Safety of Antidepressant Classes Used Following Traumatic Brain Injury Psychotropic Medication Use among Medicare Beneficiaries Following Traumatic Brain Injury. This is particularly true of the complex, experience-based treatments that predominate in rehabilitation over medically-oriented treatments such as pharmacotherapy and surgery. This comprehensive search located 658 articles on the topic of TBI and depression. HHS Vulnerability Disclosure, Help We searched MEDLINE, SCOPUS, and the Cochrane Central Register of Controlled Trials (CENTRAL). Fox K. Collins C. Meclobemide in the treatment of major depressive disorder (DSM-3) following traumatic brain injury. 2017 Sep/Oct;32(5):332-342. doi: 10.1097/HTR.0000000000000322. Advertising revenue supports our not-for-profit mission. When choosing an antidepressant that's likely to work well for you, your health care provider may consider: Many mental health experts believe that certain brain chemicals called neurotransmitters are associated with depression particularly serotonin (ser-o-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and dopamine (DOE-puh-meen). Shin I.S. Bruns J. Drake A. Gentry T. Jagoda A. Katz D.L. Conclusions: Chen C.P. This is due not only to inconsistency in the quality of the research designs, but to the earlier noted difficulty in specifying active ingredients for depression within these complex treatments, many of which were deliberately multifaceted. The site is secure. Cuijpers P. van Straten A. Wamerdam L. Problem solving therapies for depression: A meta-analysis. Tomasino V. Schwartz B.L. Finkelstein E.A. to rate the evidence of the articles, with consultation between investigators as needed for accurate coding and interpretation. In the subgroup analysis according to the antidepressant used in the included studies, there was a trend towards statistical significance for sertraline only (odds ratio = 0.28, 95% confidence interval: 0.08-1.03; p = 0.05); this was not evident in the study that reported the use of citalopram (odds ratio = 0.83; 95% confidence interval: 0.15-4.64; p = 0.84). Objective: Following traumatic brain injury (TBI), depressive symptoms are common and may influence recovery. Levin H. Kraus M.F. This review includes 13 studies examining pharmacotherapy for depression (Table 2). Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Antidepressants: Selecting one that's right for you, Begin Exploring Women's Health Solutions at Mayo Clinic Store, Newsletter: Mayo Clinic Health Letter Digital Edition, Book: Mayo Clinic Family Health Book, 5th Edition. NIH consensus development panel on rehabilitation of persons with traumatic brain injury. already built in. Dobson K.S. After a flood, are food and medicines safe to use? Researchers have observed that especially soon after TBI, MDD may be more biologically determined, for example by pre-injury susceptibility and/or lesion location (Jorge et al., 1993b). Risk of fractures with selective serotonin-reuptake inhibitors or tricyclic antidepressants. Would you like email updates of new search results? Keywords: Other limitations of this study include only focusing on studies of adults published in English since 1980, and a lack of meta-analysis due to the heterogeneity of the interventions and paucity of RCTs. Silver J. Axis I psychopathology in individuals with traumatic brain injury. Although the treatment group experienced significantly more reduction in emotional distress compared to those on a wait-list for a comparable period of time, their post-treatment depression and overall distress levels remained above the caseness cutoff on the SCL-90. Hidradenitis suppurativa and biologics: Get the facts. DeRubeis R.J. Hollon S.D. Mental health medications. Katon W.J. The 2 patients who partially responded to initial treatment eventually responded to maintenance ECT. A final review of each of the 27 articles was performed by one of the investigators (J.R.F. 10.1089/neu.2018.6172. for their helpful reviews of the methods and evidence tables, and Kurt Johnson, Ph.D., for his helpful review of the manuscript. The specific criteria included studies with: Using these criteria, abstracts from the 658 articles found in the database search were reviewed by two trained reviewers at the University of Washington Model Systems Knowledge Translation Center (MSKTC). Cipriani A, La Ferla T, Furukawa