College of Medical and Dental Sciences, University of Birmingham , Birmingham, UK.
Consultant Neurosurgeon. Institute of Inflammation and Aging, University of Birmingham , Birmingham, UK.
Brain Inj. 2020 Aug 23;34(10):1287-1304. doi: 10.1080/02699052.2020.1797169. Epub 2020 Aug 18.
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.
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.
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]).
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.
创伤性脑损伤（TBI）很常见。死亡率的下降导致越来越多的幸存者出现慢性后遗症，包括抑郁。由于缺乏指南，本综述旨在提供 TBI 后抑郁管理的全面、基于证据的总结。
系统检索了评估药物治疗、心理干预和经颅磁刺激（TMS）的准实验和随机对照试验（RCT）。检索的数据库包括 CENTRAL、Medline、Embase、CINAHL、PsycINFO、Web of Science 和 ProQuest 论文。使用数据提取和偏倚风险工具。在可能的情况下，将结果合并进行荟萃分析。
确定了 2719 项研究。经过摘要筛选和全文阅读，仍有 34 项研究保留下来。预防性舍曲林显著降低了抑郁的几率（OR（优势比）= 0.31 [95%CI（置信区间）= 0.12 至 0.82]）。RCT 的荟萃分析显示 TMS 对抑郁严重程度的降低作用最大（SMD（标准化均数差）= 2.43 [95%CI = 1.24 至 3.61]）。兴奋剂是唯一优于对照组的治疗方法（SMD = -1.03 [95%CI = -1.6 至 -0.47]）。
哌醋甲酯是最有效的药物治疗方法。舍曲林似乎对预防有效。心理干预的疗效尚不清楚。TMS 作为联合治疗方法似乎很有前途。研究人群的异质性和证据的缺乏意味着结果应谨慎解释。
