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Aging and disease    2015, Vol. 6 Issue (6) : 418-425     DOI: 10.14336/AD.2015.0507
Original Article |
Cortisol Supplement Combined with Psychotherapy and Citalopram Improves Depression Outcomes in Patients with Hypocortisolism after Traumatic Brain Injury
Luo Lanlan1,2, Chai Yan2, Jiang Rongcai2,3, Chen Xin2,3, Yan Tao1,2,*()
1 Neurology of Tianjin Medical University General Hospital, Tianjin, China
2 Tianjin Neurological Institute, Tianjin, China
3 Neurosurgery of Tianjin Medical University General Hospital, Tianjin, China
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Abstract  

Depression is one of the most prevalent psychiatric disorders in people with Traumatic brain injury (TBI). Depression after TBI is closely related with social and psychological factors and hypothalamic-pituitary -adrenal (HPA) axis dysfunction. However, there is a lack of evidence regarding effective treatment approaches for depression. A total of 68 patients with depression following closed TBI were recruited. Glasgow Coma Scale score (GCS) was employed to demonstrate the severity of neurological deficits and Glasgow Outcome Scale (GOS) was employed to measure functional outcome after TBI. The severity of depression was quantified using the Beck Depression Inventory-II (BDI-II) in line with DSM-IV. Citalopram and Prednisone were administered to subjects with normal cortisol levels or hypocortisolism separately, based on psychotherapeutic interventions. We investigated the relationship between degree of depression of TBI patients and the severity and progression of TBI with the therapeutic effects of Citalopram in combination with psychotherapeutic and Prednisone in depressed patients. There was no relationship between the severity of depression and the severity and progression of TBI. The basic treatment of psychotherapeutic interventions could partially relieve depressive symptoms. Combination of psychotherapeutic support and Citalopram significantly improved depressive symptoms in patients with normal cortisol levels, but not in hypocortisolic patients. Combination of Prednisone administration with psychotherapeutic treatment and Citalopram significantly improved depression outcome in hypocortisolic patients after TBI. Hypocortisolism after TBI may regulate depression. Combination of Prednisone with psychotherapeutic treatment and Citalopram may provide better therapeutic effects in depression patients with hypocortisolism after TBI.

Keywords traumatic brain injury      depression      citalopram      cortisol supplement     
Corresponding Authors: Yan Tao     E-mail: yantao78@hotmail.com
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present address: Kunming Biomed International, Kunming, Yunnan, 650500, China

Issue Date: 01 December 2015
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Luo Lanlan
Chai Yan
Jiang Rongcai
Chen Xin
Yan Tao
Cite this article:   
Luo Lanlan,Chai Yan,Jiang Rongcai, et al. Cortisol Supplement Combined with Psychotherapy and Citalopram Improves Depression Outcomes in Patients with Hypocortisolism after Traumatic Brain Injury[J]. Aging and disease, 2015, 6(6): 418-425.
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http://www.aginganddisease.org/EN/10.14336/AD.2015.0507     OR     http://www.aginganddisease.org/EN/Y2015/V6/I6/418
Figure 1.  The distribution of severity of depression and severity of TBI. There is no significant relationship between the severity of depression and severity of TBI (GCS grade) (r=0.128, p>0.05) and there is no significant difference for the severity of depression among the three GCS grades (grades 3-5) of TBI patients (H=0.129, p>0.05).
Figure 2.  The distribution of severity of depression and TBI recovery score. There is no significant relationship between the severity of depression and GOS grade of TBI outcome (r=0.206, p>0.05) and there is no significant difference for the severity of depression among three GOS grades (grades 3-5) groups (H=4.898, p>0.05).
Figure 3.  The distribution of therapy of depression and therapeutic effects in TBI patients. 8 subjects recovered from depression after TBI with psychotherapeutic support without pharmacological interventions. Citalopram was administrated to 28 patients with normal cortisol levels but showed no beneficial effects of psychotherapy support; combination treatment of prednisone and citalopram was employed in 32 patients with hypocortisolism.
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