Research Reports - Does early beta-blockade in isolated severe traumatic brain injury reduce the risk of post traumatic depression?
Injury. 2017 Jan;48(1):101-105. doi: 10.1016/j.injury.2016.10.041. Epub 2016 Oct
Ahl R(1), Sjolin G(2), Mohseni S(3).
INTRODUCTION: 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.
CONCLUSION: 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.