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.

中文翻译：

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脑外伤后抑郁症的治疗：荟萃分析的系统评价。

背景

脑外伤（TBI）十分普遍。死亡率的下降导致患有慢性抑郁症（包括抑郁症）的幸存者增加。由于缺乏指导原则，本综述旨在提供有关TBI后抑郁症治疗的全面，循证总结。

方法

系统评价了准实验和随机对照试验（RCT），以评估药物治疗，心理干预和经颅磁刺激（TMS）。数据库搜索了CENTRAL，Medline，Embase，CINAHL，PsycINFO，Web of Science和ProQuest论文。使用了数据提取和偏见风险工具。在可能的情况下，将结果合并到荟萃分析中。

结果

确定了2719项研究。经过抽象筛选和全文阅读后，剩下34个。预防性舍曲林可显着降低抑郁的几率（OR（几率）= 0.31 [95％CI（置信区间）= 0.12至0.82]）。对RCT的荟萃分析显示，TMS可使抑郁症严重程度降低幅度最大（SMD（标准化均值差）= 2.43 [95％CI = 1.24至3.61]）。兴奋剂是唯一优于对照的治疗方法（SMD = -1.03 [95％CI =-1.6至-0.47]）。

结论

哌醋甲酯是最有效的药物治疗。舍曲林似乎对预防有效。心理干预的功效尚不清楚。TMS作为联合疗法似乎很有希望。研究人群的异质性和缺乏证据意味着应谨慎解释结果。