Yue John K, Burke John F, Upadhyayula Pavan S, Winkler Ethan A, Deng Hansen, Robinson Caitlin K, Pirracchio Romain, Suen Catherine G, Sharma Sourabh, Ferguson Adam R, Ngwenya Laura B, Stein Murray B, Manley Geoffrey T, Tarapore Phiroz E
Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA.
Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
Brain Sci. 2017 Jul 25;7(8):93. doi: 10.3390/brainsci7080093.
The prevalence of neuropsychiatric disorders following traumatic brain injury (TBI) is 20%-50%, and disorders of mood and cognition may remain even after recovery of neurologic function is achieved. Selective serotonin reuptake inhibitors (SSRI) block the reuptake of serotonin in presynaptic cells to lead to increased serotonergic activity in the synaptic cleft, constituting first-line treatment for a variety of neurocognitive and neuropsychiatric disorders. This review investigates the utility of SSRIs in treating post-TBI disorders. In total, 37 unique reports were consolidated from the Cochrane Central Register and PubMed (eight randomized-controlled trials (RCTs), nine open-label studies, 11 case reports, nine review articles). SSRIs are associated with improvement of depressive but not cognitive symptoms. Pooled analysis using the Hamilton Depression Rating Scale demonstrate a significant mean decrease of depression severity following sertraline compared to placebo-a result supported by several other RCTs with similar endpoints. Evidence from smaller studies demonstrates mood improvement following SSRI administration with absent or negative effects on cognitive and functional recovery. Notably, studies on SSRI treatment effects for post-traumatic stress disorder after TBI remain absent, and this represents an important direction of future research. Furthermore, placebo-controlled studies with extended follow-up periods and concurrent biomarker, neuroimaging and behavioral data are necessary to delineate the attributable pharmacological effects of SSRIs in the TBI population.
创伤性脑损伤（TBI）后神经精神障碍的患病率为20%-50%，即使神经功能恢复后，情绪和认知障碍仍可能存在。选择性5-羟色胺再摄取抑制剂（SSRI）可阻断突触前细胞中5-羟色胺的再摄取，从而导致突触间隙中5-羟色胺能活性增加，是治疗多种神经认知和神经精神障碍的一线药物。本综述探讨了SSRI在治疗TBI后障碍中的效用。总共从Cochrane中心注册库和PubMed中整合了37篇独特的报告（8项随机对照试验（RCT）、9项开放标签研究、11篇病例报告、9篇综述文章）。SSRI与抑郁症状的改善相关，但与认知症状无关。使用汉密尔顿抑郁量表进行的汇总分析表明，与安慰剂相比，舍曲林治疗后抑郁严重程度显著降低——其他几项具有类似终点的RCT也支持这一结果。较小规模研究的证据表明，服用SSRI后情绪改善，但对认知和功能恢复无影响或有负面影响。值得注意的是，目前尚无关于SSRI对TBI后创伤后应激障碍治疗效果的研究，这是未来研究的一个重要方向。此外，需要进行安慰剂对照研究，并延长随访期，同时收集生物标志物、神经影像学和行为数据，以明确SSRI在TBI人群中的药理学作用。
