Post-stroke Depression Patients Research Articles

The association between White matter microstructure alterations detected by Diffusional kurtosis imaging in Neural circuit and post-stroke depression

ABSTRACT Aim In order to study the mechanism of post-stroke depression (PSD), we used diffusion kurtosis imaging (DKI) to describe the changes in white matter (WM) microstructure in PSD patients, to investigate the association between WM damage in limbic-cortical-striatal-pallidal-thalamic (LCSPT) circuit and PSD, and the utility of DKI in the diagnosis of PSD. Methods Fifty-eight participants were divided into different groups: control group (n=20), stroke patients without depression (Non-PSD, n=21) and PSD group (n=17). All were taken DKI scans. The WM of bilateral superior frontal gyrus, middle frontal gyrus, inferior frontal gyrus, temporal lobe, parietal lobe, occipital lobe, the anterior and posterior limb of internal capsule, the genu and splenium of corpus callosum were selected as the regions of interest (ROI) and selected mean kurtosis (MK), radial kurtosis (RK), axial kurtosis (AK) as the DKI parameters. Results Compared with control and Non-PSD, MK of PSD group in bilateral superior frontal gyrus, middle frontal gyrus, temporal lobe and the genu of corpus callosum were decreased significantly, as well as the RK in left superior frontal gyrus, bilateral middle frontal gyrus and temporal lobe. But there was no significant difference in AK. Besides, the decrease in MK and RK in frontal and temporal lobe was negatively associated with the severity of PSD. Conclusion Our research indicated that the damage to WM microstructure in the frontal lobe, temporal lobe and the genu of corpus callosum may be related toPSD. DKI explores the microstructural changes of WM in PSD patients and may be an auxiliary diagnostic method for PSD.

Therapeutic effect of Chinese herbal medicines for post-stroke depression: A meta-analysis of randomized controlled trials.

Background:Whether the addition of Chinese herbal medicine (CHM) in routine western medicines for post-stroke depression yields additional therapeutic effects still remains to be controversial. This study aimed to assess the efficacy and safety of combination of CHM with routine western medicines versus routine western medicines alone in patients with post-stroke depression (PSD).Methods:Electronic databases such as PubMed, EmBase, Cochrane library, and China National Knowledge Infrastructure were systematically searched from inception till October 2019. Studies designed as randomized controlled trials (RCTs) and that investigated the therapeutic effects of CHM plus routine western medicines (CHM group) versus routine western medicines alone (control group) in PSD patients were eligible. The relative risk (RR) and weighted mean difference (WMD) with 95% confidence interval (CI) were used to assess the categories and continuous data using random-effects model. Software STATA was applied to perform statistical analysis (Version 10.0; StataCorp, TX,).Results:A total of 18 RCTs involving a total of 1,367 PSD patients were selected for final analysis. The effective rate in CHM group was significantly higher than that in control group (RR: 1.18; 95%CI: 1.12–1.24; P < .001). Moreover, patients in CHM group showed association with lower Hamilton Depression Rating Scale (WMD: -3.17; 95%CI: -4.12 to -2.22; P < .001) and Scandinavian Stroke Scale (WMD: -3.84; 95%CI: -5.73 to -1.96; P < .001) than those in control group. Furthermore, patients in CHM were associated with high level of Barthel Index than those in control group (WMD: 11.06; 95%CI: 4.01 to 18.10; P = .002). Finally, patients in CHM group had lower risk of gastrointestinal (RR: 0.49; 95%CI: 0.31–0.77; P = .002) and neurological (RR: 0.50; 95%CI: 0.33–0.75; P = .001) adverse events than those in control group.Conclusions:The study findings revealed that addition of CHM to routine therapies could improve the therapeutic effects and reduce gastrointestinal or neurological adverse events.

Diffusion Tensor Tractography Characteristics of White Matter Tracts are Associated with Post-Stroke Depression.

