The Effect of Antidepressants on Depression After Traumatic Brain Injury: A Meta-analysis
Open accessAbstract
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.
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Antidepressants have not been shown to be more beneficial than placebo when treating depression following traumatic brain injury.
“Furthermore, antidepressants have not been shown to be more beneficial than placebo when treating depression following TBI [9].”
Recent meta-analyses have shown either borderline or no significant benefits of antidepressants over placebo in the treatment of post-TBI MDD.
“recent meta-analyses have shown either borderline11 or no significant10 benefits of antidepressants over placebo in the treatment of post-TBI MDD.”
The reliability of previous meta-analyses was affected by a high degree of bias and heterogeneity, or by a limited number of included studies.
“the reliability of the results of previous meta-analyses was affected by a high degree of bias and heterogeneity,10 or by a limited number of included studies.11”
Previous pair-wise meta-analyses have investigated the efficacy of antidepressants for post-TBI depression with mixed results.
“several pair-wise meta-analyses have investigated the efficacy of antidepressants, with mixed results.10–12”
There is no consensus on standard therapeutic guidelines for post-TBI depression.
“despite the prevalence and severity of post-TBI depression, there is no consensus on standard therapeutic guidelines.10”
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- Authors
- Kreitzer, N., Ancona, R., McCullumsmith, C., Kurowski, B. G., Foreman, B., Ngwenya, L. B., & Adeoye, O.
- Affiliations
- University of Cincinnati (US)
- ORCID
- Venue
- Journal of Head Trauma Rehabilitation
- Published
- 2019-05
- Volume
- 34
- Issue
- 3
- Pages
- E47-E54
- ISSN
- 0885-9701 (ISSN-L)
- PMC
- PMC8730802
- OpenAlex
- W2889109390
- Cited by
- 56
- References
- 65
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 8 · 2023: 4 · 2022: 10 · 2021: 7 · 2020: 10 · 2019: 6
- FWCI
- 0.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Head Trauma Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Neurological Disorders and Stroke (T32NS047996)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- antidepressants, traumatic brain injury, post-traumatic depression, major depressive disorder, pharmacotherapy, Hamilton Depression Rating Scale, depression treatment
- MeSH terms
- Brain Injuries, Traumatic, Antidepressive Agents, Depressive Disorder, Humans
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