TA, Signoretti A, Nakagawa A, Churchill R, McGuire H, Barbui C. Cochrane Database Syst Rev. If you are a Mayo Clinic patient, this could Expert reaction to a review paper on the 'serotonin theory of depression.' PDF American Academy for Cerebral Palsy and Developmental Medicine Black K. Depression after traumatic brain injury: A national institute on disability and rehabilitation research model systems multicenter investigation. All study design types were also included. Effectiveness of a guideline implementation tool for supporting management of mental health complications after mild traumatic brain injury in primary care: protocol for a randomised controlled trial. This site needs JavaScript to work properly. A. Prospectively enroll depressed patients, B. The authors wish to thank Teresa Ashman, Ph.D., Vani Rao, M.D., and Jonathan Silver, M.D. In theory, pharmacotherapy, psychotherapy, and alternative approaches might be combined and balanced for individual circumstances, risk factors, and time post-injury. To provide you with the most relevant and helpful information, and understand which The MAOI phenelzine was not found to be efficacious in the 10 amitriptyline non-responders who crossed over to this medication in the study by Saran and colleagues (Saran, 1985). 3Model Systems Knowledge Translation Center, Center for Technology and Disability Studies, University of Washington, Seattle, Washington. J Neurotrauma. Careers. Ashman T.A. A recent class IV study of citalopram in mild-to-moderate TBI (Rapoport et al., 2008) suggests that this SSRI is also well-tolerated and potentially efficacious, though the rates of response and remission were lower than for sertraline in Fann and co-workers' (Fann et al., 2000) study of mild TBI. Natural remedies for depression: Are they effective? One class II (Tiersky et al., 2005) and two class IV studies (Anson et al., 2006; Bedard et al., 2003) addressed general emotional distress as a primary outcome; this could include depression, as well as anxiety and other complaints. (copyright 9/94, 8/98) . The effectiveness of cognitive-behavioural therapy for post-traumatic headaches. How to tell if a loved one is abusing opioids. government site. Arndt S. Are there symptoms that are specific for depressed mood in patients with traumatic brain injury? If you are worried about sexual dysfunction , then Wellbutrin should be considered as a first-line option. This site needs JavaScript to work properly. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/suicidality-children-and-adolescents-being-treated-antidepressant-medications#:~:text=Antidepressants%20increase%20the%20risk%20of,suicidality%20with%20the%20clinical%20need. Hidradenitis suppurativa and diet: What's recommended? Federal government websites often end in .gov or .mil. -, Bombardier CH, Fann JR, Temkin NR, Esselman PC, Barber J, Dikmen SS. sharing sensitive information, make sure youre on a federal No other antidepressant class comparisons were associated with increased risk of adverse events. The largest study had 54 participants, and all but three were uncontrolled trials. The class I pharmacotherapy study (Ashman et al., 2009) showed trends toward superiority of sertraline over placebo in a demographically heterogeneous sample that was temporally far removed from their TBI, but was underpowered to examine predictors of response. The remaining two studies offered intensive, multifaceted treatments delivered by a rehabilitation team, either in a clinical milieu with individual and group interventions (Svendsen et al., 2004), or in the patient's home and community settings to meet individualized goals (Powell et al., 2002). Gilbody S. Bower P. Fletcher J. Richards D. Sutton A.J. Depressed patients with TBI, stroke, and Parkinson's disease all show decreased glucose metabolism in the orbital-inferior frontal and anterior temporal cortices (Mayberg, 1994). Medications for PTSD - PTSD: National Center for PTSD - Veterans Affairs doi: 10.1002/14651858.CD006533.pub2. Depression following traumatic brain injury. Given the influx of TBI related to the war efforts in Iraq and Afghanistan (often referred to as the signature wound of these conflicts), researchers should seek to elucidate differences in effectiveness of treating blast- and non-blast-related TBIs, and TBI-related depression that may be complicated by post-traumatic