Does Psychology Beat Pharmacology For Post-Brain Injury Mental Health Problems - Gyrus Group New evidence on the clinical management of mental health in the context of traumatic brain injury.
Traumatic brain injury (TBI), a leading cause of death and disability, is frequency associated with depression and anxiety. Over half of patients with traumatic brain injury are diagnosed with depression or anxiety within the first year post-TBI. Cecilia Flores-Sandoval and colleagues (2024) recently published an evidence-based review of randomised controlled trials (RCTs) for the management of mental health in the context of moderate to severe traumatic brain injury. A total of 87 RCTs including 6,471 participants, examining mental health interventions in the context of traumatic brain injury were included. Antidepressants were shown to have limited utility for the management of depressive symptoms in patients with TBI. Sertraline, a serotonin reuptake inhibitor and amitriptyline, a tricyclic antidepressant, were not efficacious for the management of depression in the context of TBI. However, one RCT showed that desipramine, a tricyclic antidepressant, led to statistically significant reductions in depressive symptom severity relative to placebo. However, further studies are needed to confirm these findings. Stimulants were also shown to have limited benefit for the management of depressive symptoms in patients with TBI, including lisdexamfetamine, dextroamphetamine, modafinil, and atomoxetine. Mixed findings were reported for methylphenidate, with only one RCT showing that this was helpful for improving mood in the context of TBI. No other stimulants improved outcomes, and some treatments were linked to poorer clinical outcomes. These findings do not support the use of stimulants for the management of depressive symptoms in TBI. A total of 4 RCTs examined the use of hormones, such as melatonin and recombinant human growth hormone (rhGH). Mixed findings were reported for melatonin, including no effect for reducing depressive symptoms in TBI, and beneficial effects for reducing anxiety relative to placebo in patients with TBI. RhGH was not helpful for improving mood relative to placebo. A total of 4 RCTs examined the use of acetylcholinesterase inhibitors on mood in patients with TBI. Huperzine A was not helpful for the management of depression, and mixed findings were reported for the use of Rivastigmine in the management of depression, with two RCTs reporting negative results and one trial reporting that Rivastigme significantly reduced depressive symptoms in TBI. Further studies are needed to confirm these findings. A total of 2 RCTs examined Cerebrolysin, porcine-derived peptides, on depression in TBI. Both RCTs found that Cerebrolysin significantly reduced depressive symptom severity in TBI relative to placebo.
A total of 62 RCTs examined the efficacy on non-pharmacological interventions. Cognitive behavioural therapy was effective for the management of hopelessness, stress, and anxiety in patients with TBI. Acceptance and commitment therapy was effective for anxiety, stress, and depression in patients with TBI.
Whilst there is inconclusive evidence on the efficacy of pharmacological treatments for the management of mental health in the context of TBI, these findings highlight the efficacy and clinical utility of psychological interventions for the management of mental health in TBI. These findings also highlight the need for the development of novel pharmacological treatments for the management of mental health in the context of TBI.
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