The objective of this study was to systematically review the literature and perform a meta-analysis of randomized controlled trials (RCTs) on the effectiveness of pharmacological and non-pharmacological interventions for depression in patients with moderate-to-severe traumatic brain injury. Databases searched were: Embase, PubMed, PsycInfo, Cochrane Central, Web of Science, and Google Scholar. Depression score on a self-report questionnaire was the outcome measure. Outcomes were collected at baseline and at the first follow-up moment. Data extraction was executed independently by two researchers. Thirteen RCTs were identified: five pharmacological and eight non-pharmacological. Although not all individual studies had significant results, the overall standardized mean difference (SMD) was −0.395, p ≤ 0.001, indicating that interventions improved the depression scores in patients with TBI. The difference in effectiveness between pharmacological interventions and non-pharmacological interventions was not significant (ΔSMD: 0.203, p = 0.238). Further subdivision into methylphenidate, sertraline, psychological, and other interventions showed a significant difference in effectiveness between methylphenidate (ΔSMD: −0.700, p = 0.020) and psychological interventions (reference). This difference was not found if other depression outcomes in four of the included studies were analyzed. The SMD of low-quality studies did not differ significantly from moderate- and high-quality studies (ΔSMD: 0.321, p = 0.050). Although RCTs targeting interventions for depression after TBI are scarce, both pharmacological and non-pharmacological interventions appear to be effective in treating depressive symptoms/depression after moderate-to-severe TBI. There is a need for high-quality RCTs in which the add-on effects of pharmacological and non-pharmacological interventions are investigated.

中文翻译：

---

中重度创伤性脑损伤后抑郁症的药物和非药物干预：系统评价和荟萃分析。

本研究的目的是系统地回顾文献并对随机对照试验 (RCT) 进行荟萃分析，研究药物和非药物干预对中重度创伤性脑损伤患者抑郁症的有效性。搜索的数据库包括：Embase、PubMed、PsycInfo、Cochrane Central、Web of Science 和 Google Scholar。自我报告问卷上的抑郁评分是结果测量。在基线和第一次随访时收集结果。数据提取由两名研究人员独立执行。确定了 13 个 RCT：5 个药理学和 8 个非药理学。尽管并非所有个别研究都有显着结果，但总体标准化平均差 (SMD) 为 -0.395，p ≤ 0.001，表明干预改善了 TBI 患者的抑郁评分。药物干预和非药物干预之间的有效性差异不显着（ΔSMD：0.203，p  = 0.238）。进一步细分为哌甲酯、舍曲林、心理干预和其他干预措施，结果表明哌甲酯（ΔSMD：-0.700，p  = 0.020）和心理干预（参考）之间的有效性存在显着差异。如果分析了四项纳入研究的其他抑郁结果，则没有发现这种差异。低质量研究的 SMD 与中等和高质量研究的 SMD 没有显着差异（ΔSMD：0.321，p = 0.050）。尽管针对 TBI 后抑郁症干预措施的 RCT 很少，但药物和非药物干预措施似乎都能有效治疗中度至重度 TBI 后的抑郁症状/抑郁症。需要研究药物和非药物干预的附加效应的高质量 RCT。