Objective: Following traumatic brain injury (TBI), depressive symptoms are common and may influence recovery. However, these drugs are not without side effects--some of them serious--and they should not be used without proper evaluation and monitoring. Hibbard M.R. While more data are needed on the efficacy and tolerability of SNRIs in this population, data from a small study of milnacipran (which is not available in the U.S. or the U.K.) after TBI, and SNRI efficacy data from other populations suggesting higher rates of remission and documenting analgesic effects (Thase, 2008) indicate that SNRIs may be another reasonable option in this population. Marwitz J.H. Ashman T.A. Cox A.L. One class II (Tiersky et al., 2005) and two class IV studies (Anson et al., 2006; Bedard et al., 2003) addressed general emotional distress as a primary outcome; this could include depression, as well as anxiety and other complaints. You may opt-out of email communications at any time by clicking on Review/update the Depression following TBI is associated with worse global outcomes (Federoff et al., 1992), worse social functioning during the first year post-injury (Jorge et al., 1993b; Schoenhuber and Gentilini, 1988), and lower health-related quality of life (Christensen et al., 1994; Rutherford, 1977), even after controlling for medical, demographic, and neuropsychological factors. Ownsworth T. The impact of defensive denial upon adjustment following traumatic brain injury. for their helpful reviews of the methods and evidence tables, and Kurt Johnson, Ph.D., for his helpful review of the manuscript. Fann J.R. Bombardier C.H. One study each included a dual-action serotonin-norepinephrine reuptake inhibitor (SNRI: milnacipran), a psychostimulant (methylphenidate), a cholinesterase inhibitor (donepezil), and an anticonvulsant (carbamazepine). Sertraline versus other antidepressive agents for depression. The new research "provides further support of the possibility that depression following neurological injury could be avoided, rather than . Kolakowsky-Hayner S.A. Gourley E.V., 3rd Kreutzer J.S. Walters B. Whyte J. Zapata A. Zitnay G. Guidelines for the pharmacologic treatment of neurobehavioral sequelae of traumatic brain injury. Bupropion is one of the few antidepressants not frequently associated with sexual side effects. It would also be worthwhile to study depression treatments with efficacy in other medical populations that may be even more feasible for use in TBI populations, including behavioral activation and social problem-solving based treatments. Rae D.S. The class IV study by Perino and associates (Perino et al., 2001) of combination citalopram and carbamazepine did not allow conclusions to be drawn about the efficacy or either of the medications alone. Epub 2008 Dec 30. We searched MEDLINE, SCOPUS, and the Cochrane Central Register of Controlled Trials (CENTRAL). Accessed Aug. 17, 2022. Zaloshnja E. Miller T. Langlois J.A. 1999;53(5 Suppl 2):S68-75 40 this case demonstrates the importance of close monitoring for the Patients with mild TBI are especially appropriate for antidepressant therapy because they, on average, more closely resemble patients with no known TBI history enrolled in typical primary Major Depressive Disorder clinical trials than patients enrolled in TBI trials in placebo-controlled trials published to date. It also showed the ability to inhibit lymphocyte activity. Salomon R.M. Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Dijkers M. Kropp G.C. Engel C.C. Results: We observed a total of 23,021 adverse events. doi: 10.1002/14651858.CD006117.pub4. This review includes 13 studies examining pharmacotherapy for depression (Table 2). More research is needed in psychotherapeutic interventions for depression after TBI, since many of the modifiable risk factors for MDD in this population (ineffective coping, poor problem solving, social isolation, and a lack of pleasant rewarding activities) are potentially amenable to treatment targeting the behavioral level. Frontal lobe dysfunction in secondary depression. Deb S. Lyons I. Koutzoukis C. Ali I. McCarthy G. Rate of psychiatric illness 1 year after traumatic brain injury. health information, we will treat all of that information as protected health Fiebelkorn I.A. Bedard and colleagues (Bedard et al., 2003), in a small (n=10) class IV study, reported marginally significant pre- to post-treatment change on the BDI-II, but results may have been biased by use of three treatment dropouts as a control group. This site needs JavaScript to work properly. Narrow W.E. Living better with hidradenitis suppurativa, Male depression: Understanding the issues, Managing hidradenitis suppurativa: Early treatment is crucial, Hidradenitis suppurativa-related health risks. 2022; doi:10.1016/j.jad.2021.12.134. After a flood, are food and medicines safe to use? Antidepressants are used to treat several conditions, including post-traumatic stress disorder and severe phobias like agoraphobia or social phobia.. 