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Abstract
OBJECTIVE Depression is among the most pervasive and debilitating neuropsychiatric sequelae experienced by patients following a traumatic brain injury (TBI). While the individual mechanisms underlying depression and TBI have been widely studied, the neurobiological bases of depression after TBI remain largely unknown. This article highlights the potential mechanisms of action implicated in depression after TBI. RESULTS We review putative mechanisms of action including neuroinflammation, neuroendocrine dysregulation, metabolic abnormalities, and neurotransmitter and circuitry dysfunction. We also identify the current limitations in the field and propose directions for future research. CONCLUSION An improved understanding of the underlying mechanisms will aid the development of precision-guided and personalized treatments for patients suffering from depression after TBI.
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Affiliation(s)
- Aava Bushra Jahan
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, US.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, US
| | - Kaloyan Tanev
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, US
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2
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Current and Potential Pharmacologic Therapies for Traumatic Brain Injury. Pharmaceuticals (Basel) 2022; 15:ph15070838. [PMID: 35890136 PMCID: PMC9323622 DOI: 10.3390/ph15070838] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
The present article reviewed the pharmacologic therapies of traumatic brain injury (TBI), including current and potential treatments. Pharmacologic therapies are an essential part of TBI care, and several agents have well-established effects in TBI care. In the acute phase, tranexamic acid, antiepileptics, hyperosmolar agents, and anesthetics are the mainstay of pharmacotherapy, which have proven efficacies. In the post-acute phase, SSRIs, SNRIs, antipsychotics, zolpidem and amantadine, as well as other drugs, have been used to manage neuropsychological problems, while muscle relaxants and botulinum toxin have been used to manage spasticity. In addition, increasing numbers of pre-clinical and clinical studies of pharmaceutical agents, including potential neuroprotective nutrients and natural therapies, are being carried out. In the present article, we classify the treatments into established and potential agents based on the level of clinical evidence and standard of practice. It is expected that many of the potential medicines under investigation will eventually be accepted as standard practice in the care of TBI patients.
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3
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Hicks AJ, Clay FJ, James AC, Hopwood M, Ponsford JL. Effectiveness of Pharmacotherapy for Depression after Adult Traumatic Brain Injury: an Umbrella Review. Neuropsychol Rev 2022; 33:393-431. [PMID: 35699850 PMCID: PMC10148771 DOI: 10.1007/s11065-022-09543-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
Symptoms of depression are common following traumatic brain injury (TBI), impacting survivors' ability to return to work, participate in leisure activities, and placing strain on relationships. Depression symptoms post TBI are often managed with pharmacotherapy, however, there is little research evidence to guide clinical practice. There have been a number of recent systematic reviews examining pharmacotherapy for post TBI depression. The aim of this umbrella review was to synthesize systematic reviews and meta-analyses of the effectiveness of pharmacotherapy for the management of post TBI depression in adults. Eligible reviews examined any pharmacotherapy against any comparators, for the treatment of depression in adults who had sustained TBI. Seven databases were searched, with additional searching of online journals, Research Gate, Google Scholar and the TRIP Medical Database to identify published and unpublished systematic reviews and meta-analyses in English up to May 2020. A systematic review of primary studies available between March 2018 and May 2020 was also conducted. Evidence quality was assessed using Joanna Briggs Institute Critical Appraisal Instruments. The results are presented as a narrative synthesis. Twenty-two systematic reviews were identified, of which ten reviews contained a meta-analysis. No new primary studies were identified in the systematic review. There was insufficient high quality and methodologically rigorous evidence to recommend prescribing any specific drug or drug class for post TBI depression. The findings do show, however, that depression post TBI is responsive to pharmacotherapy in at least some individuals. Recommendations for primary studies, systematic reviews and advice for prescribers is provided. Review Registration PROSPERO (CRD42020184915).
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Affiliation(s)
- Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Ground Floor, 185-187 Hoddle St, Richmond, Melbourne, VIC, 3121, Australia.
| | - Fiona J Clay
- Department of Forensic Medicine, Monash University, Southbank, Australia
| | - Amelia C James
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Ground Floor, 185-187 Hoddle St, Richmond, Melbourne, VIC, 3121, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Professorial Psychiatry Unit, Albert Road Clinic, Department of Psychiatry, University of Melbourne, 31 Albert Road, Melbourne, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Ground Floor, 185-187 Hoddle St, Richmond, Melbourne, VIC, 3121, Australia
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4
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Minchew HM, Radabaugh HL, LaPorte ML, Free KE, Cheng JP, Bondi CO. A combined therapeutic regimen of citalopram and environmental enrichment ameliorates attentional set-shifting performance after brain trauma. Eur J Pharmacol 2021; 904:174174. [PMID: 34004206 PMCID: PMC8906929 DOI: 10.1016/j.ejphar.2021.174174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 01/09/2023]
Abstract
Traumatic brain injuries (TBI) have led to lasting deficits for an estimated 5.3 million American patients. Effective therapies for these patients remain scarce and each of the clinical trials stemming from success in experimental models has failed. We believe that the failures may be, in part, due to the lack of preclinical assessment of cognitive domains that widely affect clinical TBI. Specifically, the behavioral tasks in the TBI literature often do not focus on common executive impairments related to the frontal lobe such as cognitive flexibility. In previous work, we have demonstrated that the attentional set-shifting test (AST), a task analogous to the clinically-employed Wisconsin Card Sorting Test (WCST), could be used to identify cognitive flexibility impairments following controlled cortical impact (CCI) injury. In this study, we hypothesized that both the administration of the antidepressant drug citalopram (CIT) and exposure to a preclinical model of neurorehabilitation, environmental enrichment (EE), would attenuate cognitive performance deficits on AST when provided alone and lead to greater benefits when administered in combination. Adult male rats were subjected to a moderate-severe CCI or sham injury. Rats were randomly divided into experimental groups that included surgical injury, drug therapy, and housing condition. We observed that both CIT and EE provided significant cognitive recovery when administered alone and reversal learning performance recovery increased the most when the therapies were combined (p < 0.05). Ongoing studies continue to evaluate novel ways of assessing more clinically relevant measurements of high order cognitive TBI-related impairments in the rat model.
