a Lishman Brain Injury Unit, Maudsley Hospital, London, UK.
Neuropsychol Rehabil. 2003 Jan-Mar;13(1-2):65-87. doi: 10.1080/09602010244000354.
Biological aspects of depression after brain injury, in particular traumatic brain injury (TBI) and stroke, are reviewed. Symptoms of depression after brain injury are found to be rather non-specific with no good evidence of a clear pattern distinguishing it from depression in those without brain injury. Nevertheless symptoms of disturbances of interest and concentration are particularly prevalent, and guilt is less evident. Variabilitiy of mood is characteristic. The prevalence of depression is similar after both stroke and TBI with the order of 20-40% affected at any point in time in the first year, and about 50% of people experience depression at some stage. There is no good evidence for areas of specific vulnerability in terms of lesion location, and early suggestions of a specific association with injury to the left hemisphere have not been confirmed. Insight appears to be related to depressed mood with studies of TBI indicating that greater insight over time post-injury may be associated with greater depression. We consider that this relationship may be due to depression appearing as people gain more awareness of their disability, but also suggest that changes in mood may result in altered awareness. The risk of suicide after TBI is reviewed. There appears to be about a three to fourfold increased risk of suicide after TBI, although much of this increased risk may be due to pre-injury factors in terms of the characteristics of people who suffer TBI. About 1% of people who have suffered TBI will commit suicide over a 15-year follow-up. Drug management of depression is reviewed. There is little specific evidence to guide the choice of antidepressant medication and most psychiatrists would start with a selective serotonin reuptake inhibitor (SSRI). It is important that the drug management of depression after brain injury is part of a full package of care that can address biological as well as psychosocial factors in management.
脑损伤后（尤其是创伤性脑损伤和中风）的抑郁的生物学方面进行了综述。脑损伤后抑郁的症状相当不特异，没有明确的证据表明其与无脑损伤者的抑郁有明显区别。不过，兴趣和注意力障碍的症状尤其常见，而内疚感则不太明显。情绪多变是其特征。中风和 TBI 后抑郁的患病率相似，在发病后的第一年任何时间点，约有 20-40%的人受到影响，约有 50%的人在某个阶段会经历抑郁。就病变部位而言，没有明确的易损性区域的证据，早期提出的与左半球损伤的特定关联也未得到证实。洞察力似乎与抑郁情绪有关，对 TBI 的研究表明，随着时间的推移，随着创伤后洞察力的增强，可能与抑郁程度的增加有关。我们认为，这种关系可能是由于抑郁在人们对残疾的认识增强时出现，但我们也认为情绪变化可能导致意识改变。对 TBI 后自杀的风险进行了回顾。TBI 后自杀的风险似乎增加了 3 到 4 倍，尽管这种增加的风险在很大程度上可能归因于 TBI 患者的特征等预先存在的因素。在 15 年的随访中，约有 1%的 TBI 患者会自杀。对抑郁的药物治疗进行了综述。目前几乎没有具体的证据来指导抗抑郁药物的选择，大多数精神科医生会从选择性 5-羟色胺再摄取抑制剂（SSRI）开始。脑损伤后抑郁的药物治疗是全面治疗的一部分，它可以解决管理中的生物学和心理社会因素，这一点非常重要。
