evidence-based treatment recommendations for depression following TBI.

Pilot study to develop telehealth tinnitus management for persons with and without traumatic brain injury

“…Most of the participants in this study screened negative for depression, although it was noted that the mTBI group screened positive for depression most often. These findings are consistent with the literature that provides substantial evidence that TBI is associated with sleep disturbance, anxiety, PTSD, and depression [50][51][52][53][54][55].…”

Treatment for depression following mild traumatic brain injury in adults: A meta-analysis

“…Thus, there is a clear need for large randomised controlled trials of treatment for depression after mild TBI. Overall, the findings from the current meta-analysis support the conclusions of previous reviews, that is, there is insufficient evidence to TREATMENT FOR DEPRESSION AFTER MILD TBI 14 recommend a particular type of treatment for depression after mild TBI (Warden, Gordon et al 2006;Chew and Zafonte 2009;Fann, Hart et al 2009). …”

“…To ensure best coverage of the literature the Digital Dissertations database was also searched, as were the reference lists of all relevant papers, including previous reviews (Gualtien 1999;Comper, Bisschop et al 2005;Fann, Hart et al 2009), to check for any new studies that had not already been identified. Citations to key articles were also identified through searching the Web of Science and checked for any studies not already identified.…”

“…The Neurobehavioural Guidelines Working Group (Warden, Gordon et al 2006) suggest the use of amitriptyline, desipramine and sertraline, even though they note a lack of evidence to support any specific recommendations. A more recent systematic review (Fann, Hart et al 2009) concluded that serotonergic antidepressants and cognitive behavioural interventions appeared to be the most promising interventions for depression following TBI, however they also noted that the studies they reviewed were difficult to compare due to study samples differing in TBI severity and acuity, intervention type, length of treatment and use of various outcome measures. In an attempt to obtain a clearer picture of the most efficacious treatment for depression following TBI, the current meta-analysis focuses on those with mild TBI, as they are the largest patient group.…”

The Use of a Rehabilitation Team to Manage Outcome after Emergency Head Injury Admission

“…We also found that a considerable number of patients live alone and that depression was common with 32% showing significant depressive symptoms. It is already well known that mood disorders are common after brain injury [31,32]. Emotional difficulties are magnified in individuals with cognitive and physical impairments and our results highlight the need to address this.…”