Aims: To use data generated from an integrated care pathway (ICP) to describe the characteristics of patients presenting with depression in a brain injury rehabilitation programme and to assess their response to treatment with sertraline.
Setting: A regional rehabilitation unit providing inpatient rehabilitation for young patients (16–65) with severe complex disabilities.
Design: Prospective cohort study of 82 patients admitted to the unit during the 15-month period between between 1 September 1999 and 1 December 2000. Response to sertraline was assessed in an open-label, before-andafter study design
Methods and design: All admissions were screened and included in the ICP if there was clinical suspicion of depression, past or present. Anti-depressant medication was prescribed, where appropriate, according to the ICP protocol. Depression was diagnosed on clinical grounds against DSM-IV criteria, and measured where feasible using the Beck Depression Inventory (BDI-II) administered by interview, pretreatment and at 6–8 weeks.
Results: Of 82 admissions 41 (50%) were managed using the ICP and 27 (64%) were either started on or changed to sertraline – 21 for depression ± lability and six for emotional lability only. All of the depressed patients improved clinically at some level and no signi”cant side-effects were observed. The BDI-II was assessable in 17/21 who showed a mean improvement of 14.5 ± 9.7 (con”dence interval (CI) 9.3–19.7, p < 0.001). Eleven patients (52%) had previously failed to respond with a different selective serotonin re-uptake inhibitor (SSRI) agent but still made a signi”cant response when changed to sertraline with a mean reduction in BDI-II of 16.3 ± 10.9 (CI 8.4–24.11, p < 0.001).
Conclusions: The ICP was practical to use and provided systematic data on assessment of depression and response to treatment in ‘real-life’ clinical practice in a brain injury rehabilitation setting. Sertraline appears to be useful and well-tolerated in this context. A full placebo-controlled study is now required.
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