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Affiliation(s)
- Heather M Minchew
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Hannah L Radabaugh
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Megan L LaPorte
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Kristin E Free
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jeffrey P Cheng
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Corina O Bondi
- Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Neurobiology, University of Pittsburgh, Pittsburgh, PA, 15213, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, 15213, USA.
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5
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Pharmacotherapy for Treatment of Cognitive and Neuropsychiatric Symptoms After mTBI. J Head Trauma Rehabil 2021; 35:76-83. [PMID: 31834058 DOI: 10.1097/htr.0000000000000537] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Cognitive and neuropsychiatric symptoms are extremely common following mild traumatic brain injury (TBI), also known as concussion. Although most patients will recovery rapidly, a significant minority go on to experience persistent symptoms. There are currently no FDA-approved medications for treatment of cognitive and neuropsychiatric problems in the context of mild TBI, yet a number of agents are prescribed "off-label" for these complaints. Rigorous trials are lacking, but there are a number of open-label studies, and some small randomized controlled trials that support the safety and possible efficacy of pharmacotherapies in this population. Clinical trials conducted in samples with more severe brain injuries can also serve as a guide. METHODS Review of the literature. RESULTS & CONCLUSIONS There is the most support in the literature for the neurostimulant methylphenidate for treatment of mild TBI-related cognitive dysfunction, and the selective serotonin reuptake inhibitor, sertraline, for the treatment of postinjury depression. There is clearly a need for more well-designed studies to guide clinicians in selecting the appropriate medication and dose. Without clear guidance from the literature, a cautious approach of starting low and titrating slowly is recommended.
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Fakhoury M, Shakkour Z, Kobeissy F, Lawand N. Depression following traumatic brain injury: a comprehensive overview. Rev Neurosci 2020; 32:289-303. [PMID: 33661587 DOI: 10.1515/revneuro-2020-0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 10/21/2020] [Indexed: 12/19/2022]
Abstract
Traumatic brain injury (TBI) represents a major health concern affecting the neuropsychological health; TBI is accompanied by drastic long-term adverse complications that can influence many aspects of the life of affected individuals. A substantial number of studies have shown that mood disorders, particularly depression, are the most frequent complications encountered in individuals with TBI. Post-traumatic depression (P-TD) is present in approximately 30% of individuals with TBI, with the majority of individuals experiencing symptoms of depression during the first year following head injury. To date, the mechanisms of P-TD are far from being fully understood, and effective treatments that completely halt this condition are still lacking. The aim of this review is to outline the current state of knowledge on the prevalence and risk factors of P-TD, to discuss the accompanying brain changes at the anatomical, molecular and functional levels, and to discuss current approaches used for the treatment of P-TD.
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Affiliation(s)
- Marc Fakhoury
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Zaynab Shakkour
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nada Lawand
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.,Department of Neurology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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7
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Hicks AJ, Clay FJ, Hopwood M, James AC, Perry LA, Jayaram M, Batty R, Ponsford JL. Efficacy and Harms of Pharmacological Interventions for Anxiety after Traumatic Brain Injury: Systematic Review. J Neurotrauma 2020; 38:519-528. [PMID: 33045912 DOI: 10.1089/neu.2020.7277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
After a traumatic brain injury (TBI), many persons experience significant and debilitating problems with anxiety. The aim of this systematic review was to critically evaluate the evidence regarding efficacy of pharmacological interventions for anxiety after TBI. We reviewed studies published in English before July 2020 and included original research on pharmacological interventions for anxiety after TBI in adults ≥16 years of age. MEDLINE, PubMed, CINAHL, EMBASE, PsycINFO, and CENTRAL databases were searched, with additional searching of key journals, clinical trials registries, and international drug regulators. The primary outcomes of interest were reduction in symptoms of anxiety and occurrence of harms. The secondary outcomes of interest were changes in depression, cognition, quality of life, and participation. Data were summarized in a narrative synthesis, and evidence quality was assessed using the Cochrane Risk of Bias tool. Only a single non-peer-reviewed, randomized controlled trial of 19 male military service members with mild TBI met inclusion criteria. This study found no significant effect of citalopram on anxiety symptoms over a 12-week intervention. The trial was stopped early because of poor recruitment, and much of the study detail was not included in the report. The methodological quality of the study was difficult to assess because of the lack of detail. No recommendations could be drawn from this review. There is a critical need for adequately powered and controlled studies of pharmacological interventions for anxiety after TBI across all severities that examine side-effect profiles and consider issues of comorbidity and effects of long-term pharmacotherapy.
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Affiliation(s)
- Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Fiona J Clay
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia.,Professorial Psychiatry Unit, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia.,Professorial Psychiatry Unit, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Amelia C James
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Luke A Perry
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Mahesh Jayaram
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Batty
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
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8
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Beedham W, Belli A, Ingaralingam S, Haque S, Upthegrove R. The management of depression following traumatic brain injury: A systematic review with meta-analysis. Brain Inj 2020; 34:1287-1304. [PMID: 32809854 DOI: 10.1080/02699052.2020.1797169] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is prevalent. Declining mortality has led to increasing survivors with chronic sequalae, including depression. With a lack of guidelines, this review aims to provide a comprehensive, evidence-based summary of the management of depression following TBI. METHODS Systematic searches were conducted for quasi-experimental and randomized controlled trials (RCTs) assessing pharmacotherapy, psychological interventions, and transcranial magnetic stimulation (TMS). Databases searched CENTRAL, Medline, Embase, CINAHL, PsycINFO, Web of Science, and ProQuest dissertations. Data extraction and risk-of-bias tools were used. Where possible, outcomes were combined into meta-analyses. RESULTS 2719 studies were identified. After abstract screening and full-text reading, 34 remained. Prophylactic sertraline significantly reduced the odds of depression (OR (odds ratio) = 0.31 [95%CI (confidence interval) = 0.12 to 0.82]). Meta-analysis of RCT's showed TMS to have the greatest reduction in depression severity (SMD (Standardized-Mean-Difference) = 2.43 [95%CI = 1.24 to 3.61]). Stimulants were the only treatment superior to control (SMD = -1.03 [95%CI = - 1.6 to -0.47]). CONCLUSION Methylphenidate was the most effective pharmacotherapy. Sertraline appears effective for prevention. The efficacy of psychological interventions is unclear. TMS as a combination therapy appears promising. Heterogeneity of study populations and dearth of evidence means results should be interpreted cautiously.
