Antidepressant Use Not Linked to Worse Traumatic Brain Injury Outcomes
Key Clinical Summary
- No increased mortality: Preinjury use of serotonergic antidepressants was not associated with higher 30-day mortality after traumatic brain injury.
- Lower neurosurgical risk: Patients taking antidepressants had a modestly lower likelihood of requiring emergency brain surgery.
- No hospitalization impact: Length of hospital stay did not differ between antidepressant users and nonusers.
Concerns that serotonergic antidepressants may worsen outcomes after traumatic brain injury (TBI) have persisted due to their potential effects on bleeding risk. A large nationwide cohort study from Finland, however, found no evidence that preinjury antidepressant use increases short-term mortality, need for emergency brain surgery, or length of hospitalization following TBI. Findings were published in Neurology.
Study Findings
The retrospective cohort study analyzed data from 54,876 patients aged 16 years or older who were hospitalized with TBI in Finland between 2005 and 2018. Of these patients, 7,845 (14.3%) were taking antidepressants at the time of injury, identified through national prescription records.
Researchers aimed to examine the association between preinjury antidepressant use, antidepressant type and serotonergic profile, and short-term TBI outcomes, including mortality, acute neurosurgical operations (ANOs), and length of hospital stay.
The primary outcome was all-cause mortality within 30 days of injury. Overall, 4,105 patients died within 1 month, including 7.6% of antidepressant users and 7.5% of nonusers. Adjusted models showed that antidepressant use was not associated with 30-day mortality (adjusted hazard ratio, 0.98; 95% CI, 0.90–1.07; p = 0.696). Antidepressant type and serotonergic profile were also not associated with mortality.
Secondary outcomes included ANOs and length of hospitalization. Emergency brain surgery was required in 6.8% of antidepressant users compared with 8.6% of nonusers. After adjustment, antidepressant use was associated with an 11% lower risk of ANOs (adjusted relative risk, 0.89; 95% CI, 0.82–0.97; p = 0.007). Hospital length of stay did not differ between groups.
Clinical Implications
These findings provide evidence-based reassurance for clinicians managing patients with depression or anxiety who are at risk for traumatic brain injury. The absence of increased short-term mortality or neurosurgical intervention suggests that discontinuation of serotonergic antidepressants solely due to concerns about acute TBI outcomes may be unnecessary.
The modestly lower rate of emergency brain surgery among antidepressant users may reflect unmeasured clinical or demographic factors, rather than a protective pharmacologic effect. Nonetheless, the data do not support earlier concerns that serotonergic agents exacerbate intracranial bleeding or complicate early TBI recovery.
These results support current prescribing practices and highlight the importance of individualized risk assessment rather than blanket medication avoidance. The study’s nationwide scope and robust adjustment for confounders strengthen its relevance to real-world clinical care, particularly in similar high-income healthcare settings.
Expert Commentary
“Concerns have previously been raised that serotonergic antidepressants might increase the risk of bleeding in the brain or complicate early recovery after traumatic brain injury,” said first author Jussi P. Posti, MD, PhD, University of Turku, Finland, in a press release. “However, our study found no evidence to support those concerns.” He added that the findings “provide reassurance for people who take antidepressants that antidepressant use does not appear to worsen early recovery after traumatic brain injury.”
Conclusion
In this large Finnish cohort, preinjury antidepressant use was not associated with worse short-term outcomes after traumatic brain injury. The results support the safety of continuing serotonergic antidepressants in patients who experience TBI, while highlighting the need for future studies on long-term recovery and broader healthcare settings.
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