Division of Neurocritical Care (Drs Kreitzer, Foreman, and Adeoye), Department of Emergency Medicine (Drs Kreitzer and Adeoye and Ms Ancona), Department of Psychiatry (Dr McCullumsmith), Department of Pediatrics (Dr Kurowski), Department of Physical Medicine and Rehabilitation (Dr Kurowski), Department of Neurology and Rehabilitation Medicine (Drs Foreman and Ngwenya), and Department of Neurosurgery (Dr Ngwenya), University of Cincinnati, Cincinnati, Ohio.
J Head Trauma Rehabil. 2019 May/Jun;34(3):E47-E54. doi: 10.1097/HTR.0000000000000439.
Following traumatic brain injury (TBI), depressive symptoms are common and may influence recovery. We performed a meta-analysis to estimate the benefit of antidepressants following TBI and compare the estimated effects between antidepressants and placebo.
Multiple databases were searched to find prospective pharmacological treatment studies of major depressive disorder (MDD) in adults following TBI.
Effect sizes for antidepressant medications in patients with TBI were calculated for within-subjects designs that examined change from baseline after receiving medical treatment and treatment/placebo designs that examined the differences between the antidepressants and placebo groups.
A random-effects model was used for both analyses.
Of 1028 titles screened, 11 were included. Pooled estimates showed nonsignificant difference in reduction of depression scores between medications and placebo (standardized mean difference of 5 trials = -0.3; 95% CI, -0.6 to 0.0; I = 17%), and a significant reduction in depression scores for individuals after pharmacotherapy (mean change = -11.2; 95% CI, -14.7 to -7.6 on the Hamilton Depression Scale; I = 87%).
This meta-analysis found no significant benefit of antidepressant over placebo in the treatment of MDD following TBI. Pooled estimates showed a high degree of bias and heterogeneity. Prospective studies on the impact of antidepressants in well-defined cohorts of TBI patients are warranted.
创伤性脑损伤（TBI）后常出现抑郁症状，可能会影响康复。我们进行了一项荟萃分析，以评估 TBI 后使用抗抑郁药的益处，并比较抗抑郁药与安慰剂的估计效果。
在多个数据库中搜索了 TBI 后成年人重度抑郁症（MDD）的前瞻性药物治疗研究。
采用受试者内设计评估接受药物治疗后从基线变化的 TBI 患者抗抑郁药的效果大小，以及采用治疗/安慰剂设计评估抗抑郁药与安慰剂组之间的差异。
对两种分析均采用随机效应模型。
在筛选的 1028 个标题中，有 11 个符合纳入标准。汇总估计表明，药物治疗与安慰剂治疗在降低抑郁评分方面无显著差异（5 项试验的标准化均数差值=-0.3；95%CI，-0.6 至 0.0；I²=17%），且个体在接受药物治疗后抑郁评分显著降低（汉密尔顿抑郁量表的平均变化=-11.2；95%CI，-14.7 至-7.6；I²=87%）。
本荟萃分析未发现 TBI 后抗抑郁药治疗 MDD 优于安慰剂。汇总估计显示存在高度偏倚和异质性。有必要对 TBI 患者明确队列中抗抑郁药的影响进行前瞻性研究。
