Antidepressants are best practice for depression after traumatic brain injury

Traumatic brain injury (TBI) is a serious public health concern that accounts for a significant proportion of deaths and disabilities each year. In addition to physical and cognitive impairments, TBI is significantly associated with psychological and emotional distress in the months or years after injury. In fact, at least 20 percent of patients meet the criteria for major depression in the first six months following TBI, which typically slows the injury recovery process and reduces overall quality of life. As a result, there is a significant need for reliable interventions and treatments to help individuals recover from TBI-related depression.

Antidepressant drugs are typically considered the gold standard for treating depression in TBI patients. However, new studies suggest that these medications may not be any more effective than placebo drugs, calling to question the value of antidepressants for patients with brain injuries. Despite mixed evidence about the effectiveness of antidepressants for TBI, a group of neuropsychologists recently recommended that clinicians should continue to prescribe these medications as first-line treatment for TBI-related depression.

The researchers argued that any improvement in depressive symptoms is positive, even if these strides are due to placebo effects rather than the effectiveness of medication. Furthermore, they noted that antidepressant drugs are not a one-size-fits-all solution for psychological disorders. Patients whose depression does not respond to a single antidepressant medication can experience significant benefits when they are prescribed an additional antidepressant, which can augment the overall effectiveness of the drugs. Because a wide variety of antidepressant drugs are commonly available, individuals may also experience improvement in depressive symptoms after switching to a different medication altogether.

Finally, they pointed out that traditional measures for depression may be less accurate for individuals with TBI because underlying injury-related symptoms can interfere with results. Consequently, measures may under-report individuals’ improvement in depressive symptoms, leading to the assumption that antidepressants are ineffective. Existing studies of common depression rating scales, such as the Hamilton Depression Rating Scale, have found that traditional measures typically fail to capture improvements in depression after brain injury. As a result, there is a need for depression measures specialized for individuals with TBI.

The team of neuropsychologists concluded that mixed evidence about the effectiveness of antidepressants for TBI-related depression should not lead to a change in best practices. They acknowledged the value of other interventions, such as psychotherapy, but they maintained that clinicians should continue to use antidepressants as a front-line treatment for depression in the months following TBI.

Silverberg ND & Panenka WJ. Antidepressants for depression after concussion and traumatic brain injury are still best practice. BMC Psychiatry. (March 2019).

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