This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s Terms & Conditions.

Original Research

A Randomized Controlled Trial of Antidepressant Continuation for Major Depression Following Traumatic Brain Injury

Mark J. Rapoport, MD, FRCPC; Robert A. Mitchell, BSc; Scott McCullagh, MD, FRCPC; Nathan Herrmann, MD, FRCPC; Florance Chan, MSc; Alex Kiss, PhD; Anthony Feinstein, MD, FRCPC; and Krista L.Lanctôt, PhD

Published: April 20, 2010

Article Abstract

Objective: This study examines whether continuation therapy with citalopram can prevent a relapse following remission of major depression due to traumatic brain injury.

Method: After 65 subjects with DSM-IV-diagnosed major depression following traumatic brain injury were treated with open-label citalopram (20 mg to 50 mg/d), 25 subjects (38.5%) met criteria for remission. Of those, 21 (84.0%) were randomly assigned to either same-dose citalopram or placebo and followed monthly over 40 weeks. Remission was defined as a Hamilton Depression Rating Scale (HDRS) score of ≤‘ ‰7 or a Clinical Global Impressions-Improvement rating of "much improved" or better. The main outcome variable was the presence of relapse, as defined by meeting criteria for major depressive episode according to the DSM-IV and an HDRS score ≥‘ ‰16. Data were collected from February 16, 2005, to May 5, 2008.

Results: Ten subjects were randomly assigned to citalopram and 11 to placebo. There were 3 dropouts, including 1 for adverse drug effects (diarrhea). Relapse occurred in 11 subjects (52.4%), with a mean‘ ‰±‘ ‰SD time to relapse of 23.52‘ ‰±‘ ‰16.6 weeks. The groups did not differ in relapse rates (drug: 50.0% [5/10] vs placebo: 54.5% [6/11], Fisher exact test, P‘ ‰=‘ ‰.835) or time to relapse (log rank test χ2‘ ‰=‘ ‰0.148, P‘ ‰=‘ ‰.700).

Conclusions: The present study suggests important limitations of continuation pharmacotherapy in the prevention of relapse of major depression following traumatic brain injury.

Trial Registration: Identifier: NCT00162916

J Clin Psychiatry

Submitted: December 15, 2008; accepted April 21, 2009.

Online ahead of print: April 20, 2010 (doi:10.4088/JCP.09m05086blu).

Corresponding author: Mark J. Rapoport, MD, FRCPC, 2075 Bayview Ave, Rm FG37, Toronto, Ontario, M4N 3M5, Canada (

Volume: 71

Quick Links:

Continue Reading…

Subscribe to read the entire article


Buy this Article as a PDF