Role of Sertraline in insomnia associated with post traumatic brain injury (TBI) depression

Traumatic brain injury (TBI) is a major cause of disability (1, 2). Sleep disturbances, such as insomnia, are very common following traumatic brain injury and have been reported in frequencies from 40% (3) to as high as 84% (4). Sleep disruption can be related to the TBI itself but may also be secondary to neuropsychiatric (e.g., depression) or neuromuscular (e.g., pain) conditions associated with TBI or to the pharmacological management of the injury and its consequences. Post-TBI insomnia has been associated with numerous negative outcomes including daytime fatigue, tiredness, difficulty functioning: impaired performance at work, memory problems, mood problems, greater functional disability, reduced participation in activities of daily living, less social and recreational activity, less employment potential, increased caregiver burden, greater sexual dysfunction, and also lower ratings of health, poor subjective wellbeing. These negative consequences can hamper the person’s reintegration into the community, adjustment after injury, and overall QOL. (5) The connection between depression and insomnia has not been investigated within the post TBI population to a great extent. For the general population, clinically significant insomnia is often associated with the presence of an emotional disorder (6). Fichtenberg et al. (2002) (7), in his study established that the strongest relationship with the diagnosis of insomnia belonged to depression. Given the high prevalence of depression during the first 2 years following TBI (8), a link between depression and insomnia among TBI patients makes innate sense. The present study aims at assessing role of sertralline in post TBI insomnia associated with depression