3.3.4.6 Selective Serotonin Reuptake Inhibitor

What type of medication is sertraline and how does it work to control aggression post ABI?

  1. Sertraline (Zoloft) is a selective serotonin reuptake inhibitor (SSRI). 
     
  2. Since decreased serotonin is associated with both depression and aggression after brain injury, sertraline has been proposed as an effective treatment for alleviating these problems 38;39.

What is the evidence for sertraline in the management of aggression post ABI?

  1. There is Level 2 evidence that sertraline does not affect arousal and alertness.
     
  2. There is Level 2 evidence that the use of sertraline for depression also improves cognitive performance.
     
  3. Based on 2 non-RCT studies, there is Level 2 evidence that sertraline significantly improves depression, irritability, aggression, psychological distress, anger, functioning, and postconcussive symptoms.
     
  4. There is Level 2 evidence based on one non-RCT that sertraline HCL decreases the incidence of aggressive behaviours.
     
  5. Overall, Sertraline may improve depressive symptoms, psychological distress, and aggression, but it does not improve arousal.
  • Sertraline, a serotonin specific reuptake inhibitor, was effective in reducing aggression and irritability in brain injured patients in one study 38.
     
  • In another RCT were patients were randomized to receive either sertraline or placebo,both groups experienced similar rates of improvementon the Orientation Log, Agitated Behaviour Scale, and Galveston Orientation and Amnesia Test 40.
     
  • Sertraline was also assessed to determine its effectson cognitive performance of patients diagnosed with TBI and depression.  Improvements in psychomotor speed, recent verbal memory, recent visual memory, general cognitive efficiency, and self-perception of cognitive symptomatology were found 41.
     
  • In an early study conducted by Fann et al. 39the effects of sertraline on  patients diagnosed with major depression after TBI was assessed.  Statistically significant improvements were found for depression, psychological distress, anger, functioning, postconcussive symptoms, and aggression.
     
  • Kant et al 38examined the effect of sertraline HCL on reducing aggression and irritability in  brain injured patients two years post-injury. Positive effects were reported to occur (i.e., decrease in reported aggression and irritability) at each follow-up visit compared to baseline.
     

For a more detailed discussion on these studies please see ERABI/Mental Health Issues Post ABI.