PurposeTo analyze the changes in white matter tracts in patients with post-stroke depression (PSD), and the correlation between these changes and the depressive state.Patients and MethodsThe numbers of white matter tracts and corresponding fractional anisotropy (FA) in the acute phase (the onset time <72 hours) were examined in each subject by diffusion tensor tractography (DTT). Diffusion tensor imaging (DTT), a new development of diffusion tensor imaging (DTI), enables visualization of white matter fiber tracts, which are thought to be closely related to the occurrence of PSD, According to the scores of Hamilton Depression Scale (HAMD) recorded at the 2nd week, 1st month, 3rd month, 6th month, and 12th month, forty patients were randomly selected and were classified into PSD group (n=20), non-depression post-stroke group (N-PSD, n=20), and control normal group (NORM, n=20), respectively. Correlations between the number of bundles (lines) in the white matter tract and corresponding FA, and HAMD score were finally assessed.Results1) FAs of the ipsilesional crossed corticocerebellar tract, the corticospinal tract, and the anterior thalamic radiation in PSD group were significantly lower than those in N-PSD and NORM groups (P<0.01); 2) Lines in the three areas in the PSD group were significantly lower than those in the N-PSD and NORM groups (P<0.01); and 3) FA and lines in the three areas of PSD patients were negatively correlated to HAMD scores (correlation coefficient=−0.586, −0.793, −0.626, −0.533, −0.642, and −0.524, respectively, all P<0.05).ConclusionFA and lines of the ipsilesional crossed corticocerebellar tract, the corticospinal tract, and the anterior thalamic radiation in PSD patients are significantly correlated to the depressive state. The crossed corticocerebellar tract, the corticospinal tract and the anterior thalamic radiation are involved in the development of PSD.

Assessment of Quality of Life and Incidence of Depression in Post Stroke Patients

Depression is a common illness worldwide. Social, psychological and biological factors can lead to depression. Chronic illness among the elderly is a significant reason affecting mental health. Often it is not diagnosed correctly. An observational study was conducted to assess the quality of life and the incidence of depression in post-stroke patients. Subjects were recruited to the study by investigations during ward/OP visits. The subjects were briefed about the study, and informed consent was obtained. Data were collected using various study tools and analyzed statistically by computing proportion for all qualitative data and mean, standard deviation, median, the interquartile range for quantitative data. A total of 50 subjects were enrolled in the study based on inclusion and exclusion criteria. Severe cognitive impairment was revealed in 14% of the patients. The burden of depression and severity was evaluated using Patient health questionnaire-9 and Hamilton depression scale, respectively. It was found that 22 subjects (44%) had moderate depression, while 2 (4%) had severe depression. The functionality of the subjects was measured and found that 18% of subjects were 'dependent' on their caregiver. SSQOL assessment showed the lowest score in the domains 'work &amp; productivity' and 'energy". As much as treating the etiological factors of stroke, dealing with the mental aspect of stroke is necessary. Assessing and treating post-stroke depression is essential to reduce the morbidity and mortality of patients. Hence, early assessment and management of mental health after stroke is necessary to prevent a chance of developing another stroke.

The therapeutic effects and safety of bright light therapy combined with escitalopram oxalate on insomnia in patients with poststroke depression.

Bright light therapy (BLT) is known to treat depression and sleep disorders in clinical practice, but its efficacy on poststroke depression (PSD) has not been studied. To investigate the therapeutic effects and safety of BLT combined with escitalopram oxalate (ESC) on insomnia in patients with PSD. Ischemic stroke patients with depressive symptoms and a score of ≥8 on the Hamilton Depression Scale (HAMD-17) while meeting DSM-IV criteria were diagnosed as having PSD. A total of 112 PSD patients with symptoms of insomnia were randomly assigned to polytherapy (BLT plus ESC) and monotherapy (ESC only) groups. Each regimen continued for 6 weeks. The primary outcomes were a change in scores on the Pittsburgh Sleep Quality Index (PSQI) and a remission rate (PSQI ≤7 at the endpoint). The secondary outcomes included changes in the HAMD-17 and Barthel Index (BI) scores. Adverse effects were assessed by the Adverse Events Scale. The endpoint assessment included 106 patients (monotherapy, 54; polytherapy, 52). The mean changes in the PSQI scores for the monotherapy and polytherapy groups were 4.85 (1.47) and 5.87 (1.72) (P = 0.001), respectively. Compared to monotherapy, polytherapy improved PSQI remission rate (71.4% vs 50.0%; χ2 = 5.390; P = 0.020), and HAMD-17 score (6.70 [2.12] vs 4.75 [1.98]; P < 0.001). Both treatments improved BI score, with no statistical difference, and were well tolerated, with few significant differences in treatment-associated adverse events. BLT combined with ESC is effective and well tolerated for the treatment of PSD-associated insomnia.