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Affiliation(s)
- William Beedham
- College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK
| | - Antonio Belli
- Consultant Neurosurgeon. Institute of Inflammation and Aging, University of Birmingham , Birmingham, UK
| | - Sathana Ingaralingam
- College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK
| | - Sayeed Haque
- Senior Lecturer in Medical Statistics., University of Birmingham , Birmingham, UK
| | - Rachel Upthegrove
- Professor of Psychiatry and Youth Mental Health. Institute for Mental Health, University of Birmingham , Birmingham, UK
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Kreitzer N, Ancona R, McCullumsmith C, Kurowski BG, Foreman B, Ngwenya LB, Adeoye O. The Effect of Antidepressants on Depression After Traumatic Brain Injury: A Meta-analysis. J Head Trauma Rehabil 2020; 34:E47-E54. [PMID: 30169440 PMCID: PMC8730802 DOI: 10.1097/htr.0000000000000439] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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 = 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 = 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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Affiliation(s)
- Natalie Kreitzer
- Division of Neurocritical Care (Drs Kreitzer, Foreman, and Adeoye), Department of Emergency Medicine (Drs Kreitzer and Adeoye and Ms Ancona), Department of Psychiatry (Dr McCullumsmith), Department of Pediatrics (Dr Kurowski), Department of Physical Medicine and Rehabilitation (Dr Kurowski), Department of Neurology and Rehabilitation Medicine (Drs Foreman and Ngwenya), and Department of Neurosurgery (Dr Ngwenya), University of Cincinnati, Cincinnati, Ohio
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Narapareddy BR, Narapareddy L, Lin A, Wigh S, Nanavati J, Dougherty J, Nowrangi M, Roy D. Treatment of Depression After Traumatic Brain Injury: A Systematic Review Focused on Pharmacological and Neuromodulatory Interventions. PSYCHOSOMATICS 2020; 61:481-497. [PMID: 32660873 DOI: 10.1016/j.psym.2020.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 01/13/2023]
Abstract
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.
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Affiliation(s)
- Bharat R Narapareddy
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Laren Narapareddy
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Shreya Wigh
- University of New Mexico, College of Arts and Sciences, Albuquerque, NM
| | - Julie Nanavati
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Milap Nowrangi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
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11
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Pharmacologic Treatment of Neurobehavioral Sequelae Following Traumatic Brain Injury. Crit Care Nurs Q 2020; 43:172-190. [DOI: 10.1097/cnq.0000000000000301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Slowinski A, Coetzer R, Byrne C. Pharmacotherapy Effectiveness in Treating Depression After Traumatic Brain Injury: A Meta-Analysis. J Neuropsychiatry Clin Neurosci 2020; 31:220-227. [PMID: 30636565 DOI: 10.1176/appi.neuropsych.18070158] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depression is a highly prevalent neuropsychiatric sequela among individuals who have experienced traumatic brain injury (TBI). Despite its high prevalence, there continues to be conflicting evidence surrounding the efficacy of medication for treating depression post-TBI and whether different treatments have distinct effects. The aim of this study was to systematically review and synthesize the available evidence for the effectiveness of pharmacotherapy for depression following a TBI. METHODS A meta-analysis was completed using several online databases (PubMed, National Institute of Health and Care Excellence, and Healthcare Databases Advanced Search) to search for clinical trials involving various pharmacological treatments for depression in patients with TBIs. Twelve studies met the inclusion criteria and were assessed using their sample size, treatment duration, treatment used, TBI severity, method of assessment, and medication response. Standardized mean difference effect sizes (Cohen's d) were calculated for each study using pre- and postintervention scores and pooled using a random effects model to produce a summary effect size. RESULTS Fourteen effect sizes were calculated, and a mild to moderate pooled effect size (Cohen's d=-0.49, 95% CI: -0.96, -0.02, p=0.02) was found. Ten studies demonstrated effect sizes that were statistically significant, and four were nonsignificant. The weighted pooled effect size was higher for single-group design studies (Cohen's d=-1.35, 95% CI: -2.14, -0.56, N=5) compared with independent-group designs (Cohen's d=0.001, CI: -0.59, 0.58; N=9). CONCLUSIONS This meta-analysis tentatively supports the view that pharmacological treatment may be effective in reducing depressive symptoms in those with depression following TBI. However, evidence from randomized controlled trials alone demonstrated no beneficial effect. The limitations are also discussed.
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Affiliation(s)
- Anya Slowinski
- The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board NHS, Wales, United Kingdom (Coetzer, Byrne); and the School of Psychology, Bangor University, Bangor, Wales, United Kingdom (Slowinski, Coetzer, Byrne)
| | - Rudi Coetzer
- The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board NHS, Wales, United Kingdom (Coetzer, Byrne); and the School of Psychology, Bangor University, Bangor, Wales, United Kingdom (Slowinski, Coetzer, Byrne)
| | - Christopher Byrne
- The North Wales Brain Injury Service, Betsi Cadwaladr University Health Board NHS, Wales, United Kingdom (Coetzer, Byrne); and the School of Psychology, Bangor University, Bangor, Wales, United Kingdom (Slowinski, Coetzer, Byrne)
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13
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Liu Q, Li R, Qu W, Li B, Yang W, Cui R. Pharmacological and non-pharmacological interventions of depression after traumatic brain injury: A systematic review. Eur J Pharmacol 2019; 865:172775. [DOI: 10.1016/j.ejphar.2019.172775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/26/2019] [Accepted: 11/01/2019] [Indexed: 12/27/2022]
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Polich G, Iaccarino MA, Zafonte R. Psychopharmacology of traumatic brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2019; 165:253-267. [PMID: 31727216 DOI: 10.1016/b978-0-444-64012-3.00015-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The pathophysiology of traumatic brain injury (TBI) can be highly variable, involving functional and/or structural damage to multiple neuroanatomical networks and neurotransmitter systems. This wide-ranging potential for physiologic injury is reflected in the diversity of neurobehavioral and neurocognitive symptoms following TBI. Here, we aim to provide a succinct, clinically relevant, up-to-date review on psychopharmacology for the most common sequelae of TBI in the postacute to chronic period. Specifically, treatment for neurobehavioral symptoms (depression, mania, anxiety, agitation/irritability, psychosis, pseudobulbar affect, and apathy) and neurocognitive symptoms (processing speed, attention, memory, executive dysfunction) will be discussed. Treatment recommendations will reflect general clinical practice patterns and the research literature.
