Pharmacological and non-pharmacological interventions of depression after traumatic brain injury: A systematic review

Individuals with traumatic brain injury (TBI) manifest a high incidence of depression, which is associated with an impaired recovery from TBI and a lower quality of life. Several neurobiological changes in patients with TBI contribute a form of depression that is unique to that of general depression. This is evinced by the poor efficacy of antidepressants in treating post-TBI depression relative to general depression. In general, however, the treatment of post-TBI depression has received relatively scattered attention in the literature. The purpose of this review is thus to discuss about the possible pathology of depression following TBI and summarize the recent findings on the treatment of it in clinical studies. While both pharmacological and non-pharmacological approaches can reportedly attenuate depressive symptoms in patients with TBI to a moderate extent, the various limitations of such studies require that further well-powered, randomized controlled trials with larger sample sizes and longer follow-ups are warranted to investigate the exact pathophysiology underlying post-TBI depression, the mechanism underlying treatment efficacy, and the optimal pharmacological and non-pharmacological interventions for this population. A combination of different treatments in a comprehensive therapeutic regimen may be an optimal direction for future research.