Treatment for depression after traumatic brain injury: a systematic review

J Neurotrauma. 2009 Dec;26(12):2383-402. doi: 10.1089/neu.2009.1091.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Antidepressive Agents / therapeutic use
  • Brain Injuries / complications*
  • Brain Injuries / physiopathology
  • Brain Injuries / psychology*
  • Clinical Trials as Topic / methods
  • Clinical Trials as Topic / trends
  • Cognitive Behavioral Therapy / methods
  • Cognitive Behavioral Therapy / trends
  • Depressive Disorder / etiology*
  • Depressive Disorder / physiopathology
  • Depressive Disorder / therapy*
  • Humans
  • Neuropsychology / methods
  • Neuropsychology / trends*
  • Psychiatry / methods
  • Psychiatry / trends*
  • Psychotherapy / methods
  • Psychotherapy / trends
  • Selective Serotonin Reuptake Inhibitors / therapeutic use


  • Antidepressive Agents
  • Serotonin Uptake Inhibitors