Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?
BACKGROUND
Depressive symptoms occur in approximately half of trauma patients, negatively impacting on functional outcome and quality of life following severe head injury. Pontine noradrenaline has been shown to increase upon trauma and associated β-adrenergic receptor activation appears to consolidate memory formation of traumatic events. Blocking adrenergic activity reduces physiological stress responses during recall of traumatic memories and impairs memory, implying a potential therapeutic role of β-blockers. This study examines the effect of pre-admission β-blockade on post-traumatic depression.


METHODS
All adult trauma patients (≥18 years) with severe, isolated traumatic brain injury (intracranial Abbreviated Injury Scale score (AIS) ≥3 and extracranial AIS <3) were recruited from the trauma registry of an urban university hospital between 2007 and 2011. Exclusion criteria were in-hospital deaths and prescription of antidepressants up to one year prior to admission. Pre- and post-admission β-blocker and antidepressant therapy data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. Patients with and without pre-admission β-blockers were matched 1:1 by age, gender, Glasgow Coma Scale, Injury Severity Score and head AIS. Analysis was carried out using McNemar's and Student's t-test for categorical and continuous data, respectively.


RESULTS
A total of 545 patients met the study criteria. Of these, 15% (n=80) were prescribed β-blockers. After propensity matching, 80 matched pairs were analyzed. 33% (n=26) of non β-blocked patients developed post-traumatic depression, compared to only 18% (n=14) in the β-blocked group (p=0.04). There were no significant differences in ICU (mean days: 5.8 (SD 10.5) vs. 5.6 (SD 7.2), p=0.85) or hospital length of stay (mean days: 21 (SD 21) vs. 21 (SD 20), p=0.94) between cohorts.


CONCLUSIONS
β-blockade appears to act prophylactically and significantly reduces the risk of post-traumatic depression in patients suffering from isolated severe traumatic brain injuries. Further prospective randomized studies are warranted to validate this finding.
Karolinska University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, 171 76, Stockholm, Sweden; School of Medical Sciences, Orebro University, Fakultetsgatan 1, 702 81, Orebro, Sweden. Electronic address: rebecka.ahl@cantab.net.
Rebecka
R
Ahl
Orebro University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, 701 85, Orebro, Sweden. Electronic address: gabriel.sjolin@regionorebrolan.se.
Gabriel
G
Sjolin
Karolinska University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, 171 76, Stockholm, Sweden; Orebro University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, 701 85, Orebro, Sweden; School of Medical Sciences, Orebro University, Fakultetsgatan 1, 702 81, Orebro, Sweden. Electronic address: mohsenishahin@yahoo.com.
Shahin
S
Mohseni
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D003863:Depression / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007902:Length of Stay; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D057216:Propensity Score; D011788:Quality of Life; D013548:Sweden / Q000453:epidemiology; D014193:Trauma Centers
D000319:Adrenergic beta-Antagonists
Beta-blockade; Depression; Traumatic brain injury