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Affiliation(s)
- Ginger Polich
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Mary Alexis Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States.
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15
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Minen MT, Boubour A, Walia H, Barr W. Post-Concussive Syndrome: a Focus on Post-Traumatic Headache and Related Cognitive, Psychiatric, and Sleep Issues. Curr Neurol Neurosci Rep 2017; 16:100. [PMID: 27709555 DOI: 10.1007/s11910-016-0697-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Post-traumatic headache (PTH) is a secondary headache disorder following traumatic brain injury. We sought to examine the recent literature on PTH and associated cognitive, psychiatric, and sleep conditions to understand the latest findings about the associated conditions and available screening tools, and to understand the available treatment options for PTH. RECENT FINDINGS Up to one third of PTH patients may have depression and about one quarter may have insomnia. Anxiety and cognitive issues are also common. While there are few studies examining abortive medications for PTH, recent studies of preventive medications examine the efficacy of topiramate, and topiramate may be better than other oral preventive medications. Other currently investigated treatments include nerve blocks, onabotulinum toxin A, transmagnetic stimulation, and behavioral therapy (biofeedback). Due to an expanded focus on and knowledge of concussion and PTH, comorbid psychiatric, cognitive, and sleep issues have become more widely acknowledged and studied. However, more high-quality studies must be conducted to examine the underlying pathophysiology of PTH and associated symptoms and to determine the most effective abortive and preventive treatment options.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Medical Center, 240 East 38th Street 20th floor, New York, NY, 10016, USA.
| | | | - Harjasleen Walia
- Department of Neurology, NYU Langone Medical Center, 240 East 38th Street 20th floor, New York, NY, 10016, USA
| | - William Barr
- Department of Neuropsychology, NYU Langone Medical Center, New York, NY, USA
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Yue JK, Burke JF, Upadhyayula PS, Winkler EA, Deng H, Robinson CK, Pirracchio R, Suen CG, Sharma S, Ferguson AR, Ngwenya LB, Stein MB, Manley GT, Tarapore PE. Selective Serotonin Reuptake Inhibitors for Treating Neurocognitive and Neuropsychiatric Disorders Following Traumatic Brain Injury: An Evaluation of Current Evidence. Brain Sci 2017; 7:E93. [PMID: 28757598 PMCID: PMC5575613 DOI: 10.3390/brainsci7080093] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/15/2017] [Accepted: 07/20/2017] [Indexed: 01/15/2023] Open
Abstract
The prevalence of neuropsychiatric disorders following traumatic brain injury (TBI) is 20%-50%, and disorders of mood and cognition may remain even after recovery of neurologic function is achieved. Selective serotonin reuptake inhibitors (SSRI) block the reuptake of serotonin in presynaptic cells to lead to increased serotonergic activity in the synaptic cleft, constituting first-line treatment for a variety of neurocognitive and neuropsychiatric disorders. This review investigates the utility of SSRIs in treating post-TBI disorders. In total, 37 unique reports were consolidated from the Cochrane Central Register and PubMed (eight randomized-controlled trials (RCTs), nine open-label studies, 11 case reports, nine review articles). SSRIs are associated with improvement of depressive but not cognitive symptoms. Pooled analysis using the Hamilton Depression Rating Scale demonstrate a significant mean decrease of depression severity following sertraline compared to placebo-a result supported by several other RCTs with similar endpoints. Evidence from smaller studies demonstrates mood improvement following SSRI administration with absent or negative effects on cognitive and functional recovery. Notably, studies on SSRI treatment effects for post-traumatic stress disorder after TBI remain absent, and this represents an important direction of future research. Furthermore, placebo-controlled studies with extended follow-up periods and concurrent biomarker, neuroimaging and behavioral data are necessary to delineate the attributable pharmacological effects of SSRIs in the TBI population.
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Affiliation(s)
- John K Yue
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
| | - John F Burke
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
| | - Pavan S Upadhyayula
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Department of Psychiatry, University of California, San Diego, CA 92093, USA.
| | - Ethan A Winkler
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
| | - Hansen Deng
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
| | - Caitlin K Robinson
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA 94143, USA.
| | - Catherine G Suen
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Department of Neurology, University of Utah School of Medicine, Salt Lake, UT 84112, USA.
| | - Sourabh Sharma
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL 60660, USA.
| | - Adam R Ferguson
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
| | - Laura B Ngwenya
- Department of Neurological Surgery, University of Cincinnati, Cincinnati, OH 45220, USA.
| | - Murray B Stein
- Department of Psychiatry, University of California, San Diego, CA 92093, USA.