2010;167(3):312320. This content does not have an English version. Cuijpers P. van Straten A. Wamerdam L. Problem solving therapies for depression: A meta-analysis. eCollection 2022. Svendsen H.A. The most recent data from international literature suggest using beta-blockers, neuroleptics, antiepileptics, antidepressants, benzodiazepines, amantadine and other drugs. The fact that depression was not the focus of the psychotherapeutic and rehabilitation study interventions provides an essential context within which to interpret the composition of the treatments reviewed. Accessibility What is pancreatic cancer? Cuijpers P. van Straten A. Wamerdam L. Behavioral activation treatments of depression: A meta-analysis. Kant R. Coffey C.E. Six of these 7 patients improved on desipramine; however, 4 patients who were not responding in the placebo group were crossed over to desipramine after only 1 month. WJP has received consulting fees from Core Capital partners and Drayton Medcanna, and has a private practice in forensic neuropsychiatry. Occipital nerve stimulation: Effective migraine treatment? Antidepressant drugs. Esiri M.M. McMillan T. Brief mindfulness training for attentional problems after traumatic brain injury: A randomised control treatment trial. The sole class I study (Powell et al., 2002) reported no significant effects of such treatment on the proportions of participants who met criteria for depression. Kraus J. Labbate L.A. Ryan L.M. Lipsey J.R. Price T.R. Yavuzer G. Cullen N. Bakdalieh Y. MeSH Tagliaferri F. Compagnone C. Korsic M. Servadei F. Kraus J. With persistence, you and your health care provider can find one that works so that you can enjoy life more fully again. 2021 Jun 15;6(3):CNC92. A diagram of the study selection is shown in Figure 1. Cochrane Database Syst Rev. Johnston M.V. Accessibility Thompson R.S. The .gov means its official. Based on the best evidence available to guide pharmacological treatment, it is advisable to start with low doses of medications with slow titration toward a therapeutic response, being cognizant of adverse effects that may be more common in neurologically-injured patients (e.g., seizures, sedation, and cognitive dysfunction), and using depression measures that have been validated in the TBI population, such as the Patient Health Questionnaire-9 depression scale (PHQ-9) (Fann et al., 2005). In theory, pharmacotherapy, psychotherapy, and alternative approaches might be combined and balanced for individual circumstances, risk factors, and time post-injury. Hart T. Treatment definition in complex rehabilitation interventions. U.S. Food and Drug Administration. Clipboard, Search History, and several other advanced features are temporarily unavailable. Chen J.K. Johnston K.M. Newburn G. Edwards R. Thomas H. Collier J. One study reported results of holistic, interdisciplinary milieu therapy, including individual and group treatment in a day program targeted to a wide range of cognitive and psychosocial outcomes (Svendsen et al., 2004). Temkin N.R. Brooks N. Campsie L. Symington C. Beattie A. McKinlay W. The five year outcome of severe blunt head injury: A relative's view. Is it safe to take an anti-depressant after a brain injury? Seel R.T. Kreutzer J.S. doi: 10.1002/14651858.CD004186. -, Bombardier CH, Fann JR, Temkin NR, Esselman PC, Barber J, Dikmen SS. Introduction: Posted on BrainLine August 30, 2011. Suicidality in children and adolescents being treated with antidepressant medications. However, significant improvement was reported on a primary outcome measure, the Brain Injury Community Rehabilitation Outcome-39 scales (BICRO-39), which includes a scale of psychological well-being. National Institute of Mental Health. The remaining studies either lacked experimental control or used weak controls unlikely to minimize bias, and were classified as class IV. Clearly, the field is in need of large, appropriately controlled pharmacological, psychosocial, alternative, and multi-modal prevention and treatment studies for depression that: In addition, the following specific recommendations are made for both current and future trials. The effectiveness of cognitive-behavioural therapy for post-traumatic headaches. Three of the original 10 patients dropped out (one with mania and one with seizures), leaving 7 in the final analysis. Robinson R.G. doi: 10.1002/14651858.CD006533.pub2. -, Neurology. Federal government websites often end in .gov or .mil. Pilot evaluation of a mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries. Therapeutic benefits of pharmacologic and nonpharmacologic treatments for depressive symptoms after traumatic brain injury: a systematic review and network meta-analysis. An official website of the United States government. Alternatively, cost-effective treatment may require collaborative, multimodal, or stepped-care treatment models to achieve adequate rates of remission in a population with multiple risk factors and comorbidities. The small sample size and other limitations of the study limit the ability to draw conclusions about the efficacy of TCAs in patients with TBI, particularly in light of the findings of the uncontrolled TCA studies done by Saran and co-workers (Saran, 1985) and Dinan and Mobayed (Dinan and Mobayed, 1992). Although there were no statistically significant group differences in response rates or decrease in HAM-D scores over 10 weeks, 59% of the sertraline group were responders (50% decrease in baseline HAM-D), while only 32% of the placebo group were responders, among the completers. Similarly to Tiersky and associates (Tiersky et al., 2005), these authors noted that despite the improvement, post-treatment depression scores remained elevated compared to those of an uninjured control group. Funding for this study was provided by the National Institute on Disability