Identification of Potential Metabolite Markers for Middle-Aged Patients with Post-Stroke Depression Using Urine Metabolomics.

BackgroundPost-stroke depression (PSD) is one of the most common complications in stroke survivors. But, there are still no objective methods to diagnose PSD. This study aims to identify potential biomarkers for diagnosing PSD in middle-aged stroke survivors.MethodsMiddle-aged subjects aged 30 to 59 years (92 PSD patients and 89 stroke survivors without depression) were included in this study. Urinary metabolites were detected by gas chromatography-mass spectrometry (GC-MS). Differential urinary metabolites and potential biomarkers were screened by applying statistical analysis.ResultsThe different urinary metabolic phenotypes between PSD patients and stroke survivors without depression were identified. A total of 12 differential urinary metabolites were accurately identified by using orthogonal partial least-squares-discriminant analysis. After analyzing those 12 differential urinary metabolites by step-wise logistic regression analysis, only seven metabolites (palmitic acid, hydroxylamine, myristic acid, glyceric acid, lactic acid, tyrosine and azelaic acid) were finally selected as potential biomarkers for diagnosing PSD in middle-aged stroke survivors. A panel consisting of these potential biomarkers could effectively diagnose middle-aged PSD patients.ConclusionUrinary metabolic profiles were different between middle-aged PSD patients and stroke survivors without depression. Our results would be helpful in future for developing an objective method to diagnose PSD in middle-aged stroke survivors.

Poststroke depression in patients with impaired communication.

Poststroke depression in patients with impaired communication.

Decreased Serum Netrin-1 as a Predictor for Post-Stroke Depression in Chinese Patients with Acute Ischemic Stroke

Background and AimsExperimental studies demonstrated that netrin-1 (NT-1) is an important factor influencing the recovery after ischemic stroke. However, whether NT-1 levels were associated with the post-stroke depression (PSD) remains unclear. We aimed to evaluate the relationship between NT-1 levels and PSD at 3 months in patients with ischemic stroke. MethodsFrom January 2018 to December 2019, consecutive Chinese patients with first-ever ischemic stroke were prospectively recruited. Serum NT-1 levels were measured at admission. Patients with a 17-item Hamilton Depression Scale score of ≥7 were given the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, for diagnosis of PSD. ResultsA total of 238 patients (mean age, 62.5 years; 45.4% female) were enrolled. The median NT-1 concentrations were 467.8 pg/mL (interquartile range, 351.8–581.0 pg/mL). During the 3-month follow-up period, 64 patients (26.9%) experienced PSD. Serum NT-1 levels were significantly lower in PSD patients than in patients without PSD (median, 380.3 pg/mL versus 478.5 pg/mL; P = 0.001). After adjusting for demographic characteristic, National Institutes of Health stroke score, and other potential confounders by multiple logistic regression analysis, patients with NT-1 levels in the first quartile were more likely to have 3-month PSD (as compared with the fourth quartile, odds ratio 3.83, 95% confidence intervals, 1.53–9.63, P = 0.004). Similar significant findings were observed when the NT-1 levels were added as a continuous variable. ConclusionsOur data demonstrated that decreased serum NT-1 levels, in a Chinese population, were significantly associated with PSD at 3 months.

Factors related to post-stroke depression during the first 2 weeks after stroke

Introduction This study aimed to clarify factors associated with post-stroke depression in patients with acute stroke within 2 weeks of onset. Method Eighty-eight patients with stroke were divided into post-stroke depression ( n = 49) and non-post-stroke depression ( n = 39) groups based on their Hamilton Depression Rating Scale scores. We evaluated stroke severity, upper limb function, activities of daily living, frontal lobe/cognitive function, and level of apathy. Activity levels were measured using an ActiGraph GT9X Link system. Mann–Whitney U-tests were used to determine differences between the two groups. Spearman’s rank correlation and logistic regression analyses were also performed. Results The post-stroke depression and non-post-stroke depression groups exhibited significant differences in National Institutes of Health Stroke Scale scores at admission and discharge; Functional Independence Measure exercise items, cognitive items, and total items at admission; Fugl-Meyer Assessment scores; and Apathy Rating Scale scores. Logistic regression indicated that Fugl-Meyer Assessment scores were associated with post-stroke depression. Conclusion Stroke severity, paralysis, and physical function/activities of daily living ability are associated with post-stroke depression in the acute phase. Our findings suggest that increases in physical impairment severity are associated with increased post-stroke depression risks. Rehabilitation professionals should focus on identifying post-stroke depression in early post-stroke stages.

