Abstract
Post-stroke depression (PSD) is an important complication of stroke, leading to increased disability and mortality. Given that there is no consensus on which treatment is optimal for PSD, we aimed to evaluate the relative efficacies of available pharmacological and non-pharmacological interventions. We conducted a network meta-analysis to incorporate evidence from relevant trials and provide direct and indirect comparisons. We searched PubMed, Cochrane Library Central Register of Controlled Trials, and Embase until November 1, 2016 for randomized controlled trials involving different pharmacological and non-pharmacological PSD treatment interventions. The primary outcome was reduction in the Hamilton depression scale (HAMD) score. This study is registered with PROSPERO (number, CRD42016049049). Of a total of 1,152 studies, 23 randomized trials comprising 1,542 participants were included. Nine PSD treatment interventions were considered. Noradrenaline reuptake inhibitor (NRI) was associated with the highest reduction in the HAMD score, followed by tricyclic antidepressant (TCA), psychotherapy plus antidepressant, and selective serotonin reuptake inhibitor (SSRI). This study indicated that NRIs, SSRIs, and TCAs are associated with a considerable higher HAMD score reduction compared with the control treatment. rTMS is a beneficial therapeutic approach for managing PSD to obtain good response to treatments compared with the control treatment.
Highlights
Stroke is one of the leading causes of death and disability, and depression is a common sequela of stroke
Three trials only recruited patients diagnosed with major depression, nine trials included patients with both major and minor depression, and the remaining 11 trials did not clearly specify this aspect
We found that paroxetine (MD 13.40, 95% credible intervals (CrI) 3.98–23.34; surface under the cumulative ranking curve (SUCRA) = 0.91), imipramine (MD 11.43, 95% CrI 2.03–21.10; SUCRA = 0.70), reboxetine (MD 9.17, 95% CrI 1.63–16.60; SUCRA = 0.69), nortriptyline (MD 7.85, 95% CrI 3.72–11.88; SUCRA = 0.63), and citalopram (MD 7.74, 95% CrI 9.56–15.18; SUCRA = 0.61) were associated with a significantly better overall change in the Hamilton Depression Rating Scale (HAMD) score
Summary
Stroke is one of the leading causes of death and disability, and depression is a common sequela of stroke. The pathogenesis of PSD remains controversial with respect to whether PSD is a direct consequence of specific neuroanatomical impairment or an indirect result of a patient’s negative psychological response to a stroke-related impairment[7]. Many factors such as stroke severity, lesion location, and functional and cognitive impairment may contribute to PSD development[8]. Studies suggested that depression severity was an independent predictive factor of the severity of an impairment among stroke survivors in performing daily activities and that depression has detrimental effects on rehabilitation and www.nature.com/scientificreports/. Selective serotonin reuptake inhibitors (SSRIs) are gaining popularity as first-line treatment for PSD and late-life depression[12,16], neither studies provide conclusive evidence with respect to the superiority of SSRIs over any other treatments nor strong data recommend one particular SSRI over another for PSD management
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