Concussion Symptoms and Neurocognitive Performance of Children and Adolescents on Antidepressants

There is a well-established association between pre-existing depression/anxiety and greater post-concussion symptom burden, but the potential impact of antidepressant medications has not been fully explored. The primary objective of this study was to compare pre-injury/baseline and post-injury concussion symptom scores and neurocognitive performance of athletes on antidepressant medications, both with healthy controls and with those with depression/anxiety not on antidepressants. This is a cross-sectional study using data collected from 49,270 junior and high school athletes from computerized neurocognitive assessments (Immediate Post-Concussion Assessment and Cognitive Test [ImPACT]) administered between 2009 and 2018 held by the Massachusetts Concussion Management Coalition. The main outcome measures were symptom scores and neurocognitive performance measures, all of which were assessed both at baseline and post-injury. Statistical analysis included analysis of variance and Tukey pairwise comparisons for continuous variables and Fisher's exact test for categorical variables. Multivariate regression models were used to adjust for potential confounding variables. Both at baseline and post-injury, athletes with depression/anxiety had mean total symptom scores that were more than double that of healthy controls regardless of antidepressant use. While there were no significant differences in neurocognitive performance at baseline, depression/anxiety was associated with small but significant decreases in post-injury visual memory and visual motor scores. Both at baseline and after sustaining a concussion, young athletes with depression/anxiety experience significantly greater symptom burden compared with healthy controls regardless of antidepressant use.