Preventing Depression After Traumatic Brain Injury

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Nearly 80% of depressive symptoms occur within the first 6 months after TBI.
Nearly 80% of depressive symptoms occur within the first 6 months after TBI.

Sertraline appears to be efficacious in preventing the onset of depressive symptoms following traumatic brain injury (TBI), according to a study published in JAMA Psychiatry.

A team of researchers headed by Ricardo Jorge, MD, Professor at the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, set out to investigate whether prophylactic administration of sertraline prevents the emergence of depressive symptoms following TBI.

The researchers randomized 94 patients, aged 18 to 25 years, who had been hospitalized for TBI to receive either placebo or 100 mg/day of sertraline (n=46 and n=48, respectively). Patients were treated for 24 weeks or until development of a mood disorder. The main outcome was time to onset of TBI-associated depressive disorders, as defined by DSM-IV.

At 24 weeks, the number of patients needed to treat to prevent depression was 5.9 (95% CI, 3.1-71.1; likelihood ratio test χ2 =4.6; P= .03) for sertraline, versus placebo, “meaning the hazards for developing depression were about four times the hazards of participants receiving sertraline treatment,” they explained. They added that this prophylactic effect was “not restricted to the few participants with a remote history of depressive disorders.” However, there was no difference in neuropsychological variables between the sertraline and the placebo groups.

Adverse events in both groups were mild moderate, although the odds of having dry mouth and diarrhea were higher for participants receiving sertraline treatment than for those receiving placebo.

The researchers acknowledged several limitations in their study, including the relatively small sample size. Additionally, follow-up was limited to 6 months following the incident TBI. They pointed out, however, that previous studies on the incidence of depressive disorders during the first year following TBI indicate that approximately 80% of depressive episodes have their onset during the first 6 months. Moreover, their findings are “consistent with previous reports on the efficacy of antidepressants to prevent depression after stroke,” they stated.

In light of the prevalence and functional effect of depression among patients with TBI, the findings of this study have “profound therapeutic implications,” the authors concluded. “Preventive treatment may have a decisive effect in reducing the burden of depressive disorders and improving the recovery and quality of life of patients with TBI."

Reference

Jorge RE, Acion L, Burin DI, Robinson RG. Sertraline for preventing mood disorders following traumatic brain injury: a randomized clinical trial. JAMA Psychiatry. 2016. doi:10.1001/jamapsychiatry.2016.2189. [Epub ahead of print]

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