Is Sertraline Effective Prophylaxis Against Secondary Depression

Abstract

Background Depression secondary to any traumatic brain injury is the commonest form of psychiatric co-morbidity, irrespective of severity. Depression secondary to TBI is associated with increased treatment resistance, sometimes from onset, as well as increased risk of suicide, independent of the pre-existing risk in all post-TBI patients. Prophylaxis against secondary depression is therefore paramount for this patient group, though research remains in its early stages. Objectives This literature review aims to determine whether sertraline, a common agent used for treatment of secondary depression in TBI patients, can be used as effective prophylaxis within the same group. Methods Searches were conducted via Cochrane, PubMed, PsycINFO and Embase with identical exclusion and inclusion criteria applied. 7 relevant papers were identified, with relevant assessment for quality and bias via the CASP checklists. The PRISMA guidelines were also used to evaluate the papers found. Results Notable results determined a treatment number of 5.9 at 24 weeks post-injury, and a lower incidence in cases of secondary depression at 12 weeks, respectively. However, inconsistencies in doses given, course length and other biases have contributed to divisive results, including overall incidence of secondary depression being statistically borderline at 6 months post-injury. Conclusion Whilst current literature is promising, further studies are required to ascertain the efficacy of sertraline as a prophylactic agent. Varying types of TBI, increased ethnic and racial diversity and uniform assessment are required in these studies.