Selective Serotonin Reuptake Inhibitors for Treating Neurocognitive and Neuropsychiatric Disorders Following Traumatic Brain Injury: An Evaluation of Current Evidence

John K. Yue; John F. Burke; Pavan S. Upadhyayula; Ethan A. Winkler; Hansen Deng; Caitlin K. Robinson; Romain Pirracchio; Catherine G. Suen; Sourabh Sharma; Adam R. Ferguson; Laura B. Ngwenya; Murray B. Stein; Geoffrey T. Manley; Phiroz E. Tarapore

doi:10.3390/brainsci7080093

Brain Sciences (Jul 2017)

Selective Serotonin Reuptake Inhibitors for Treating Neurocognitive and Neuropsychiatric Disorders Following Traumatic Brain Injury: An Evaluation of Current Evidence

John K. Yue,
John F. Burke,
Pavan S. Upadhyayula,
Ethan A. Winkler,
Hansen Deng,
Caitlin K. Robinson,
Romain Pirracchio,
Catherine G. Suen,
Sourabh Sharma,
Adam R. Ferguson,
Laura B. Ngwenya,
Murray B. Stein,
Geoffrey T. Manley,
Phiroz E. Tarapore

Affiliations

John K. Yue: Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA
John F. Burke: Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA
Pavan S. Upadhyayula: Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA
Ethan A. Winkler: Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA
Hansen Deng: Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA
Caitlin K. Robinson: Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA
Romain Pirracchio: Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA 94143, USA
Catherine G. Suen: Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA
Sourabh Sharma: Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA
Adam R. Ferguson: Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA
Laura B. Ngwenya: Department of Neurological Surgery, University of Cincinnati, Cincinnati, OH 45220, USA
Murray B. Stein: Department of Psychiatry, University of California, San Diego, CA 92093, USA
Geoffrey T. Manley: Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA
Phiroz E. Tarapore: Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, Building 1, Room 101, San Francisco, CA 94110, USA

DOI: https://doi.org/10.3390/brainsci7080093
Journal volume & issue: Vol. 7, no. 8
p. 93

Abstract

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The prevalence of neuropsychiatric disorders following traumatic brain injury (TBI) is 20%–50%, and disorders of mood and cognition may remain even after recovery of neurologic function is achieved. Selective serotonin reuptake inhibitors (SSRI) block the reuptake of serotonin in presynaptic cells to lead to increased serotonergic activity in the synaptic cleft, constituting first-line treatment for a variety of neurocognitive and neuropsychiatric disorders. This review investigates the utility of SSRIs in treating post-TBI disorders. In total, 37 unique reports were consolidated from the Cochrane Central Register and PubMed (eight randomized-controlled trials (RCTs), nine open-label studies, 11 case reports, nine review articles). SSRIs are associated with improvement of depressive but not cognitive symptoms. Pooled analysis using the Hamilton Depression Rating Scale demonstrate a significant mean decrease of depression severity following sertraline compared to placebo—a result supported by several other RCTs with similar endpoints. Evidence from smaller studies demonstrates mood improvement following SSRI administration with absent or negative effects on cognitive and functional recovery. Notably, studies on SSRI treatment effects for post-traumatic stress disorder after TBI remain absent, and this represents an important direction of future research. Furthermore, placebo-controlled studies with extended follow-up periods and concurrent biomarker, neuroimaging and behavioral data are necessary to delineate the attributable pharmacological effects of SSRIs in the TBI population.

Published in Brain Sciences

ISSN: 2076-3425 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry
Website: https://www.mdpi.com/journal/brainsci/

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