Admission Heart Rate Variability Is Associated With Poststroke Depression in Patients With Acute Mild-Moderate Ischemic Stroke.

BackgroundStroke has been shown to cause cardiac autonomic dysfunction. Depression is common complication after acute ischemic stroke (AIS). The purpose of this study was to investigate whether decreased heart rate variability (HRV) was related to poststroke depression (PSD) in patients with mild-moderate AIS.MethodsIn this study, we assessed autonomic function of ischemic stroke patients within 72 h from symptom onset by fractal dimension (FD). 503 patients (mean age 65.93 ± 10.19) with mild-moderate AIS underwent FD test after admission. Depressive symptoms were assessed using 17-item Hamilton Depression Rating Scale (HDRS) at baseline (within 7 days) and 3 months. Depression were defined if HDRS >6 points. According to the data of FD, we investigated association with early-onset PSD status and 3-month PSD.Results59.24% (293/503) of patients had early-onset PSD status at baseline, and 38.66% (184/476) of patients had PSD at 3 months. ROC curve analysis shown that the optimal cut point of FD for early-onset PSD status and 3-month PSD were FD ≤ 1.27 and FD ≤ 1.19, respectively. In fully adjusted models, higher NIHSS [adjusted odd ratios (OR), 1.15; 95% confidence interval (CI), 1.05–1.27; P=0.005], younger age (adjusted OR, 1.18; 95% CI, 1.01–1.13; P=0.046), and FD ≤ 1.27 (adjusted OR, 3.31; 95% CI, 2.23–4.92; P<0.001) were associated with increased risk of early-onset PSD status. Higher NIHSS (adjusted OR, 1.21; 95% CI, 1.09–1.43; P<0.001) and FD ≤ 1.19 (adjusted OR, 2.68; 95% CI, 1.79–4.03; P=0.000) were associated with increased risk of 3-month PSD.ConclusionsPSD is common after mild-moderate AIS and is highly correlated with decreased HRV, FD could serve as an objective tool to help in prediction of PSD.

EFFECTIVENESS OF EARLY REHABILITATION IN PATIENTS WITH ACUTE ISCHEMIC STROKE IN NEUROLOGY UNIT

Introduction. The theoretical grounding and solution of the scientific problem, which consists in the study of factors that contribute to the improvement of patients with ischemic brain stroke rehabilitation, are presented in this paper; it is a study of modern methods of rehabilitation and their effectiveness. The objective of the study was to find out reasons why the conducted research shows the significant importance of the use of kinesitherapy, transcutaneous electrical nerve stimulation, and psychotherapy in the system of early rehabilitation of patients. Based on the study, we established that the lateralization of brain lesions is an important factor that affects the rehabilitation potential of patients. The signs of motor impairment and cognitive deterioration in patients with ischemic stroke requires the development of individual and intensive rehabilitation measures in order to restore brain function and adequate treatment of all possible manifestations that impair the effectiveness of rehabilitation and the quality of patients’ life after ischemic stroke. In addition, our task was to study the incidence of post-stroke depressive disorders and their relationship with psychosocial factors. Material and methods. The empirical part was performed by collecting information about 60 patients who were treated and had initial rehabilitation in the early recovery period in the stroke unit. Patients were divided into 2 groups according to the timing of recovery to assess the likelihood of post-stroke depression and recovery against time. The analysis of data obtained after processing of materials was carried out using Microsoft Excel’16 program. Statistical processing of the results was carried out by the method of variational statistics using the Student’s test. The data were collected from patients with cerebral circulation disorders of Communal Institution in the neurology unit of Sumy City Council “City Clinical Hospital No.4”. Study results: It was established that gender is not a determining factor in the recovery of patients after ischemic stroke and does not significantly impact the rehabilitation prognosis. The most effective factors in recovering lost functions and skills after an ischemic stroke were complexity, phasing, and early start of rehabilitation measures. Post-stroke depression is a common consequence of ischemic stroke and 54 (90 %) patients (p &lt; 0.05) have it. The characteristic feature of depression in post-stroke patients was the persistence of symptoms, mild and moderate degree of severity, criticism of their condition, etc. Depressive disorders were complex, polymorphic, and included signs of both organic depression and personal response to the development of brain damage. The relationship of depression with the severity of neurological deficits, localization of the focus, as well as with psychosocial factors such as lonely living, loss of work, high social and professional status were shown. Further study of cognitive impairment and the role of specialists in solving the problem of their correction is required. Thus, a complete clinical-neurological and rehabilitation characteristic of patients with different baseline data and conditions is given, based on the results of our own research

