Selective serotonin reuptake inhibitors in the treatment of major depressive disorder after brain trauma: Systematic review and meta-analysis

BACKGROUND Traumatic brain injury (TBI) poses a considerable risk to human health. After TBI, individuals are susceptible to a range of psychiatric disorders, with depression being a primary complication. Selective serotonin reuptake inhibitors (SSRIs) are frequently used in the treatment of depression; however, their efficacy in addressing major depressive disorder (MDD) in adults following TBI remains uncertain. AIM To investigate the efficacy of SSRIs in the treatment of MDD after TBI. METHODS A comprehensive search across multiple databases was conducted following the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, encompassing studies published until May 2024. This review focused on studies that examined the efficacy of SSRIs in the treatment of MDD following TBI. Studies were assessed based sample size, treatment duration, treatment methodologies, severity of brain injury, assessment techniques, and drug response. A random-effects model was used to derive the summary effect size. RESULTS Eight studies compared the reduction in depression scores in patients with MDD after TBI and SSRI treatment. The eight studies did not exhibit heterogeneity (I-2 = 38%). The depression score for MDD after TBI in the SSRI group decreased more than that in the control group [odds ratio (OR) 1.68, 95%CI: 1.09-2.58, P = 0.02]. The adverse reactions after treatment included diarrhea, dizziness, dry mouth, nausea, or vomiting. There was no difference in the incidence of adverse reactions after treatment between the two groups (OR 1.16, 95%CI: 0.78-1.73, P = 0.46]. These studies did not show significant heterogeneity (I-2 = 44%). CONCLUSION SSRIs may be effective in treating patients with MDD after TBI. Adequately powered, randomized, controlled trials are required to confirm these findings.