Antidepressants for Depression Associated with Traumatic Brain Injury: A Meta-analytical Study of Randomised Controlled Trials.

INTRODUCTION: Depression following traumatic brain injury is experienced by 16% to 60% of affected patients. The present study aimed to update the best evidence-based pharmacological treatments for tackling such chronic and debilitating disorders. METHODS: We systematically reviewed and meta-analysed randomised controlled trials published from 1990 until August 2017 that compared the efficacy of antidepressants with placebo in the treatment of post-traumatic brain injury depression. We searched MEDLINE, SCOPUS, and the Cochrane Central Register of Controlled Trials (CENTRAL). RESULTS: Four studies were eligible for the meta-analysis. The antidepressants studied were the selective serotonin reuptake inhibitors sertraline and citalopram. The rate of non-responders at the end of the follow-up period was lower in the treatment groups compared with placebo (odds ratio = 0.42, 95% confidence interval: 0.15-1.17); this difference was not statistically significant (p = 0.10). In subgroup analysis of the studies that reported mean Hamilton Depression Rating Scale score differences between treatment and control groups in both baseline and endpoint evaluations, the pooled mean difference was reduced from 2.11 (95% confidence interval: -1.25 to 5.46) to -2.36 (95% confidence interval: -5.59 to 0.87), in favour of the treatment group, though not statistically significant (p = 0.06). No evidence of heterogeneity was detected. In the subgroup analysis according to the antidepressant used in the included studies, there was a trend towards statistical significance for sertraline only (odds ratio = 0.28, 95% confidence interval: 0.08-1.03; p = 0.05); this was not evident in the study that reported the use of citalopram (odds ratio = 0.83; 95% confidence interval: 0.15-4.64; p = 0.84). CONCLUSIONS: Sertraline might be effective, though not statistically significant, in treating patients with post-traumatic brain injury depression. Adequately powered randomised controlled trials - extended to the plethora of newer antidepressants aiming to prove their non-inferiority to the selective serotonin reuptake inhibitors studied - are needed to confirm our results. The dearth of quality studies of this devastating problem of public health is rather impressive.

Male depression: Discrete differences between the two sexes.

Recent research indicates that subtle differences may exist in the symptom profile of male and female depression. The aim of this review is to examine male/female differences in depressive psychopathology in light of the latest research findings and discuss whether these differences might suggest the need for gender specific treatments. Multiple searches using Medline (1985-2008) were carried out. Additional searches were made using the reference lists of published papers and chapters from books. Differences exist in the clinical profile and comorbidity of male and female individuals with depression. Subtle genetic differences, the role of hormones, the role of preexisting anxiety, and personality differences are some of the factors responsible for these findings. These differences imply that different treatment options should be available for males and females suffering from depression. The available data suggest that clinically relevant differences in depressive symptom profile and the underlying pathophysiology between genders in depression do exist. The identification of distinct endophenotypes for major depression, will not only improve our understanding of the disease, but will also contribute to more specific treatment strategies.