Treatment Strategy to Prevent Mood Disorders Following Traumatic Brain Injury

Traumatic brain injury (TBI) is a leading cause of death and disability among young adults.
Mood disorders are the most frequent psychiatric complication of TBI, and have a large
impact on family functioning, interpersonal relationships, and ability to return to work or
school. Furthermore, a significant proportion of these disorders will progress to more
chronic and treatment refractory forms. In spite of their clinical relevance, mood and
anxiety disorders remain largely unrecognized and not adequately treated, contributing to
greater disability and decreased participation in the aftermath of TBI.

The goals of this study are to learn more about how people recover from brain injury and to
evaluate the effect of sertraline (also known as Zoloft) compared to placebo (an inactive
substance) in preventing the occurrence of emotional and behavioral problems—such as
depression, lack of motivation, anxiety, irritability or aggressive outbursts—following TBI.

In the study, a group of 104 participants with TBI—recruited immediately after resolution of
posttraumatic amnesia—will be randomly assigned to receive six months of double-blind
treatment with sertraline or placebo.

This study will determine how these emotional and behavioral problems influence thinking,
physical recovery, and return to a productive life six months after brain injury.
Researchers will also determine if certain brain changes can predict the occurrence of
behavioral problems and if treatment with sertraline can prevent them. Additionally, the
researchers will examine the effect of sertraline on frequent post-TBI behavioral disorders
such as aggression, impulsivity, poor decision making and apathetic symptoms.

Magnetic resonance imaging (MRI)-based volumetry and diffusion tensor imaging will be used
to examine the structural correlates of mood and anxiety disorders and to evaluate them as
biological predictors of treatment response and community reintegration. The researchers
hypothesize that early preventive treatment with sertraline will reduce mood and behavioral
symptoms, prevent the occurrence of structural and functional brain changes associated with
the onset of mood disorders, increase access to and participation in rehabilitation programs
for TBI, and, consequently, improve psychosocial outcome.

Inclusion Criteria:

- Age 18 years or over.

- Meeting the Center for Disease Control (CDC) criteria for TBI.

- Mild, Moderate, or Severe TBI as categorized by initial Glasgow Coma Scale (GCS)
scores 13 to 15, 9 to 12, or 3 to 8, respectively.

- Complete recovery from Post Traumatic Amnesia (PTA) within 4 weeks of the traumatic
episode.

Exclusion Criteria:

- Penetrating head injuries.

- Clinical or neuro-radiological evidence of associate spinal cord injury.

- Patients with severe comprehension deficits (i.e., those who are not able to complete
part II of the Token Test) that precludes a thorough neuropsychiatric evaluation.

- Presence of Diagnostic and Statistical Manual IV defined mood, anxiety or psychotic
disorder at the time of enrollment to the study. However, patients with a history of
alcohol abuse or alcohol dependence during the year preceding TBI will be included in
the study.

- Patients who were taking antidepressants at the time of TBI or during a six month
period prior to the traumatic event.

- Patients who have failed an adequate previous trial with sertraline or had side
effects that prompted the discontinuation of this medication.

- Pregnant women or women that plan to become pregnant during the period of the study.

- Severe complicating illness such as neoplastic disease or uncompensated heart, renal
or liver failure.