Ritalin may be the best course of treatment for depression caused by a traumatic brain injury, researchers have found.
Depression is the most common consequence of a TBI, according new research published in the journal Brain Injury. Up to one third of people have been found to have depression in the first year of having their injury, rising to 61 per cent in the subsequent seven years.
Depression has been found to impact recovery after a brain injury, and increase the risk of suicide, the paper states.
There are three main types of treatment for TBI-related depression: medicine, psychological interventions, and brain stimulation, otherwise known as transcranial magnetic stimulation (TMS).
In the review of 34 studies, researchers from the University of Birmingham, found that antidepressants and psychological interventions were no better an intervention than a control group that continued their usual treatment, or a placebo.
‘Despite their well-evidenced efficacy in a population without TBI, antidepressants appear to be of questionable efficacy for treating depression following TBI,’ the paper states.
‘Furthermore, given that these medications are accompanied by further potential risk, the uncertainty of their application in this population is further amplified.’
‘Psychological intervention’s lack of physiological alterations is clearly advantageous in this population with neurological fragility, however, with a lack of clear efficacy, it is difficult to justify their use.’
Stimulants, in particular Ritalin, which is commonly used to treat ADHD, were the only treatment to perform better than the control group at reducing the severity of patients’ depression.
However, the researchers conclude that, due to a lack of high quality evidence, it is too early to make recommendations regarding their use.
‘Furthermore, this review did not take into account the risk of side effects, which must be considered before making an informed prescribing decision,’ the paper states.
While TMS was found to be effective in reducing depression severity in TBI patients, this was based on a ‘dearth of evidence,’ the researchers write.
‘TMS demonstrates significant potential, however, there is currently insufficient evidence to suggest that, as a monotherapy, this intervention is any better than control.’
The researchers also measured how interventions for depression following a TBI improved patient’s scores of quality of life. They found that TMS improved quality of life, closely followed by stimulants, while antidepressants and psychological interventions resulted in smaller quality of life improvements.
‘As antidepressants are associated with considerable side effects, it is highly probable that this could be the root of any differences in quality of life,’ the study states.
The researchers say this is the first of its kind to review quality of life scores among people with depression as a result of TBI.