and Rehabilitation Research (NIDRR), Office of Special Education and Rehabilitative Services, U.S. Department of Education, Washington, D.C. for the University of Washington Model Systems Knowledge Translation Center (H133A060070). Of the remaining studies, the class I study (Powell et al., 2002) and one class IV study (Svendsen et al., 2004) examined a wide range of outcomes befitting comprehensive treatment programs, including physical and cognitive as well as emotional symptoms (Svendsen et al., 2004), and multiple measures at the level of function, activity, and societal participation (Powell et al., 2002). Mayo Clinic does not endorse companies or products. Hackett M.L. 2012 Oct 17;10:CD006533. Robinson R.G. 2010;303(19):19381945. There is poor evidence supporting the use of any pharmacologic treatments for neuropsychiatric disorders following traumatic brain injury (TBI), especially among older adults. Based on the current evidence, we identify gaps in the literature and make recommendations for clinical care and future research. Am J Psychiatry. A 2006 review of pharmacological treatments for neurobehavioral sequelae of TBI, including mood disorders, concluded that there was limited evidence to support or refute the effectiveness of psychotropic medications used in the general population to treat depression after TBI (Warden et al., 2006). 2011;82(8):914923. -, Price A, Rayner L, Okon-Rocha E, et al. Conduct more trials on innovative delivery systems, such as telephone, telehealth, and web-based models, which have the potential of overcoming some of the treatment barriers faced by TBI patients (e.g., with regard to mobility, transportation, accessibility, and finances). Depression following traumatic brain injury. The criteria used to search for published studies for this systematic review included peer-reviewed studies: (1) investigating depression and depressive symptomatology; (2) in an adult population that included those with TBI; (3) published since 1980; and (4) written in English. The https:// ensures that you are connecting to the Bookshelf Both the methylphenidate and sertraline groups had greater improvements in HAM-D scores than the placebo group, though methylphenidate had the added benefit of improving cognition, alertness, and post-concussive symptoms greater than sertraline. There is evidence for the use of sertraline (25150mg/d) for depression after TBI, and the Neurobehavioral Guidelines Working Group (Warden et al., 2006) recommends the use of sertraline as a first-line option for treatment of post-TBI depression. Antidepressants and alcohol: What's the concern? A recent clinical trial and new meta-analysis including that trial found no benefit of antidepressants for depression following TBI. And both are considered first-choice options for treating depression. Ochs L. Matheis R.J. Flexyx neurotherapy system in the treatment of traumatic brain injury: An initial evaluation. While none of these studies provided sufficient evidence for practice guidelines, taken together they do indicate that well-controlled studies are beginning to be applied to the problem of depression after TBI. From the studies reviewed, there is insufficient evidence to support practice recommendations regarding any of the psychotherapeutic or rehabilitation interventions for depression following TBI. Pharmacology - ANTIDEPRESSANTS - SSRIs, SNRIs, TCAs, MAOIs, Lithium ( MADE EASY) I'm wondering about their effectiveness and safety after a brain injury. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. J Neurotrauma. Ischemic stroke was the most frequent (8296 events). Sometimes surgery is needed as part of emergency care to reduce damage to the brain. In the only evidence class II study, Lee and associates (Lee et al., 2005) randomized 30 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 2000) MDD within 1 year of mild to moderate TBI to receive 4 weeks of 20mg methylphenidate, 100mg sertraline, or placebo. Each type of antidepressant affects these neurotransmitters in slightly different ways. eCollection 2021 Sep. Antidepressant treatment for postnatal depression. Ouellet M-C, Beaulieu-Bonneau S, Sirois M-J, et al. A goal may be that predominantly biologically- or psychosocially-mediated depressed subgroups can be identified, followed by the application of treatments that target these specific substrates. -, Zahniser E, Nelson LD, Dikmen S, et al. Pelzer E. Rau H. Temkin N. Validity of the patient health questionnaire-9 in assessing depression following traumatic brain injury. Generating an ePub file may take a long time, please be patient. Concussion. Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. Bupropion doesn't have the same effects on the brain as other drugs. Main body: Compared to TCAs, SSRI use was associated with increased risk of hemorrhagic stroke. Bowen D.M. Robinson R.G. Perino C. Rago R. Cicolini A. Torta R. Monaco F. Mood and behavioural disorders following traumatic brain injury: Clinical evaluation and pharmacological management. Accessed Aug. 18, 2022. Some types of antidepressants should be avoided in most cases because they have side effects that can cause problems in people with TBI. Schoenberger N.E. Hidradenitis suppurativa: Where can I find support? Social impairment and depression after traumatic brain injury. Research trials should attempt to include documentation of participants' pre-injury psychological status to the extent possible. Pinner M. Subjective experience in patients with brain injury and their close relatives before and after a rehabilitation programme. Rehabilitation of persons with traumatic brain injury. 