stress disorder. O'Reardon J.P. Lovett M.L. Rosenthal M. Christensen B.K. Depression may occur without a feeling of sadness. Hart T. Fann J.R. Novack T.A. The two magnetic field stimulation studies (Baker-Price and Persinger, 2003; Baker-Price and Persinger, 1996) used stimulus levels (1 microtesla) much smaller than those used in the currently FDA-approved repetitive transcranial magnetic stimulation depression treatments. injured mice given the antidepressant imipramine (known commercially as tofranil) had 70 percent more brain cells after four weeks than mice not treated with antidepressants, said study. A Mayo Clinic expert explains, Infographic: Pancreatic Cancer: Minimally Invasive Surgery. Presynaptic serotonergic markers in community-acquired cases of Alzheimer's disease: Correlations with depression and neuroleptic medication. You may opt-out of email communications at any time by clicking on Results: Dr. Mark Truty (surgery, MN) better outcomes with chemo. Overview of Pharmacological and Other Biological Intervention Studies for Depression in Persons with TBI (n=19). Epub 2016 Dec 28. FOIA The mean number of changes per article between two reviewers was .85 (less than one change per article), with a range of 0 to 4, indicating strong reviewer and data consistency. Among the 27 studies meeting criteria for inclusion in this review, there were only two evidence class I studies and four evidence class II studies. Thompson R.S. Objective: -, Neurology. Psychiatric illness following traumatic brain injury in an adult health maintenance organization population. Prospectively enrolled depressed patients, Depressed patients retrospectively identified at baseline and results reported for them separately, Pre-post scores on depression measure were reported, but there was no selection for depressed patients as a subgroup. Migraines: Are they triggered by weather changes? Moser D. Tateno A. Crespo-Facorro B. Arndt S. Major depression following traumatic brain injury. Rapoport M.J. Chan F. Lanctot K. Herrmann N. McCullagh S. Feinstein A. Accessed Aug. 17, 2022. In addition, clomipramine is a well-tolerated antidepressant. Stanislav S.W. Meade M.A. If a study did not meet the criteria, it was excluded from further review. J Neurotrauma. Antidepressants Selecting one thats right for you, Advertising and sponsorship opportunities. All four of these studies described the inclusion of ingredients other than pure CBT, including individualized cognitive retraining (Tiersky et al., 2005). Alternatively, cost-effective treatment may require collaborative, multimodal, or stepped-care treatment models to achieve adequate rates of remission in a population with multiple risk factors and comorbidities. Salt craving: A symptom of Addison's disease? 1998-2022 Mayo Foundation for Medical Education and Research (MFMER). The University of Kansas Health System Outpatient Clinical Concussion Comprehensive Protocol: An Interdisciplinary Approach. Davenport M, Condon B, Lamoureux C, Phipps Johnson JL, Chen J, Rippee MA, Zentz J. This site needs JavaScript to work properly. The .gov means its official. HHS Vulnerability Disclosure, Help Interventions that involve explicit teaching, behavior change, and/or environmental manipulations cannot typically be hidden from the patient or the treater; thus the removal of bias by using standard blinding procedures, such as placebo treatment, is not straightforward (see also Hart et al., 2008). In addition to this drug being the best for losing or maintaining weight, it is also a medication that shouldnt affect your sex life. the unsubscribe link in the e-mail. Martino C. Krysko M. Petrides G. Tobias K.G. Fann J.R. Bombardier C.H. New evidence suggests that antidepressant medication may be no more effective than placebo in this population. Moncrieff J. Wessely S. Hardy R. Active placebos versus antidepressants for depression. Significant cognitive impairment was not reported in this small case series. 