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
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Leung A, Metzger-Smith V, He Y, Cordero J, Ehlert B, Song D, Lin L, Shahrokh G, Tsai A, Vaninetti M, Rutledge T, Polston G, Sheu R, Lee R. Left Dorsolateral Prefrontal Cortex rTMS in Alleviating MTBI Related Headaches and Depressive Symptoms. Neuromodulation 2017; 21:390-401. [DOI: 10.1111/ner.12615] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/22/2017] [Accepted: 04/10/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Albert Leung
- Department of Anesthesiology; The University of California; San Diego, La Jolla, CA, USA
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | | | - Yifan He
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - James Cordero
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Brandon Ehlert
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - David Song
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
- Department of Neuroscience; The University of California; San Diego, La Jolla, CA, USA
| | - Lisa Lin
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | | | - Alice Tsai
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Michael Vaninetti
- Department of Anesthesiology; The University of California; San Diego, La Jolla, CA, USA
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Thomas Rutledge
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
- Department of Psychiatric; The University of California; San Diego, La Jolla, CA, USA
| | - Greg Polston
- Department of Anesthesiology; The University of California; San Diego, La Jolla, CA, USA
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
| | - Robert Sheu
- Naval Medical Center San Diego; San Diego, CA, USA
| | - Roland Lee
- Veteran Affairs San Diego Healthcare System; San Diego, CA, USA
- Department of Radiology; The University of California; San Diego, La Jolla, CA, USA
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Surmeli T, Eralp E, Mustafazade I, Kos IH, Özer GE, Surmeli OH. Quantitative EEG Neurometric Analysis-Guided Neurofeedback Treatment in Postconcussion Syndrome (PCS): Forty Cases. How Is Neurometric Analysis Important for the Treatment of PCS and as a Biomarker? Clin EEG Neurosci 2017; 48:217-230. [PMID: 27354361 DOI: 10.1177/1550059416654849] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postconcussion syndrome (PCS) has been used to describe a range of residual symptoms that persist 12 months or more after the injury, often despite a lack of evidence of brain abnormalities on magnetic resonance imaging and computed tomography scans. In this clinical case series, the efficacy of quantitative EEG-guided neurofeedback in 40 subjects diagnosed with PCS was investigated. Overall improvement was seen in all the primary (Symptom Assessment-45 Questionnaire, Clinical Global Impressions Scale, Hamilton Depression Scale) and secondary measures (Minnesota Multiphasic Personality Inventory, Test of Variables for Attention). The Neuroguide Traumatic Brain Index for the group also showed a decrease. Thirty-nine subjects were followed up long term with an average follow-up length of 3.1 years (CI = 2.7-3.3). All but 2 subjects were stable and were off medication. Overall neurofeedback treatment was shown to be effective in this group of subjects studied.
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Affiliation(s)
- Tanju Surmeli
- 1 Living Health Center for Research and Education, Sisli, Istanbul, Turkey
| | - Emin Eralp
- 2 Brain Power Institute, Sisli, Istanbul, Turkey
| | - Ilham Mustafazade
- 1 Living Health Center for Research and Education, Sisli, Istanbul, Turkey
| | - Ismet Hadi Kos
- 1 Living Health Center for Research and Education, Sisli, Istanbul, Turkey
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Predictors of Pharmacological Intervention in Adolescents With Protracted Symptoms After Sports-Related Concussion. PM R 2017; 9:847-855. [DOI: 10.1016/j.pmrj.2016.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/22/2016] [Accepted: 12/29/2016] [Indexed: 01/10/2023]
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21
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Bhatnagar S, Iaccarino MA, Zafonte R. Pharmacotherapy in rehabilitation of post-acute traumatic brain injury. Brain Res 2016; 1640:164-179. [DOI: 10.1016/j.brainres.2016.01.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/09/2016] [Accepted: 01/11/2016] [Indexed: 11/30/2022]
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Miller Phillips M, Reddy CC. Managing Patients with Prolonged Recovery Following Concussion. Phys Med Rehabil Clin N Am 2016; 27:455-74. [DOI: 10.1016/j.pmr.2015.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
It is time to stop using the term concussion as it has no clear definition and no pathological meaning. This confusion is increasingly problematic as the management of ‘concussed’ individuals is a pressing concern. Historically, it has been used to describe patients briefly disabled following a head injury, with the assumption that this was due to a transient disorder of brain function without long-term sequelae. However, the symptoms of concussion are highly variable in duration, and can persist for many years with no reliable early predictors of outcome. Using vague terminology for post-traumatic problems leads to misconceptions and biases in the diagnostic process, producing uninterpretable science, poor clinical guidelines and confused policy. We propose that the term concussion should be avoided. Instead neurologists and other healthcare professionals should classify the severity of traumatic brain injury and then attempt to precisely diagnose the underlying cause of post-traumatic symptoms.
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Affiliation(s)
- David J Sharp
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Peter O Jenkins
- Computational, Cognitive, and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, London, UK
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24
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Plantier D, Luauté J. Drugs for behavior disorders after traumatic brain injury: Systematic review and expert consensus leading to French recommendations for good practice. Ann Phys Rehabil Med 2016; 59:42-57. [PMID: 26797170 DOI: 10.1016/j.rehab.2015.10.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/12/2015] [Accepted: 10/18/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE There are no handbook or recommendations for the use of pharmacological agents to treat neurobehavioral disorders after traumatic brain injury (TBI). This work proposes a systematic review of the literature and a user guide on neuroleptics, antidepressants, beta-blockers, mood stabilizers and other medications for irritability, aggressiveness, agitation, impulsivity, depression, apathy… METHOD Steering, working and reading groups (62 people) were formed under the control of the French High Authority for Health (HAS) in collaboration with the SOFMER scientific society (French Society of Physical and Rehabilitation Medicine). Articles were searched by HAS officers in the Medline database from 1990 to 2012, crossing TBI and pharmacological agents. The HAS method to select, read and analyze papers is close to the PRISMA statements. RESULTS Out of 772 references, 89 were analyzed, covering a total of 1306 people with TBI. There is insufficient evidence to standardize drug treatments for these disorders. There are however some elements to establish consensus recommendations for good clinical practice. Propranolol can improve aggression (B grade). Carbamazepine and valproate seem effective on agitation and aggression and are recommended as first line treatment (Expert Consensus [EC]). There is no evidence of efficacy for neuroleptics. Their prescription is based on emergency situation for a crisis (loxapine) but not for long-term use (EC). Antidepressants are recommended to treat depression (EC) with a higher standard of proof for Selective Serotonin Reuptake Inhibitors (SSRI, grade B). Other products are described. CONCLUSION The choice of treatment depends on the level of evidence, target symptoms, custom objectives, clinical experience and caution strategies.
