Depression in patients with acute traumatic brain injury

Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Md.
American Journal of Psychiatry (Impact Factor: 12.3). 07/1992; 149(7):918-23. DOI: 10.1097/00001199-199309000-00019
Source: PubMed


This study was undertaken to examine patients with closed head injuries for the presence of depressive disorders.
A consecutive series of 66 patients with closed head injuries but no significant spinal cord or other organ system injury were examined by means of a semistructured psychiatric interview. The Hamilton Rating Scale for Depression as well as scales measuring impairment in activities of daily living, intellectual functioning, and social functioning were administered. The patients' CT scans were also examined.
Seventeen patients had major depression and two had minor depression. The presence of left dorsolateral frontal lesions and/or left basal ganglia lesions and, to a lesser extent, parietal-occipital and right hemisphere lesions was associated with an increased probability of developing major depression. Compared to the nondepressed group, the group with major depression had a higher frequency of previous psychiatric disorder and showed evidence of poorer social functioning.
Major depression occurs in about one-quarter of patients after traumatic brain injury. This is the same frequency as in other major disorders such as stroke. Major depression appears to be provoked by one or more factors that include poor premorbid social functioning and previous psychiatric disorder or injury to certain critical brain locations.

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    • "This occurrence could be due to stress and loss of ability to perform daily routine life activities on the same scale prior to the brain injury. It is often noticed that people who have suffered from brain injury may also experience emotional distress and it is possible for those people to develop depressive illness (Fann,Uomoto and Katon, 2000;Fedoroff, et al, 1992;Hassan, et al, 2002). Other symptoms of depression often noticed in patients with brain injury include losing interest in daily activities, disturbed sleep pattern and eating disorder (Khan-bourne andBrown, 2003). "

    Full-text · Article · Jan 2015
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    • "The studies that have focused on lesions or spectroscopic analysis (e.g. [6] [21] [30]) have reported ACC, thalamic , frontal, temporal, parietal and posterior cerebral areas to relate to the development of MD. However, there is inconsistency in severity of the TBI subjects across the studies and the techniques that were utilised to measure regional brain volumes. "
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    ABSTRACT: Previous research suggests that many people who sustain a traumatic brain injury (TBI), even of the mild form, will develop major depression (MD). We previously reported white matter integrity differences between those who did and did not develop MD after mild TBI. In this current paper, we aimed to investigate whether there were also volumetric differences between these groups, as suggested by previous volumetric studies in mild TBI populations. A sample of TBI-with-MD subjects (N = 14), TBI-without-MD subjects (N = 12), MD-without-TBI (N = 26) and control subjects (no TBI or MD, N = 23), received structural MRI brain scans. T1-weighted data were analysed using the Freesurfer software package which produces automated volumetric results. The findings of this study indicate that (1) TBI patients who develop MD have reduced volume in temporal, parietal and lingual regions compared to TBI patients who do not develop MD, and (2) MD patients with a history of TBI have decreased volume in the temporal region compared to those who had MD but without a history of TBI. We also found that more severe MD in those with TBI-with-MD significantly correlated with reduced volume in anterior cingulate, temporal lobe and insula. These findings suggest that volumetric reduction to specific regions, including parietal, temporal and occipital lobes, after a mild TBI may underlie the susceptibility of these patients developing major depression, in addition to altered white matter integrity.
    Full-text · Article · Sep 2014 · Behavioural Brain Research
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    • "In persons with neurological and medical conditions, depression may exacerbate neuropsychological impairment and slow the pace of cognitive recovery (Chen et al., 1996; Jorge et al., 1993a; Levin and Kraus, 1994; Mayberg, 1994; Miller et al., 1990; Robinson et al., 1985; Schoenhuber and Gentilini, 1988). Depression following TBI is associated with worse global outcomes (Federoff et al., 1992), worse social functioning during the first year post-injury ( Jorge et al., 1993b; Schoenhuber and Gentilini, 1988), and lower healthrelated quality of life (Christensen et al., 1994; Rutherford, 1977), even after controlling for medical, demographic, and neuropsychological factors. Depressed survivors of TBI with MDD lasting more than 6 months exhibit deterioration in social functioning and performance of activities of daily living (Bourdon et al., 1992). "
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    ABSTRACT: The aim of this systematic review was to critically evaluate the evidence on interventions for depression following traumatic brain injury (TBI) and provide recommendations for clinical practice and future research. We reviewed pharmacological, other biological, psychotherapeutic, and rehabilitation interventions for depression following TBI from the following data sources: PubMed, CINAHL, PsycINFO, ProQuest, Web of Science, and Google Scholar. We included studies written in English published since 1980 investigating depression and depressive symptomatology in adults with TBI; 658 articles were identified. After reviewing the abstracts, 57 articles met the inclusion criteria. In addition to studies describing interventions designed to treat depression, we included intervention studies in which depressive symptoms were reported as a secondary outcome. At the end of a full review in which two independent reviewers extracted data, 26 articles met the final criteria that included reporting data on participants with TBI, and using validated depression diagnostic or severity measures pre- and post-treatment. Three external reviewers also examined the study methods and evidence tables, adding 1 article, for a total of 27 studies. Evidence was classified based on American Academy of Neurology criteria. The largest pharmacological study enrolled 54 patients, and none of the psychotherapeutic/rehabilitation interventions prospectively targeted depression. This systematic review documents that there is a paucity of randomized controlled trials for depression following TBI. Serotonergic antidepressants and cognitive behavioral interventions appear to have the best preliminary evidence for treating depression following TBI. More research is needed to provide evidence-based treatment recommendations for depression following TBI.
    Full-text · Article · Sep 2009 · Journal of neurotrauma
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