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The Effect of Antidepressants on Depression After Traumatic Brain Injury

A Meta-analysis

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

The Journal of Head Trauma Rehabilitation: August 30, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/HTR.0000000000000439
Original Article: PDF Only

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 2 = 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 2 = 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.

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.

Corresponding Author: Natalie Kreitzer, MD, University of Cincinnati, Medical Sciences Bldg, Room 1513, 231 Albert Sabin Dr, PO Box 670769, Cincinnati, OH 45267 (kreitzne@ucmail.uc.edu).

The authors thank Dr Uwe Stolz for assistance with methodology expertise and comments that greatly improved the manuscript.

Dr Foreman receives speaking fees from UCB Pharma Inc and research funding through the Department of Defense and the National Institutes of Health/National Institutes of Neurological Disorders and Stroke.

The authors declare no conflicts of interest.

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