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Affiliation(s)
- D Plantier
- Department of Physical Medicine and Rehabilitation (PM&R), Neurological Rehabilitation, Renée-Sabran Hospital, University Hospital of Lyon, boulevard Édouard-Herriot, 83400 Hyères, France.
| | - J Luauté
- Physical Medicine and Rehabilitation, Neurological Rehabilitation, Henry-Gabrielle Hospital, University Hospital of Lyon, 69230 Saint-Genis-Laval, France; Neuroscience Research Center of Lyon (CRNL) IMPACT team, Inserm U1028, CNRS, UMR5292, 69500 Bron, France
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25
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Leung A, Shukla S, Fallah A, Song D, Lin L, Golshan S, Tsai A, Jak A, Polston G, Lee R. Repetitive Transcranial Magnetic Stimulation in Managing Mild Traumatic Brain Injury-Related Headaches. Neuromodulation 2015; 19:133-41. [DOI: 10.1111/ner.12364] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/07/2015] [Accepted: 09/15/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Albert Leung
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Shivshil Shukla
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Amir Fallah
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - David Song
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Lisa Lin
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Shahrokh Golshan
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
- Biostatistics Core; Veterans Medical Research Foundation; San Diego CA USA
| | - Alice Tsai
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Amy Jak
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Greg Polston
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
| | - Roland Lee
- Veteran Administration San Diego Healthcare System; La Jolla CA USA
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26
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Gordon WA, Cantor J, Kristen DO, Tsaousides T. Long-term social integration and community support. HANDBOOK OF CLINICAL NEUROLOGY 2015; 127:423-31. [PMID: 25702232 DOI: 10.1016/b978-0-444-52892-6.00027-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
TBI often results in reduced social participation. This decrease in social participation is independent of injury severity and time since injury. Thus, it is one of the many stable hallmarks of TBI. Changes in social participation have been related to many factors, including emotional dysregulation and disturbance and executive dysfunction. While there are evidenced-based treatments available to improve mood and executive functioning, none of the research has examined the impact of the various treatments on social participation or social integration. Therefore, while it is reasonable to expect that individuals who are feeling better about themselves and who improve their approach to day-to-day function will also experience increased social contact, there is no evidence to support this claim. This chapter reviews the literature on post-TBI social integration and its relationship to depression and executive dysfunction. In addition the intervention research in this area is briefly examined.
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Affiliation(s)
- Wayne A Gordon
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USA.
| | - Joshua Cantor
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Dams-O'Connor Kristen
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Theodore Tsaousides
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY, USA
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Dhaliwal SK, Meek BP, Modirrousta MM. Non-Invasive Brain Stimulation for the Treatment of Symptoms Following Traumatic Brain Injury. Front Psychiatry 2015; 6:119. [PMID: 26379560 PMCID: PMC4549551 DOI: 10.3389/fpsyt.2015.00119] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/10/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a common cause of physical, psychological, and cognitive impairment, but many current treatments for TBI are ineffective or produce adverse side effects. Non-invasive methods of brain stimulation could help ameliorate some common trauma-induced symptoms. OBJECTIVE This review summarizes instances in which repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS) have been used to treat symptoms following a TBI. A subsequent discussion attempts to determine the value of these methods in light of their potential risks. METHODS The research databases of PubMed/MEDLINE and PsycINFO were electronically searched using terms relevant to the use of rTMS and tDCS as a tool to decrease symptoms in the context of rehabilitation post-TBI. RESULTS Eight case-studies and four multi-subject reports using rTMS and six multi--subject studies using tDCS were found. Two instances of seizure are discussed. CONCLUSION There is evidence that rTMS can be an effective treatment option for some post-TBI symptoms, such as depression, tinnitus, and neglect. Although the safety of this method remains uncertain, the use of rTMS in cases of mild TBI without obvious structural damage may be justified. Evidence on the effectiveness of tDCS is mixed, highlighting the need for additional investigations.
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Affiliation(s)
| | - Benjamin P Meek
- Department of Psychiatry, University of Manitoba , Winnipeg, MB , Canada
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Rao V, McCann U, Han D, Bergey A, Smith MT. Does acute TBI-related sleep disturbance predict subsequent neuropsychiatric disturbances? Brain Inj 2014; 28:20-6. [PMID: 24328797 DOI: 10.3109/02699052.2013.847210] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE To determine whether sleep disturbance in the acute post-traumatic brain injury (TBI) period predicts symptoms of depression, anxiety or apathy measured 6 and 12 months after TBI. RESEARCH DESIGN Longitudinal, observational study. METHODS AND PROCEDURES First time closed-head injury patients (n = 101) were recruited and evaluated within 3 months of injury and followed longitudinally, with psychiatric evaluations at 6 and 12 months post-injury. Pre- and post-injury sleep disturbances were measured via the Medical Outcome Scale (MOS) for Sleep. Subjects were also assessed for anxiety, depression, apathy, medical comorbidity and severity of TBI. MAIN OUTCOMES AND RESULTS Sleep disturbance in the acute TBI period was associated with increased symptoms of depression, anxiety and apathy 12 months post-injury. CONCLUSIONS Sleep disturbances experienced soon after trauma (i.e. <3 months after injury) predicted neuropsychiatric symptoms 1 year after injury, raising two important clinical questions: (1) Is sleep disturbance soon after trauma a prognostic marker of subsequent neuropsychiatric symptoms? and (2) Can early treatment of sleep disturbance during the post-TBI period reduce subsequent development of neuropsychiatric symptoms? Future studies with larger sample sizes and appropriate control groups could help to answer these questions, using evidence-based methods for evaluating and treating sleep disturbances.
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Affiliation(s)
- Vani Rao
- Division of Geriatric Psychiatry & Neuropsychiatry and
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Barker-Collo S, Starkey N, Theadom A. Treatment for depression following mild traumatic brain injury in adults: a meta-analysis. Brain Inj 2013; 27:1124-33. [PMID: 23895287 DOI: 10.3109/02699052.2013.801513] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE Development of depression after TBI is linked to poorer outcomes. The aim of this manuscript is to review evidence for the effectiveness of current treatments. RESEARCH DESIGN Two meta-analyses were undertaken to examine the effectiveness of both pharmacological and non-pharmacological interventions for depression after mild TBI. METHOD AND PROCEDURES PubMed, Medline, PsychInfo, Web of Science and Digital Dissertations were searched and 13 studies located. Meta Analyst Beta 3.13 was used to conduct analyses of pre- vs post-effects then to examine treatment group vs control group effects. MAIN OUTCOMES AND RESULTS Studies using a pre-post design produced an overall effect size of 1.89 (95% CI = 1.20-2.58, p < 0.001), suggesting that treatments were effective; however, the overall effect for controlled trials was 0.46 (95% CI = -0.44-1.36, p < 0.001), which favoured the control rather than treatment groups. CONCLUSIONS This study highlights the need for additional large well-controlled trials of effective treatments for depression post-TBI.
