The Effect of Antidepressants on Depression After Traumatic Brain Injury: A Meta-analysis.
Natalie Kreitzer, Rachel Ancona, Cheryl McCullumsmith and 4 others
PMID 30169440WHAT IT FOUND
Antidepressants did not reduce depression after traumatic brain injury more than placebo in 5 randomized trials.
Scores improved before and after treatment in uncontrolled studies, but that cannot separate drug effect from time or spontaneous improvement.
Key findings
01In 5 randomized controlled trials, antidepressant treatment did not significantly reduce depressive symptoms compared with placebo.
02Pooled pre- and post-treatment Hamilton Depression Scale scores improved by a mean change of -11.2 across 9 studies, but this analysis had no placebo group.
03Removing the 2017 Fann study changed the randomized placebo comparison from nonsignificant to significant improvement, so one trial influenced the result.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
All but 4 included studies had a high risk of bias, and the search was limited to English-language articles. The included studies varied widely in antidepressant type, treatment length, time since injury, TBI severity, and whether prior depression, substance use, or other conditions were excluded. The significant pre-post improvement came from studies without a placebo group, so it cannot show that the drug caused the change. Removing the 2017 Fann study changed the randomized placebo comparison from nonsignificant to significant improvement, so the result is sensitive to one trial. Publication bias was not examined because the analysis lacked power. Only 10 of 218 individuals in the randomized trials received methylphenidate rather than an SSRI or placebo, so the results are more reflective of SSRI treatment.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the pooled Hamilton Depression Scale improvement (mean change -11.2) as proof antidepressants work. The randomized comparison with placebo was not significant (difference -0.3; 95% CI -0.6 to 0.0), and uncontrolled studies cannot separate drug effect from time or spontaneous improvement.