2013 Apr;84(4):441-5 On the basis of the external reviews, one additional article meeting the final criteria was identified and included in the current review, for a total of 27 articles. Hicks AJ, Clay FJ, James AC, Hopwood M, Ponsford JL. Adequately powered randomised controlled trials - extended to the plethora of newer antidepressants aiming to prove their non-inferiority to the selective serotonin reuptake inhibitors studied - are needed to confirm our results. Evaluation of a coping skills group following traumatic brain injury. Gomez-Hernandez R. Max J.E. Sander A. Kreutzer J. Rosenthal M. Delmonico R. Young M.E. The increased risk of depression is not limited to those with moderate to severe TBI; it is also present among those with mild TBI (Fann et al., 2004; Hoge et al., 2008). Rush AJ. already built in. In the U.S., an estimated 1.4 million people sustain a TBI annually, and approximately 3.17 million Americans live with TBI-related disabilities (Zaloshnja et al., 2008). The studies enrolled a wide range of TBI severity at varying time points ranging from acutely to several years post-TBI, although specific TBI characteristics were not always reported. 2017 Sep/Oct;32(5):332-342. doi: 10.1097/HTR.0000000000000322. Interventions for treating depression after stroke. Studies of other biological interventions were even more limited in sample size, with the best evidence being a RCT of 12 patients assigned to biofeedback or a wait-list control group. Disclaimer, National Library of Medicine Cognitive tolerability of electroconvulsive therapy in a patient with a history of traumatic brain injury. Although the data on the treatment of depression following TBI have grown over the past decade, the paucity of adequately powered and controlled studies, including randomized controlled trials, limits the ability to establish evidence-based treatment guidelines. Overview of Pharmacological and Other Biological Intervention Studies for Depression in Persons with TBI (n=19). When choosing an antidepressant that's likely to work well for you, your health care provider may consider: Many mental health experts believe that certain brain chemicals called neurotransmitters are associated with depression particularly serotonin (ser-o-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and dopamine (DOE-puh-meen). Hidradenitis suppurativa: When does it appear? Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills, Intervention: Help a loved one overcome addiction. Regarding non-pharmacological treatment, Rosenthal and colleagues commented in a 1998 comprehensive review that psychotherapy was frequently done with depressed persons with TBI, but no recommendations could be formulated because the published research was limited to uncontrolled case studies (Rosenthal et al., 1998). Serotonin-norepinephrine reuptake inhibitors, or SNRIs, such as venlafaxine (Effexor) are newer drugs that also may be a good option for people with TBI. Amitriptyline versus other types of pharmacotherapy for depression. Koponen S. Taiminen T. Portin R. Himanen L. Isoniemi H. Heinonen H. Hinkka S. Tenovuo O. Axis I and II psychiatric disorders after traumatic brain injury: A 30-year follow-up study. At the end of this full review, 26 of the 57 articles met the final criteria. Of the group studies, three used random assignment to treatment conditions: one (Powell et al., 2002) met criteria for class I evidence, and two (McMillan, 2002; Tiersky et al., 2005) were considered class II. Increased vulnerability to MDD after TBI is associated with a prior history of MDD (Fann et al., 2004; Koponen et al., 2002), as well as unemployment, low income, and minority status (Seel et al., 2003b). Thase M.E. Brown L.L. No other antidepressant class comparisons were associated with increased risk of adverse events. Bupropion and mirtazapine are as effective as SSRIs and SNRIs. Depression medicines. Nunez NA, et al Augmentation strategies for treatment resistant major depression: A systematic review and network meta-analysis. Turner-Stokes L. Hassan N. Pierce K. Clegg F. Managing depression in brain injury rehabilitation: The use of an integrated care pathway and preliminary report of response to sertraline. Brain injuries, traumatic; Depression. As noted earlier, both biomedical and psychosocial factors contribute to MDD in people with TBI. Also, the mean time since injury was 17.7 (SD 13.7) years, making it difficult to ascertain the relative contribution of the TBI to their depressive episode. Department of Defense/International, J Am Geriatr Soc. doi: 10.2217/cnc-2020-0022. One antidepressant that stood out was clomipramine. Wroblewski B.A. Researchers have observed that especially soon after TBI, MDD may be more biologically determined, for example by pre-injury susceptibility and/or lesion location (Jorge et al., 1993b). van Zomeren A.H. van den Burg W. Residual complaints of patients two years after severe head injury. The https:// ensures that you are connecting to the Hope T. Jobst K.A. Migraines: Are they triggered by weather changes? Best Antidepressant For Sexual Dysfunction: Wellbutrin. 2010 Apr 14;(4):CD006117. 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