3 Once the patient is stable, other types of care for TBI can begin. Cognitive improvement with treatment of depression following mild traumatic brain injury. TBI, and especially mild TBI, is not a contraindication for antidepressant therapy. New evidence suggests that antidepressant medication may be no more effective than placebo in this population. Antidepressants are a type of drug that is used when treating those who suffer from depression or other related issues. Johnston M.V. Zaloshnja E. Lawrence B.A. Croghan T.W. 2018:neu.2018.6172. Temkin N.R. WEDNESDAY, Sept. 14, 2016 (HealthDay News) -- Depression can often follow a traumatic brain injury, but new research suggests the antidepressant Zoloft might help prevent this from happening. A class IV study of fluoxetine (Horsfield et al., 2002) suggests the potential efficacy of this SSRI; however, the study did not require patients to be depressed at study entry and had a duration of 8 months. One study reported results of holistic, interdisciplinary milieu therapy, including individual and group treatment in a day program targeted to a wide range of cognitive and psychosocial outcomes (Svendsen et al., 2004). Before The societal cost of TBI, including direct medical costs and indirect costs, has been estimated at $60 billion in the year 2000 in the U.S. alone (Finkelstein et al., 2006). Traumatic brain injury and Beck Depression Inventory or Zung Self-Rating Depression Scale or Center for Epidemiologic Studies or Patient Health Questionnaire or Structured Clinical Interview for DSM or Hamilton Rating Scale for Depression or Hospital Anxiety and Depression Scale or Minnesota Multiphasic Personality Inventory or Diagnostic Interview Schedule or Brief Symptom Inventory or Short Form-36 Health Survey or Neurobehavioral Functioning Inventory or Composite International Diagnostic Interview or Present-State Exam or major depression or depressive disorder, In PubMed, terms are searched as both keywords and subject headings simultaneously, and abbreviations are used for the scale names when appropriate, Brain injuries and Center for Epidemiological Studies Depression Scale or Beck Depression Inventory or Self-Rating Scale or Minnesota Multiphasic Personality Inventory or Hamilton Rating Scale for Depression or Hospital Anxiety and Depression Scale, The abbreviated terms DIS, CIDI, SCID, and PHQ-9 did not add results and were omitted from the final search, Traumatic brain injury and Beck Depression Inventory or Zung Self-Rating Depression Scale or Minnesota Multiphasic Personality Inventory or Hamilton Rating Scale for Depression, The abbreviated terms DIS, SCID, CESD, and PHQ-9 did not add results and were omitted from the final search, ProQuest Health and Medical Complete Library, Terms were searched as keywords; scale abbreviations were used when appropriate. Similarly to Tiersky and associates (Tiersky et al., 2005), these authors noted that despite the improvement, post-treatment depression scores remained elevated compared to those of an uninjured control group. Miller T.R. 8600 Rockville Pike Journal of Affective Disorders. Hope T. Jobst K.A. Depression assessment after traumatic brain injury: An empirically based classification method. In fact, the study by Bedard and colleagues (Bedard et al., 2003) excluded participants with psychiatric disorders or substance abuse, as did two other class IV studies (Gurr et al., 2005; Svendsen et al., 2004). The agents that were studied included tricyclic antidepressants (TCAs: amitriptyline and desipramine), monoamine oxidase inhibitors (MAOIs: phenelzine and meclobemide), and selective serotonin reuptake inhibitors (SSRIs: fluoxetine, sertraline, and citalopram). Valerian: A safe and effective herbal sleep aid? Fann J.R. Bombardier C.H. eCollection 2022. Lanteigne A, Sheu YH, Strmer T, Pate V, Azrael D, Swanson SA, Miller M. CNS Drugs. doi: 10.1002/14651858.CD006117. Antidepressants for Depression Associated with Traumatic Brain Injury: A Meta-analytical Study of Randomised Controlled Trials. Ouellet M-C, Beaulieu-Bonneau S, Sirois M-J, et al. 1. Gordon B. McAllister T.W. There is also an increased risk of suicide subsequent to TBI, with one study noting that 10% reported suicidal ideation at 1 year post-TBI, and 15% attempted suicide by 5 years post-injury (Brooks et al., 1986). Six of these 7 patients improved on desipramine; however, 4 patients who were not responding in the placebo group were crossed over to desipramine after only 1 month. Magnetic stimulation, biofeedback, and acupuncture remain experimental interventions at this time. Clinical depression: What does that mean? It may manifest as agitation . Unable to load your collection due to an error, Unable to load your delegates due to an error. The https:// ensures