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Affiliation(s)
- Suzanne Barker-Collo
- Department of Psychology, Faculty of Sciences, University of Auckland, Auckland, New Zealand.
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Abstract
Traumatic brain injury (TBI) is prevalent among many populations and existing data suggest that those with TBI are at increased risk for death by suicide. This systematic review serves as an update to a previous review, with the aim of evaluating the current state of evidence regarding prevalence and risk of suicide deaths, post-TBI suicidal ideation and suicide attempts, and treatments to reduce suicide-related outcomes among TBI survivors. Review procedures followed the PRISMA statement guidelines. In all, 1014 abstracts and 83 full-text articles were reviewed to identify 16 studies meeting inclusion criteria. Risk of bias for individual studies ranged from low to high, and very few studies were designed to examine a priori hypotheses related to suicide outcomes of interest. Overall, findings from this systematic review supported an increased risk of suicide among TBI survivors compared to those with no history of TBI. Evidence pertaining to suicidal thoughts and attempts was less clear, mainly due to heterogeneity of methodological quality across studies. One small randomised controlled trial was identified that targeted suicide prevention in TBI survivors. Further research is needed to identify the prevalence of post-TBI ideation and attempts, and to establish evidence-based suicide prevention practices among TBI survivors.
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Abstract
Depression is one of the most common psychiatric diagnoses among individuals with traumatic brain injury (TBI). Prevalence of post-TBI depression (PTBID) ranges from 12 to 60% and is generally higher than rates reported in the general population. The wide range in reported rates is attributed to methodological variability across studies, including measurement and sampling differences. Several systematic reviews have been published in the past 5 years, reporting on outcomes for depression across different classes of interventions, including pharmacological, biomedical and behavioural. The consensus across reviews is that more research is necessary to develop evidence-based practice guidelines. The present narrative review synthesises the findings of previous studies, focusing on the nature of the interventions, the eligibility criteria for inclusion and the assessment of outcome. Pharmacological studies are generally more rigorous methodologically, but provide mixed findings. Other biomedical interventions are only at the initial stages of research development, including case and pilot studies. The results of behavioural studies are positive regarding improvements in mood. However, the number of efficacy studies of behavioural interventions for depression is extremely limited. Recommendations for designing interventions are provided.
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Petraglia AL, Maroon JC, Bailes JE. From the Field of Play to the Field of Combat. Neurosurgery 2012; 70:1520-33; discussion 1533. [DOI: 10.1227/neu.0b013e31824cebe8] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Abstract
It is important for clinicians to recognize major depression following traumatic brain injury (TBI) because of its association with poor global and psychosocial outcome, postconcussive symptoms and cognitive deficits. The purpose of this review is to provide an up-to-date selective review of the current understanding of epidemiology, risk factors and management of major depression following TBI. Many studies of prevalence of depression following TBI have not used accepted structured criteria for the diagnoses, but those that did found wide ranges of rates, from 17% to 61%. The risk factors for development of depression following TBI are poorly understood, but past psychiatric history, frontal lesions and atrophy, and family dysfunction have been shown in more than one study to play important roles. There are few controlled trials of the treatment of major depression in patients with TBI using accepted diagnostic criteria for major depression, as well as defined criteria for response and remission. As such, it is important for clinicians to use best practice guidelines for the treatment of major depression in the absence of TBI.
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Affiliation(s)
- Mark J Rapoport
- Sunnybrook Health Sciences Centre, Geriatric Traumatic Brain Injury Clinic, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Archer T. Influence of Physical Exercise on Traumatic Brain Injury Deficits: Scaffolding Effect. Neurotox Res 2011; 21:418-34. [DOI: 10.1007/s12640-011-9297-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 12/02/2011] [Accepted: 12/02/2011] [Indexed: 12/19/2022]
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Lanctôt KL, Rapoport MJ, Chan F, Rajaram RD, Strauss J, Sicard T, McCullagh S, Feinstein A, Kiss A, Kennedy JL, Bassett AS, Herrmann N. Genetic predictors of response to treatment with citalopram in depression secondary to traumatic brain injury. Brain Inj 2010; 24:959-69. [PMID: 20515362 DOI: 10.3109/02699051003789229] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To determine which serotonergic system-related single nucleotide polymorphisms (SNPs) predicted variation in treatment response to citalopram in depression following a traumatic brain injury (TBI). METHODS Ninety (50 M/40 F, aged 39.9, SD = 18.0 years) post-TBI patients with a major depressive episode (MDE) were recruited into a 6-week open-label study of citalopram (20 mg/day). Six functional SNPs in genes related to the serotonergic system were examined: serotonin transporter (5HTTLPR including rs25531), 5HT1A C-(1019)G and 5HT2A T-(102)C, methylene tetrahydrofolate reductase (MTHFR) C-(677)T, brain-derived neurotrophic factor (BDNF) val66met and tryptophan hydroxylase-2 (TPH2) G-(703)T. Regression analyses were performed using the six SNPs as independent variables: Model 1 with response (percentage Hamilton Depression (HAMD) change from baseline to endpoint) as the dependent variable and Model 2 with adverse event index as the dependent variable (Bonferroni corrected p-value < 0.025). RESULTS MTHFR and BDNF SNPs predicted greater treatment response (R(2)= 0.098, F = 4.65, p = 0.013). The 5HTTLPR predicted greater occurrence of adverse events (R(2)= 0.069, F = 5.72, p = 0.020). CONCLUSION Results suggest that polymorphisms in genes related to the serotonergic system may help predict short-term response to citalopram and tolerability to the medication in patients with MDE following a TBI.
