Preventing Depression Following Brain Injury

Depression is a common feature following traumatic brain injury (TBI). Post-TBI depression may be difficult to treat and evolve into a chronic depression syndrome.

A recent published study demonstrates that prophylactic SSRI antidepressant treatment may reduce the incidence of depression following TBI.

This study was conducted by investigators affiliated with Baylor College of Medicine and the Department of Psychiatry at the University of Iowa.

Ninety four subjects were recruited to this randomized control trial.

Active drug treatment was provided by the selective serotonin reuptake inhibitor sertraline. Subjects were dosed up to 100 mg per day of sertraline and followed for 24 weeks.

The primary findings of the study included the following:

• Sertraline was well-tolerated with few adverse events in the study population
• By 24 weeks approximately 25% of control subjects met criteria for depression while only about 7% of sertraline subjects met criteria for depression
• The number of subjects needed to treat to prevent one person developing depression post-TBI was 5.9

The authors note in the discussion that sertraline and the SSRI class may be linked to:

"enhanced neuroplasticity in mood regulation areas, such as the hippocampus and prefrontal cortex"

The authors had previously noted an enhanced neuropsychological performance following TBI with the SSRI escitalopram. They were unable to replicate that finding in the current study.

This is an important study that deserves wider replication. If confirmed, SSRI primary prevention of depression following TBI may become a common practice.

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Photo of monarch butterfly depositing egg on milkweed plant is from the author's files.

Jorge RE, Acion L, Burin DI, & Robinson RG (2016). Sertraline for Preventing Mood Disorders Following Traumatic Brain Injury: A Randomized Clinical Trial. JAMA psychiatry PMID: 27626622