Citation

Kreitzer N, Ancona R, McCullumsmith C, Kurowski BG, Foreman B, Ngwenya LB, Adeoye OM. J. Head Trauma Rehabil. 2019; 34(3): E47-E54.

Affiliation

Division of Neurocritical Care (Drs Kreitzer, Foreman, and Adeoye), Department of Emergency Medicine (Drs Kreitzer and Adeoye and Ms Ancona), Department of Psychiatry (Dr McCullumsmith), Department of Pediatrics (Dr Kurowski), Department of Physical Medicine and Rehabilitation (Dr Kurowski), Department of Neurology and Rehabilitation Medicine (Drs Foreman and Ngwenya), and Department of Neurosurgery (Dr Ngwenya), University of Cincinnati, Cincinnati, Ohio.

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/HTR.0000000000000439

PMID

30169440

Abstract

OBJECTIVE: Following traumatic brain injury (TBI), depressive symptoms are common and may influence recovery. We performed a meta-analysis to estimate the benefit of antidepressants following TBI and compare the estimated effects between antidepressants and placebo. PARTICIPANTS: Multiple databases were searched to find prospective pharmacological treatment studies of major depressive disorder (MDD) in adults following TBI. MAIN MEASURES: Effect sizes for antidepressant medications in patients with TBI were calculated for within-subjects designs that examined change from baseline after receiving medical treatment and treatment/placebo designs that examined the differences between the antidepressants and placebo groups.

DESIGN: A random-effects model was used for both analyses.

RESULTS: Of 1028 titles screened, 11 were included. Pooled estimates showed nonsignificant difference in reduction of depression scores between medications and placebo (standardized mean difference of 5 trials = -0.3; 95% CI, -0.6 to 0.0; I = 17%), and a significant reduction in depression scores for individuals after pharmacotherapy (mean change = -11.2; 95% CI, -14.7 to -7.6 on the Hamilton Depression Scale; I = 87%).

CONCLUSIONS: 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.

Language: en