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Affiliation(s)
- Krista L Lanctôt
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Umene-Nakano W, Yoshimura R, Ueda N, Suzuki A, Ikenouchi-Sugita A, Hori H, Otani K, Nakamura J. Predictive factors for responding to sertraline treatment: views from plasma catecholamine metabolites and serotonin transporter polymorphism. J Psychopharmacol 2010; 24:1764-71. [PMID: 19825907 DOI: 10.1177/0269881109106899] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the present study, we investigated the effects of sertraline on plasma levels of 3-methoxy-4-hydroxyphenylglycol (MHPG), homovanillic acid (HVA), and serum brain-derived neurotrophic factor (BDNF) levels in 59 depressed patients treated with sertraline. We also examined the relationship between the dynamics of the catecholamine metabolites, BDNF, serotonin transporter-linked polymorphic region (5-HTTLPR) gene polymorphism (long and short alleles), and the clinical response to sertraline. The extent of clinical improvement was evaluated using the 17-item Hamilton Rating Scale for Depression (Ham-D) before and 8 weeks after treatment with sertraline. Responders were defined as showing at least a 50% decrease in the Ham-D score. Baseline plasma HVA levels of responders to sertraline treatment were significantly lower than those of non-responders (p = 0.02). In addition, a positive correlation was identified between changes in plasma HVA levels and the rate of response to sertraline treatment (p = 0.001). A trend toward higher baseline serum BDNF levels was found in responders compared with non-responders (p = 0.095). In addition, serum BDNF levels were slightly increased (not significant) in responders (p = 0.058), but not in non-responders. Responders had a higher short-allele genotype frequency in the 5-HTTLPR for the promoter region than did non-responders (p = 0.037). These results suggest that pre-treatment plasma HVA levels and the 5-HTTLPR genotype for the promoter might be associated with a response to sertraline.
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Affiliation(s)
- Wakako Umene-Nakano
- Department of Psychiatry, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyusyu, Fukuoka, Japan.
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Hoffman JM, Bell KR, Powell JM, Behr J, Dunn EC, Dikmen S, Bombardier CH. A Randomized Controlled Trial of Exercise to Improve Mood After Traumatic Brain Injury. PM R 2010; 2:911-9. [DOI: 10.1016/j.pmrj.2010.06.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 06/05/2010] [Accepted: 06/12/2010] [Indexed: 10/18/2022]
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Fann JR, Hart T, Schomer KG. Treatment for depression after traumatic brain injury: a systematic review. J Neurotrauma 2010; 26:2383-402. [PMID: 19698070 DOI: 10.1089/neu.2009.1091] [Citation(s) in RCA: 215] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
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. We reviewed pharmacological, other biological, psychotherapeutic, and rehabilitation interventions for depression following TBI from the following data sources: PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar. We included studies written in English published since 1980 investigating depression and depressive symptomatology in adults with TBI; 658 articles were identified. After reviewing the abstracts, 57 articles met the inclusion criteria. In addition to studies describing interventions designed to treat depression, we included intervention studies in which depressive symptoms were reported as a secondary outcome. At the end of a full review in which two independent reviewers extracted data, 26 articles met the final criteria that included reporting data on participants with TBI, and using validated depression diagnostic or severity measures pre- and post-treatment. Three external reviewers also examined the study methods and evidence tables, adding 1 article, for a total of 27 studies. Evidence was classified based on American Academy of Neurology criteria. The largest pharmacological study enrolled 54 patients, and none of the psychotherapeutic/rehabilitation interventions prospectively targeted depression. This systematic review documents that there is a paucity of randomized controlled trials for depression following TBI. Serotonergic antidepressants and cognitive behavioral interventions appear to have the best preliminary evidence for treating depression following TBI. More research is needed to provide evidence-based treatment recommendations for depression following TBI.
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Affiliation(s)
- Jesse R Fann
- Departments of Psychiatry and Behavioral Sciences, Rehabilitation Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA.
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The efficacy of a scheduled telephone intervention for ameliorating depressive symptoms during the first year after traumatic brain injury. J Head Trauma Rehabil 2009; 24:230-8. [PMID: 19625862 DOI: 10.1097/htr.0b013e3181ad65f0] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether an intervention designed to improve functioning after traumatic brain injury (TBI) also ameliorates depressive symptoms. DESIGN Single-blinded, randomized controlled trial comparing a scheduled telephone intervention to usual care. PARTICIPANTS One hundred seventy-one persons with TBI discharged from an inpatient rehabilitation unit. METHODS The treatment group received up to 7 scheduled telephone sessions over 9 months designed to elicit current concerns, provide information, and facilitate problem solving in domains relevant to TBI recovery. OUTCOME MEASURES Brief Symptom Inventory-Depression (BSI-D) subscale, Neurobehavioral Functioning Inventory-Depression subscale, and Mental Health Index-5 from the Short-Form-36 Health Survey. RESULTS Baseline BSI-D subscale and outcome data were available on 126 (74%) participants. Randomization was effective except for greater severity of depressive symptoms in the usual care (control) group at baseline. Outcome analyses were adjusted for these differences. Overall, control participants developed greater depressive symptom severity from baseline to 1 year than did the treatment group. The treated group reported significantly lower depression symptom severity on all outcome measures. For those more depressed at baseline, the treated group demonstrated greater improvement in symptoms than did the controls. CONCLUSIONS Telephone-based interventions using problem-solving and behavioral activation approaches may be effective in ameliorating depressive symptoms following TBI. Proactive telephone calls, motivational interviewing, and including significant others in the intervention may have contributed to its effectiveness.
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Current treatment options for depression after mild traumatic brain injury. Curr Treat Options Neurol 2009; 11:377-82. [DOI: 10.1007/s11940-009-0042-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schwarzbold M, Diaz A, Martins ET, Rufino A, Amante LN, Thais ME, Quevedo J, Hohl A, Linhares MN, Walz R. Psychiatric disorders and traumatic brain injury. Neuropsychiatr Dis Treat 2008; 4:797-816. [PMID: 19043523 PMCID: PMC2536546 DOI: 10.2147/ndt.s2653] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Psychiatric disorders after traumatic brain injury (TBI) are frequent. Researches in this area are important for the patients' care and they may provide hints for the comprehension of primary psychiatric disorders. Here we approach epidemiology, diagnosis, associated factors and treatment of the main psychiatric disorders after TBI. Finally, the present situation of the knowledge in this field is discussed.
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Affiliation(s)
- Marcelo Schwarzbold
- Núcleo de Pesquisas em Neurologia Clínica e Experimental (NUPNEC), Departamento de Clínica Médica, Hospital Universitário, UFSC Florianópolis, SC, Brazil.
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