The psychotherapeutic and rehabilitation studies included in this review included both pre- and post-treatment measures of depressive symptoms; however, none of them were designed specifically to evaluate treatments for depression. Thus, there is insufficient evidence to support practice recommendations at this time. However on the basis of eight studies (4 on CBT, 2 on mindfulness meditation, and 2 on multi-faceted rehabilitation treatments), the review authors make the following recommendations:

• CBT-based treatments are an option for individuals with TBI as three of the 4 CBT-based studies reported positive effects of treatment on mood. However, there was considerable variability in the treatment models used in this set of studies, so it is difficult to identify the elements of the intervention that contributed to the effect. Studies in other clinical populations have shown CBT to have efficacy comparable to that of antidepressant medication.
• When CBT-based treatments are pulled apart to compare the cognitive components of CBT (e.g., examination and correction of distorted thinking) with the behavioral components (e.g., engaging in more reinforcing activities), research has tended to show superiority for the latter. According to one meta-analysis, therapies focusing on behavioral activation, even in simple forms such as activity scheduling, are at least as effective for depression as CBT. Thus, holistic treatment programs that include activity scheduling and increasing positive interaction with the environment as well as problem solving and goal-setting training may have good potential to improve mood and overall psychological well-being for people with TBI.
• Mindfulness meditation and multi-faceted rehabilitation interventions currently have inadequate evidence to support their use for reduction of depression in people with TBI.

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