Primary Outcome Measures:
- Time to onset of DSM-IV defined mood and anxiety disorders; Total Community Integration Questionnaire scores at baseline, 3, and 6 months; Executive function composite will measure cognitive impairment. [ Time Frame: 6 Months following traumatic brain injury ] [ Designated as safety issue: No ]
- Fractional anisotropy of frontal white matter will measure white matter integrity. [ Time Frame: 6 Months following traumatic brain injury ] [ Designated as safety issue: No ]
Secondary Outcome Measures:
- Overt Aggression Scale-Modified total score will quantify the degree of aggressive behavior. [ Time Frame: 6 Months following traumatic brain injury ] [ Designated as safety issue: No ]
- DSM-IV defined Personality change due to TBI (disinhibited, aggressive or combined types). [ Time Frame: 6 Months following traumatic brain injury ] [ Designated as safety issue: No ]
- Iowa Gambling Test score will measure the quality of decision making. [ Time Frame: 6 Months following traumatic brain injury ] [ Designated as safety issue: No ]
- Memory function composite will measure cognitive impairment. [ Time Frame: 6 Months following traumatic brain injury ] [ Designated as safety issue: No ]
- Neuroimaging variables [ Time Frame: 6 Months following traumatic brain injury ] [ Designated as safety issue: No ]
- SFE scores will measure the degree of satisfaction with social functioning at one year follow-up. [ Time Frame: 6 Months following traumatic brain injury ] [ Designated as safety issue: No ]
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.