Major depressive disorder (MDD) appears to be the most prevalent psychiatric disorder after TBI, with a point prevalence rate over 25%. The reported period prevalence of MDD within the first year is 42% and within the first 7 years is 61%. The prevalence of MDD after TBI represents a marked increase over the prevalence of MDD found in general population surveys. The increased risk of depression is not limited to those with moderate or severe TBI, but is also present among those with mild TBI.

Many different biological and psychosocial factors contribute to depression after TBI and basic questions remain about which treatment approaches are most effective. This summary describes findings from a systematic review conducted to evaluate the evidence supporting pharmacologic, other biological (e.g., electroconvulsive therapy), and psychotherapeutic or rehabilitation treatments for depression after TBI.

Key Results

• There are few randomized controlled trials for depression following TBI. However, serotonergic antidepressants and cognitive behavioral interventions (CBT) appear to have the best preliminary evidence for treating depression following TBI.
• In theory, pharmacotherapy, psychotherapy, and alternative approaches might be combined and balanced for individual circumstances, risk factors, and time post injury but at this time there is no evidence for the efficacy of combined therapies for depression after TBI.

Recommendations for Pharmacologic Approaches
Recommendations for Psychotherapeutic & Rehabilitation Approaches
Recommendations for Other Biological Approaches
Assessment & Diagnostic Considerations

Resourses

Treating Depression Following Traumatic Brain Injury: A Summary for Clinicians (PDF). Copyright © 2010 Model Systems Knowledge Translation Center (MSKTC). Based on Fann JR, Hart T, Schomer KG. (2009). Treatment for Depression Following Traumatic Brain Injury: A Systematic Review. J. Neurotrauma.2009 Aug 21. doi:10.1089/neu.2009.1091.

Hart T, Brenner L, Clark AN, Bogner JA, Novack TA, Chervoneva I, Nakase-Richardson R, Arango-Lasprilla JC. Major and minor depression after traumatic brain injury. Arch Phys Med Rehabil. 2011 Aug;92(8):1211-9. doi: 10.1016/j.apmr.2011.03.005