TY - JOUR
T1 - Treatment of Depression After Traumatic Brain Injury
T2 - A Systematic Review Focused on Pharmacological and Neuromodulatory Interventions
AU - Narapareddy, Bharat R.
AU - Narapareddy, Laren
AU - Lin, Abigail
AU - Wigh, Shreya
AU - Nanavati, Julie
AU - Dougherty, John
AU - Nowrangi, Milap
AU - Roy, Durga
N1 - Funding Information:
The authors thank Drs. Vani Rao and Kathleen Bechtold for their thoughtful feedback and useful discussions throughout the preparation of this article. They also thank Blair Anton and the Welch Medical Library for their support through library services and resources.
Publisher Copyright:
© 2020 Academy of Consultation-Liaison Psychiatry
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Background: Depression is the most common psychiatric sequela after traumatic brain injury (TBI) and poses a variety of treatment challenges. There is a lack of clinical trials focused on biological interventions used to manage TBI depression. Objective: The aim of this systematic review is to summarize the current evidence of psychotropic and neuromodulatory interventions used to treat TBI depression and to provide directions for future research. Methods: Key words were used to describe the following search terms: “traumatic brain injury”, “depression”, “pharmacological/drug therapy”, and “neuromodulation”. Studies focused on pharmacotherapy or neuromodulation in TBI depression were identified in 5 databases: Medline (PubMed), EMBASE (Embase.com), the Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), PsycINFO (EbscoHost), and Web of Science. Article inclusion/exclusion using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-based systematic protocol of extraction and evaluation was applied. Level of evidence for each study was determined using the American Academy of Neurology criteria. Results: The initial search provided 1473 citations. Twenty-two studies met inclusion criteria. Sixteen studies explored pharmacological interventions with emphasis on serotonergic agents. Results between studies were conflicting, and interventions did not always outperform placebos, although sertraline provided the highest level of evidence for treatment of TBI depression. Six studies examining neuromodulatory interventions show preliminary evidence of efficacy with a range of interventions and modes of delivery used. Conclusions: Additional research including large-sample randomized-controlled trials using pharmacological, neuromodulation, or combination treatment is needed. These studies should incorporate premorbid psychosocial functioning, preinjury psychiatric disease, cognitive deficits, and functional recovery when examining outcomes.
AB - Background: Depression is the most common psychiatric sequela after traumatic brain injury (TBI) and poses a variety of treatment challenges. There is a lack of clinical trials focused on biological interventions used to manage TBI depression. Objective: The aim of this systematic review is to summarize the current evidence of psychotropic and neuromodulatory interventions used to treat TBI depression and to provide directions for future research. Methods: Key words were used to describe the following search terms: “traumatic brain injury”, “depression”, “pharmacological/drug therapy”, and “neuromodulation”. Studies focused on pharmacotherapy or neuromodulation in TBI depression were identified in 5 databases: Medline (PubMed), EMBASE (Embase.com), the Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), PsycINFO (EbscoHost), and Web of Science. Article inclusion/exclusion using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-based systematic protocol of extraction and evaluation was applied. Level of evidence for each study was determined using the American Academy of Neurology criteria. Results: The initial search provided 1473 citations. Twenty-two studies met inclusion criteria. Sixteen studies explored pharmacological interventions with emphasis on serotonergic agents. Results between studies were conflicting, and interventions did not always outperform placebos, although sertraline provided the highest level of evidence for treatment of TBI depression. Six studies examining neuromodulatory interventions show preliminary evidence of efficacy with a range of interventions and modes of delivery used. Conclusions: Additional research including large-sample randomized-controlled trials using pharmacological, neuromodulation, or combination treatment is needed. These studies should incorporate premorbid psychosocial functioning, preinjury psychiatric disease, cognitive deficits, and functional recovery when examining outcomes.
KW - antidepressant
KW - brain trauma
KW - neuromodulation
KW - neurostimulation
KW - pharmacotherapy
KW - psychotropic medication
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U2 - 10.1016/j.psym.2020.04.012
DO - 10.1016/j.psym.2020.04.012
M3 - Review article
C2 - 32660873
AN - SCOPUS:85087755341
SN - 0033-3182
VL - 61
SP - 481
EP - 497
JO - Psychosomatics
JF - Psychosomatics
IS - 5
ER -