Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Mar 19, 2025; 15(3): 100103
Published online Mar 19, 2025. doi: 10.5498/wjp.v15.i3.100103
Selective serotonin reuptake inhibitors in the treatment of major depressive disorder after brain trauma: Systematic review and meta-analysis
Ren-Xian Gao, Xiao-Na Zhang, Peng Zhu
Ren-Xian Gao, Peng Zhu, Department of Emergency, Wenzhou People's Hospital (The Third Affiliated Hospital of Shanghai University), Wenzhou 325000, Zhejiang Province, China
Xiao-Na Zhang, Department of Orthopedics, Wenzhou Central Hospital, Wenzhou 325000, Zhejiang Province, China
Author contributions: Gao RX acquisition of data, analysis and interpretation of data, drafting the article, final approval; Zhang XN, Zhu P interpretation of data, revising the article, final approval.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Peng Zhu, Department of Emergency, Wenzhou People's Hospital (The Third Affiliated Hospital of Shanghai University), No. 299 Gu'an Road, Ouhai District, Wenzhou 325000, Zhejiang Province, China. 15868714401@163.com
Received: November 13, 2024
Revised: December 21, 2024
Accepted: January 22, 2025
Published online: March 19, 2025
Processing time: 104 Days and 20.9 Hours
Abstract
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 (I2 = 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 (I2 = 44%).

CONCLUSION

SSRIs may be effective in treating patients with MDD after TBI. Adequately powered, randomized, controlled trials are required to confirm these findings.

Keywords: Antidepressant; Meta-analysis; Depression; Traumatic brain injury; Selective serotonin reuptake inhibitors

Core Tip: Results of this meta-analysis indicate that selective serotonin reuptake inhibitors have advantages over placebos for the treatment of major depressive disorder after Traumatic brain injury. The incidence of adverse reactions after treatment did not differ substantially between the two groups. However, these studies did not exhibit heterogeneity, although the sample sizes of all studies included in this meta-analysis were relatively small (n < 100). This may have resulted in an overestimation of the treatment effects in small trials. Future prospective studies with larger sample sizes are needed to verify the results of the present study.