The prevalence and functional effects of depressive disorder following traumatic brain injury are significant. Now, sertraline may be effective for preventing depressive symptoms after TBI.

A group of researchers at Baylor College of Medicine evaluated 94 patients aged 18 to 85 years who had been hospitalized for mild, moderate, or severe traumatic brain injury (TBI). Most of the patients (n=92) were Caucasian and more than half (n=56) were male. The research team randomized the patients to receive either 100 mg daily of sertraline (48 patients) or placebo (46 patients) for 24 weeks or until symptoms of a mood disorder occurred.

Overall, sertraline was effective at preventing the onset of depressive symptoms compared to placebo. Sertraline was also well tolerated  and adverse effects in both treatment groups were mild. It is unclear how long the effects of sertraline last in this patient group.

The incidence of TBI is rising and it now is a major cause of death and disability. TBI can occur from injury, stroke, falls, motor vehicle accidents, and violence. People suffering moderate to severe TBI are at risk for depression and loss of life roles. Life satisfaction declines in this population, so prevention of depressive symptoms is imperative for maintaining health and function.

Sertraline, an antidepressant, has been used to treat PTSD but its effects in TBI are still being defined. The results of the study, which were published in JAMA Psychiatry, need to be confirmed with larger sample sizes and in multicenter trials. Further, a question remains if combining sertraline with cognitive behavioral interventions will optimize long-term outcomes.

References

Almeida OP, Hankey GJ, Yeap BB, et al. Prevalence, associated factors, mood and cognitive outcomes of traumatic brain injury in later life. Int J Geriatr Psychiatry. 2015;30(12):1215-1223. PMID: 25703581

Ashman TA, Cantor JB, Gordon WA, et al. A randomized controlled trial of sertraline for the treatment of depression in persons with traumatic brain injury. Arch Phys Med Rehabil. 2009;90(5):733-740. PMID: 19406291

Hien DA, Levin FR, Ruglass LM, et al. Combining seeking safety with sertraline for PTSD and alcohol use disorders: a randomized controlled trial. J Consult Clin Psychol. 2015;83(2):359-369. PMID: 25622199

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

Juengst SB, Adams LM, Bogner JA, et al. Trajectories of life satisfaction after traumatic brain injury: influence of life roles, age, cognitive disability, and depressive symptoms. Rehabil Psychol. 2015;60(4):353-364. PMID: 26618215

Schneier FR, Campeas R, Carcamo J, et al. Combined mirtazapine and SSRI treatment of PTSD: a placebo-controlled trial. Depress Anxiety. 2015;32(8):570-579. PMID: 26115513

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