Relationship Between Abnormalities in Resting-State Quantitative Electroencephalogram Patterns and Poststroke Depression.

Spectral power analysis of quantitative EEG has gained popularity in the assessment of depression, but findings across studies concerning poststroke depression (PSD) have been inconsistent. The goal of this study was to determine the extent to which abnormalities in quantitative EEG differentiate patients with PSD from poststroke nondepressed (PSND) subjects. Resting-state EEG signals of 34 participants (11 patients with PSD and 23 PSND subjects) were recorded, and then the spectral power analysis for six frequency bands (alpha1, alpha2, beta1, beta2, delta, and theta) was conducted at 16 electrodes. Pearson linear correlation analysis was used to investigate the association between depression severity measured with the Hamilton Depression Rating Scale (HDRS) total score and absolute power values. In addition, receiver operating characteristic curves were used to assess the sensitivity and specificity of quantitative EEG in discriminating PSD. In comparison with PSND patients, PSD patients showed significantly higher alpha1 power in left temporal region and alpha2 power at left frontal pole. Higher theta power in central, temporal, and occipital regions was observed in patients with PSD. The results of Pearson linear correlation analysis showed significant association between HDRS total score and the absolute alpha1 power in frontal, temporal, and parietal regions. Absolute powers of alpha and theta bands significantly distinguish between PSD patients and PSND subjects. Besides, absolute alpha1 power is positively associated with the severity of depression.

Wrist-ankle acupuncture and Fluoxetine in the treatment of post-stroke depression: a randomized controlled clinical trial.

To investigate the effects of WAA combined with fluoxetine in the clinical treatment of post-stroke depression (PSD) . In this randomized, controlled and single-blind trial, 105 PSD patients who met the inclusion criteria were randomly divided into three equal groups: Thin wrist-ankle acupuncture (WAA) group (Thin WAA needle + Fluoxetine), Thick WAA group (Thick WAA needle + Fluoxetine), and Sham WAA group (sham WAA needle + Fluoxetine). In this trial, the primary outcome was Hamilton Depression Scale (HAMD), while the secondary outcomes included Zung self-rating depression scale (SDS) and World Health Organization Quality of Life BREF (QQL). Ninety nine PSD patients completed all the treatment. The HAMD scores and SDS scores of all the three groups decreased after treatment (P < 0.05); thick WAA group and thin WAA group decreased more obviously than the sham WAA group (P < 0.05). There was no significant difference between the QQL scores of the three groups (P > 0.05). There was no significant difference in the scores of the three scales between the thick wrist ankle needles and the thin wrist ankle needles (P > 0.05). The present study showed that WAA combined with fluoxetine can relieve the symptoms of depression after stroke. WAA therapy could improve the antidepressant effect of fluoxetine.

Effectiveness and safety of the Xuefu Zhuyu Tang for post-stroke depression: A systematic review and meta-analysis