that you are connecting to the Rehabilitation of the Adult and Child with Traumatic Brain Injury. No evidence of heterogeneity was detected. A tricyclic antidepressant (TCA) which acts by altering naturally occurring chemicals which help brain cells communicate and can lift mood. Hackett M.L. People who have issues with alcohol often are suffering from depression or other issues and hide these problems by using alcohol as medication. doi: 10.1001/jama.2010.599. The aim of this systematic review was to critically evaluate the evidence on interventions for depression following traumatic brain injury (TBI) and provide recommendations for clinical practice and future research. The rate of non-responders at the end of the follow-up period was lower in the treatment groups compared with placebo (odds ratio = 0.42, 95% confidence interval: 0.15-1.17); this difference was not statistically significant (p = 0.10). Fann J.R. Katon W.J. Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M. Cochrane Database Syst Rev. Sample is composed of those with TBI, or the sample is not exclusively TBI, but results on the TBI subsample are reported separately. Accessed Aug. 17, 2022. Kraus J. McArthur D.L. In terms of development and validation of outcome measures, more attention should be paid to measures of depression that do not require verbal self-report, particularly for participants with severe cognitive or linguistic impairments. doi: 10.1002/14651858.CD002018.pub2. FOIA Although antidepressants may not cure depression, they can reduce symptoms. Alzheimer's disease: Can exercise prevent memory loss? Federoff J. Starkstein S.E. We made comparisons between antidepressant classes to assess excess risk of each adverse event using discrete time analysis and controlling for potential confounders. Regarding non-pharmacological treatment, Rosenthal and colleagues commented in a 1998 comprehensive review that psychotherapy was frequently done with depressed persons with TBI, but no recommendations could be formulated because the published research was limited to uncontrolled case studies (Rosenthal et al., 1998). Turner GM, McMullan C, Aiyegbusi OL, Bem D, Marshall T, Calvert M, Mant J, Belli A. Int J Stroke. The frontal and temporal poles are preferentially affected by the focal and diffuse injury caused by TBI (Miller et al., 1990). In subgroup analysis of the studies that reported mean Hamilton Depression Rating Scale score differences between treatment and control groups in both baseline and endpoint evaluations, the pooled mean difference was reduced from 2.11 (95% confidence interval: -1.25 to 5.46) to -2.36 (95% confidence interval: -5.59 to 0.87), in favour of the treatment group, though not statistically significant (p = 0.06). Rae D.S. Alderfer B.S. Treatment of MDD has a strong and evolving evidence base documented by numerous systematic reviews and meta-analyses (Cuijpers et al., 2007b; Cuijpers et al., 2007a; Furukawa, 2003; Moncrieff, 2004). House A. Xia J. Epub 2019 Oct 30. doi: 10.2217/cnc-2020-0022. This work was also supported by NIDRR grants H133A070040 (Moss Traumatic Brain Injury Model System), and H133G070016 (J.R.F. J Psychiatry Neurosci. Unique characteristics of the study sample included a high rate of low-income and minority patients. A single copy of these materials may be reprinted for noncommercial personal use only. We made comparisons between antidepressant classes to assess excess risk of each adverse event using discrete time analysis and controlling for potential confounders. Yang ST, Hung HY, Ro LS, Liao MF, Amstislavskaya TG, Tikhonova MA, Yang YL, Lu KT. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your health care provider or get emergency help. 1990 until August 2017 that compared the efficacy of antidepressants with placebo in the treatment of post-traumatic brain injury depression. Kohlenberg R.J. Addis M.E. Bupropion is one of the few antidepressants that has a dopamine reuptake blocker. A new study found that antidepressants can help brain cells grow and survive after brain trauma, and can even lead to improved [] Miller J. Pentland B. Berrol S. Early evaluation and management. Background Depression is a common complication of traumatic brain injury (TBI). Accessibility Furthermore, Dinan and Mobayed (Dinan and Mobayed, 1992) excluded patients who had a pre-TBI history of affective