Depression is common after traumatic brain injury. The prevalence of depression after a year from the fact of traumatic brain injury is 33-42%, after 7 years – 61%. There is also a risk of depression in cases of mild traumatic brain injury. There is also an increased risk of suicide after TBI. 10% of patients had suicidal intentions within a year after a skull injury. 15% of patients tried to commit suicide 5 years after the injury. Depression lasting more than six months impairs patients’ social performance and quality of daily life. Patients with depression after traumatic brain injury have:
- blurred vision;
- memory impairment;
Depression is caused by direct or secondary damage to the brain tissue.
Depression after ChMP is associated with damage to the anterior ascending monoaminergic pathways, basal ganglia, and frontal lobes of the brain. Diffuse and focal damage to the gray matter of the brain is observed in the frontal and temporal regions of the brain. With depression with stroke, Parkinson’s disease, there is a decrease in glucose metabolism in the orbital- lower frontal and anterior temporal regions of the cerebral cortex.
The risk of depression increases with unfavorable social factors: unemployment, low income. In the treatment of depression , a 4-week intake of methylphenidate at 20 mg, 100 mg of sertaline is prescribed for a year after ChMP . These drugs improve HAM-D scores on the Hamilton scale. Methylphenidate also improves cognitive function. Due to the small number of studies of tricyclic antidepressants in the treatment of depression after traumatic brain injury, it is impossible to conclude about their effectiveness. Phenoelzin , a MAO group drug, is also ineffective in treating the effects of traumatic brain injury, and meclobemide is effective in treating depression after traumatic brain injury. Serotonin reuptake inhibitors (SSRIs) may be useful in the treatment of depression after TBI. But a small amount of research prevents them from being used. Studies of a small sample of patients have shown the effectiveness of sertaline and citalopram . But after taking sertalin , dystonia, nausea, dry mouth, decreased libido, sedation may occur . Taking fluoxetine caused sedation and anxiety in 50% of patients.
There is evidence of the effectiveness of electroconvulsive therapy, magnetic field, biofeedback, and acupuncture in the treatment of depression after head injury. Electroconvulsive therapy can be modified by unilateral use of electrodes at a low frequency of exposure. One study has proven the effectiveness of interdisciplinary psychotherapy in treating depression after head injury. The treatment of depression after head injury is poorly understood . Therefore, effective methods of drug therapy have yet to be discovered.