Date of Award

2019

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Department Chair

Laura Levy, DHSc, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Does sertraline decrease depression in patients who suffered a traumatic brain injury (TBI)?”

STUDY DESIGN: Review of three randomized controlled trials (RCTs) published in English between 2009-2016.

DATA SOURCES: One RCT and two double-blind, placebo-controlled, RCTs found via PubMed evaluated the benefit of the antidepressant drug, sertraline (Zoloft), in decreasing depression in patients who suffered a TBI.

OUTCOMES MEASURED: Main outcomes were measured using the DSM-IV, Hamilton Rating Score for Depression (HAM-D)6 , Beck Anxiety Inventory (BAI)6 , and the Life-3 quality of life (QOL)6 , Mini-International Neuropsychiatric Interview7 , Patient Health Questionnaire-9 (PHQ-9)9 and World Health Organization QOL (WHOQOL)9 .

RESULTS: Ashman, Cantor, Gordon, et al.6 found that 59% of patients receiving sertraline were treatment responders with a NNT=4 x 2 =3.1 and p=0.08, making these findings statistically insignificant. Jorge, Acion, Burin et al. 7 reported that the likelihood of post-TBI depression was 4.6 times more likely in the placebo group than in the group receiving sertraline with a NNT=6, NNTB=4, and the NNH=73, (p=0.03). Ansari, Jain, Sharma et al.9 recorded an improvement of 9.55 in mean PHQ-9 scores from baseline (p= 0.04) and a 16.3-22.1% improvement in mean WHOQOL scores from baseline in the group receiving sertraline, with statistically significant differences in WHOQOL domains 1-3.

CONCLUSIONS: There was evidence in all 3 studies to support the benefits of sertraline in decreasing post-TBI depression. However, only two studies provided statistically significant data. Based on the findings in the two studies that reported data with statistical significance, sertraline does decrease depression in patients who suffered a TBI. More specifically, there is also significant evidence that supports the prophylactic use of sertraline to prevent post-TBI depression.

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