How is depression treated in traumatic brain injury (TBI)?

Updated: Mar 02, 2020
  • Author: Percival H Pangilinan, Jr, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Mood disorders, particularly depression, are common sequelae of TBI. Major depression is found in about 40% of patients hospitalized for TBI. [71] Depression after TBI is further associated with cognitive decline, [8, 9, 10, 11] anxiety disorders, substance abuse, dysregulation of emotional expression, and aggressive outbursts. [72] Whitnall and colleagues reported that persistent disability (5-7 years after TBI) was strongly associated with depression and anxiety, and that it was more poorly associated with initial severity or persistent cognitive impairments. [73]

Dikmen et al found that the following factors are predictive of posttraumatic depression: educational level less than high school, unstable work history prior to injury, and alcohol abuse. [72]

Treatment options for posttraumatic depression include counseling, participation in support groups, and antidepressant medication. Early after TBI, a grief reaction is common, and this is better treated with supportive therapies than with other approaches. If drugs are used, their profiles, including their adverse effects and interactions, must be carefully considered to prevent worsening sedation or cognitive impairment. Methylphenidate and sertraline are beneficial in treating posttraumatic depression. [74]

Methylphenidate is commonly used to treat patients with hypo-arousal, initiation, and attention problems associated with TBI. Methylphenidate may hasten recovery after TBI. The positive effects of methylphenidate are improved speed in processing and sustained attention. [75] By potentiating dopamine, amantadine may improve arousal, attention, and executive functions. [76]

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