Rapoport et al.

(2010)

Canada

RCT

PEDro=9

N_Initial=21, N_Final=18

Population: TBI; Mean Age=47.67 yr; Gender: Male=11, Female=10; Severity of Injury: Mild=16, Moderate/Severe=5. Treatment Group: Mean Time Post Injury=105 days. Control Group: Mean Time Post Injury=107 days.

Treatment: Individuals who had a DSM-IV diagnosis of major depression but met the criteria for remission were assigned to either the treatment group (n=10) who were given citalopram (~40m g/day) or the control group (n=11) which received a placebo for 40 wk.

Outcome Measure: Cumulative Illness Rating Scale, Hamilton Depression Rating Scale (HDRS), Mini Mental State Examination and the Rivermead Post Concussion Symptoms Questionnaire.

1.        Comparing the treatment and control groups, relapse rates (p=0.835) and time to relapse (24.8 versus 22.3 wk, respectively, p=0.700) were not significantly different.

2.        All participants experienced adverse events regardless of the group they were placed in (e.g. headache, muscle/ joint pain, and dizziness).

3.        On the HDRS, patients with “more than mild agitation” relapsed sooner than those without that level of agitation (8.0 versus 27.18 wk, p=0.013).

4.        On the HDRS, those with “more than mild psychic anxiety” relapsed at a mean of 19.7 wk compared to those with “none to mild” who did not relapse (p=0.046).

Rapoport et al.

(2008)

Canada

PCT

N_Initial=65, N_Final=54

Population: TBI; Mean Age=39.7yr; Gender: Male=38, Female=27; Injury Severity: Mild=33, Moderate to severe=32.

Treatment: Group A (n=29) received 20 mg/day of citalopram for 6 wk whereas group B (n=36) received 20 mg titrated to 50 mg/day for 10 wk.

Outcome Measure: The Hamilton Rating Scale for Depression (HAM-D), Clinical Global Impression, and the Rivermead Post Concussion Symptoms Questionnaire (RPQ).

1.        Mean HAM-D scores decreased from baseline to 6 wk (23.66 versus 16.30, p<0.0001). Scores also decreased significantly from baseline to 10 wk (12.96, p<0.001).

2.        84.6% reported ≥1 adverse event; most often, dry mouth.

3.        Of the 54 subjects who started the study, 24.1% were in remission at 6 wk. Of the 26 assessed, 26.9% were in remission at 10 wk.

4.        The somatic score on the RPQ decreased significantly from 15.38 to 11.35 (p<0.001) at 6 wk; but not at 10 wk (10.82, p=0.0632).

Perino et al.

(2001)

Italy

Pre-Post

N=20

Population: TBI; Gender: Male=11, Female=9; Group A: N=11; Mean Age=26.9 yr; Mean GCS Score=5.5; Mean Time Post Injury=4.7 mo. Group B: N=9; Mean Age=31.3 yr; Mean GCS Score=6.1; Mean Time Post Injury=34.6 mo.

Treatment: Patients received citalopram (20 mg/day) and carbamazepine (600 mg/day), and were divided into subgroups based on time post injury (Group A: <6 mo; Group B: 24-36 mo).

Outcome Measure: Brief Psychiatric Rating Scale (BPRS) and the Clinical Global Impression (CGI).

1.        The total sample significantly improved from baseline to 12 weeks on the BPRS (62.3±17.6 versus 51.7±12.8, p≤0.05) and CGI (4.4±1.1 versus 3.4±0.8, p≤0.005).

2.        When comparing groups, group B had higher global scores on the BPRS at baseline and 12 wk.