disorder, and specific HAM-D response rates were not reported. Patients with mild TBI are especially appropriate for antidepressant therapy because they, on average, more closely resemble patients with no known TBI history enrolled in typical primary Major Depressive Disorder clinical trials than patients enrolled in TBI trials in placebo-controlled trials published to date. Singer W.D. Hidradenitis suppurativa: Where can I find support? However, we identified no studies that examined the efficacy of combined therapies for depression after TBI; presumably, these will need to await stronger evidence of efficacy for single treatments. Seel R.T. Kreutzer J.S. Weak, but complex pulsed magnetic fields may reduce depression following traumatic brain injury. 2015 Mar;29(3):245-52. doi: 10.1007/s40263-015-0231-5. Fann J.R. Uomoto J.M. There also appeared to be variation in the degree to which the treatments were based on standardized protocols or manuals; of the group studies, only three specified that a treatment manual was used (Bedard et al., 2003; Gurr and Coetzer, 2005; Tiersky et al., 2005). (The exception in this set was the study of Tiersky and colleagues [Tiersky et al., 2005], which included cognitive remediation in addition to CBT, and provided about 70h of treatment.) 2015 Nov;63(11):2227-46 What are the treatments for traumatic brain injury (TBI)? These are the most dangerous antidepressants for people with liver problems. Cochrane Database Syst Rev. No conflicting financial interests exist. The present study aimed to update the best evidence-based pharmacological treatments for tackling such chronic and debilitating disorders. All but two of the pharmacotherapy studies prospectively selected depressed patients, but all were limited in sample size and randomized controlled trials were rare. SSRIs were well-tolerated in most studies. Ochs L. Matheis R.J. Flexyx neurotherapy system in the treatment of traumatic brain injury: An initial evaluation. Mayo Clinic. A case report of classical Chinese acupuncture in a patient with severe TBI, multiple injuries, and severe pain showed improvement in pain, but not depression or anxiety scores (Donnellan, 2006). The https:// ensures that you are connecting to the Is it safe to take an anti-depressant after a brain injury? Dry mouth, nausea, decreased libido, and sedation were the most common side effects of citalopram in Rapoport and colleagues' (Rapoport et al., 2008) study. https://www.nimh.nih.gov/health/topics/depression. Kurtyka J. Roosen E. Schwartz T. DeLuca J. Pre-treatment depression and/or emotional distress was identified as significant in the case study (Ownsworth, 2005), and the study by Tiersky and associates (Tiersky et al., 2005), which used emotional distress as an inclusion criterion. Drugs for behavior disorders after traumatic brain injury: Systematic Major depressive disorder (MDD) appears to be the most prevalent psychiatric disorder after TBI, with a point prevalence rate over 25% (Rutherford, 1977; Schoenhuber and Gentilini, 1988; van Zomeren and van den Burg, 1985). 2022 Jun 21;12(6):e062527. Zaloshnja E. Miller T. Langlois J.A. Ischemic stroke was the most frequent (8296 events). van Zomeren A.H. van den Burg W. Residual complaints of patients two years after severe head injury. A 2006 review of pharmacological treatments for neurobehavioral sequelae of TBI, including mood disorders, concluded that there was limited evidence to support or refute the effectiveness of psychotropic medications used in the general population to treat depression after TBI (Warden et al., 2006). Conduct more trials on innovative delivery systems, such as telephone, telehealth, and web-based models, which have the potential of overcoming some of the treatment barriers faced by TBI patients (e.g., with regard to mobility, transportation, accessibility, and finances). Depression is increasingly recognised as a common sequel to acquired brain injury and the use of antidepressant medication in this context has increased markedly over recent years. Also, the mean time since injury was 17.7 (SD 13.7) years, making it difficult to ascertain the relative contribution of the TBI to their depressive episode. The profile of contributing factors that lead to depression in people with TBI suggests that a comprehensive biopsychosocial approach should be applied to depression management.