Posti and colleagues sought to address this gap in the body of knowledge by combing nationwide registry data to examine the association between pre-injury antidepressant use, serotonergic profiles and short-term TBI outcomes in a real-world, unselected cohort.<\/p>\n
\u201cIt addresses a common clinical dilemma at the intersection of neurotrauma, psychiatry and geriatric medicine,\u201d Posti said. <\/p>\n
They also aimed to investigate the short-term mortality outcomes in TBI, acute neurosurgical operations (ANOs) and length of hospitalization for the selected population.<\/p>\n
Their retrospective cohort study included 54,876 individuals admitted to hospital with TBI in Finland between January 2005 and December 2018. Among these were 7,845 individuals with a record of antidepressants purchased within 90 days of TBI (mean age, 64.7 years; 56% women) and 47,031 without such a record (mean age, 60.6 years; 41.4% women).<\/p>\n
Pre-injury antidepressant use was identified from national prescription records using a daily pill counting method and subcategorized by serotonergic profile (weak, intermediate, strong).<\/p>\n
The primary outcome was 30-day mortality, while secondary outcomes included ANOs and length of hospitalization. <\/p>\n
Covariates for analysis included age, sex, comorbidities, vitamin K antagonist use, admission location and study year. Results were expressed in either hazard ratios or relative risk.<\/p>\n
From the 7,845 individuals who were using antidepressants at the time of TBI, 1,113 were termed \u201cintermediate\u201d strength, 1,626 were termed \u201cweak\u201d and 5,106 termed \u201cstrong\u201d based on serotonergic profile.<\/p>\n
<\/p>\n
Jussi Posti<\/b><\/p>\n<\/div>\n
According to results, 4,105 patients died within the 30-day mortality window, with the mortality rate being 7.6% for those with antidepressants and 7.5% for those without. Mortality rates among those with antidepressants were 10% in the weak group, 7.1% for the strong group and 6.3% for the intermediate group.<\/p>\n
The researchers reported that adjusted models showed no significant association between antidepressant use and 30-day mortality (adjusted HR = 0.98; 95% CI: 0.9\u20131.07), nor were there significant associations between mortality and either serotonergic profile or type of antidepressant. <\/p>\n
Compared with controls, the adjusted HRs of 30-day death for each antidepressant group were: 0.94 (95% CI: 0.84-1.05) for the strong group; 0.95 (95% CI: 0.75-1.2) for the intermediate group; and 1.12 (95% CI: 0.95-1.31) for the weak group.<\/p>\n
However, Posti and colleagues noted that those who used antidepressants recorded a lower likelihood of ANOs (adjusted RR = 0.89; 95% CI: 0.82\u20130.97) compared with those who did not use antidepressants. ANO was performed for 4,586 patients with TBI, with mortality rates of 6.8% in the antidepressant users\u2019 group and 8.6% in those without. <\/p>\n
Patients who were using antidepressants had lower likelihood for ANO than patients not using them (aRR = 0.89; 95% CI: 0.82\u20130.97). The ANO rate was 6.5% in the strong group, 7.6% in the intermediate group and 7.2% in the weak serotonergic group. <\/p>\n
Data additionally showed that serotonergic classes of antidepressant were associated with likelihood of ANO. The RR of ANO was lower for the strong group vs. controls (aRR = 0.88; 95% CI: 0.79\u20130.97) but similar for intermediate (aRR 0.89; 95% CI: 0.73\u20131.09) and weak (aRR = 0.92; 95% CI: 0.78\u20131.09) serotonergic groups and controls.<\/p>\n
Length of hospitalization did not differ between groups, while neither antidepressant use, profile, nor type modified the association of VKA use with increased mortality or ANOs, the researchers wrote.<\/p>\n
\u201cThis provides clinically reassuring evidence that antidepressant therapy alone should not be considered a risk modifier in acute traumatic brain injury management,\u201d Posti told Healio. \u201cThe results support evidence-based decision-making in the growing population of older patients with psychiatric comorbidity and elevated traumatic brain injury risk.\u201d<\/p>\n
For more information:<\/h2>\n Jussi Posti, MD, PhD,<\/b> can be reached at psychiatry@healio.com.<\/p>\n\n
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Sources\/Disclosures<\/h3>\n Source: <\/h2>\n Posti J, et al. Neurology<\/i>. 2026;doi:10.1212\/WNL.0000000000214602.<\/p>\nReference:<\/h2>\n
Antidepressants not associated with serious complications from TBI. https:\/\/www.aan.com\/PressRoom\/Home\/PressRelease\/5309. Published Jan. 28, 2026. Accessed Jan. 29, 2026.<\/p>\n
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