IntroductionFeelings of depression are common after a stroke. Xuefu Zhuyu Tang (XFZYT) is Chinese formula of 11 herbs which is used in clinical practice in China for post-stroke depression (PSD). This systematic review and meta-analysis evaluated the efficacy and safety of XFZYT alone or in combination with antidepressants for the treatment of PSD. MethodsEight electronic databases including PubMed, Web of Science, the Cochrane Library, EBSCO, CNKI (China National Knowledge Infrastructure), CBM (Chinese Biomedicine Database), Wanfang, and VIP (Chinese Scientific Journals Database) were searched for randomized controlled trials (RCTs) on XFZYT or XFZYT combined with an antidepressant. The data were analyzed by Review Manager version 5.3 software and evaluated by GRADEpro. ResultsA total of 12 RCTs involving 889 patients with PSD were included. The results showed that (1) XFZYT combined with antidepressants alleviated depression measured by the Hamilton Depression Scale (HAMD) (mean difference(MD) =-3.72, 95 % confidence interval(CI) =[-4.40,-3.05], I2 = 46 %) and the Self-rating depression scale(SDS) (MD =-6.98, 95 %CI=[-8.44,-5.53], I2 = 0%), showing higher effective rate based on depression scales (relative rate (RR) = 1.17, 95 %CI= [1.06,1.29], I2 = 49 %) compared to antidepressants alone. There were no significant differences in terms of Barthel index and adverse events. Adjuvant treatment with XFZYT did not reduce the risk of adverse events caused by antidepressants. (2) There were no significant differences between XFZYT group and antidepressants group in terms of HAMD score (P = 0.22), effective rate (P = 0.46), and Barthel index (P = 0.35). The lack of safety data on XFZYT highlights the need further research. The quality of evidence evaluated by the GRADE approach was rated mostly “Very low” to “Low.” ConclusionsThis study provides evidence supporting the view that XFZYT is as effective as antidepressants and may be used for treating PSD in patients who prefer Chinese medicine or cannot tolerate the side effects of antidepressants. Because the quantity and quality of the included studies are limited, these conclusions need further verification through investigations with larger and high-quality trials.

Improved Resting-State Functional Dynamics in Post-stroke Depressive Patients After Shugan Jieyu Capsule Treatment.

Shugan Jieyu Capsule (SG), a Chinese herbal medicine mainly composed of Acanthopanax and Hypericum perforatum, has been used to ameliorate cognitive impairments and emotional problems induced by post-stroke depression (PSD), while the altered brain dynamics underlying the ameliorative effects of SG have remained unclear. Our study focused on investigating the potential neurobiological mechanisms of SG in improving the cognitive function of PSD patients via resting-state functional magnetic resonance imaging (fMRI). Fifteen PSD patients (mean ages: 64.13 ± 6.01 years) were instructed to take 0.72 g of SG twice a day for 8 weeks. PSD patients underwent fMRIs, the 24-item Hamilton Depression Scale (HAMD-24) and the Montreal Cognitive Assessment (MoCA) at baseline and the end of intervention, and these assessments were also performed on twenty-one healthy controls (HC) (mean ages: 60.67 ± 6.95 years). Additionally, the dynamic amplitude of low-frequency fluctuations (dALFF) and functional connectivity (dFC) were determined to reveal changes in dynamic functional patterns. We found that taking SG significantly reduced the depressive symptoms assessed by HAMD-24 and improved cognitive functions assessed by MoCA in PSD patients. Furthermore, at baseline, PSD patients showed decreased dALFF in the right precuneus and increased dFC between the right precuneus and left angular gyrus, compared with HC. After intervention, the dALFF and dFC variances of the abnormal patterns were reversed. Additionally, the dALFF variance in the right precuneus was positively correlated with MoCA scores in PSD patients after SG treatment. Collectively, our results indicate that SG may improve the cognitive function of PSD patients through alteration of brain dynamics. Our findings lay a foundation for the exploration of the neurobiological mechanisms of SG in ameliorating symptoms of PSD patients.

TREATING POST-STROKE DEPRESSION WITH ECT

Introduction Post-stroke depression (PSD) is a common and potentially debilitating sequelae after a stroke, presenting in over 30% of stroke patients. PSD often does not respond to pharmacotherapy and significantly prevents recovery of stroke patients. In addition, depression in geriatric PSD patients may present with more somatic complaints and pain rather than traditional depressive symptoms. Central post-stroke pain syndrome (CPSP), found in 10.6% of patients with ischemic strokes, may present with similar pain and may overlap with symptoms of depression. Multiple studies have demonstrated that ECT is safe and effective in PSD patients, with two studies reporting 88% and 95% efficacy rates. According to the American Psychiatric Association's Task Force on ECT, there are no contraindications to ECT and studies have demonstrated safety in post-stroke patients. After initial ECT treatment, many patients with PSD require maintenance ECT. We present a case of a 62?y/?o female with post-stroke depression with catatonia who responded successfully after 5 ECT sessions but required maintenance ECT to sustain effect. Methods The hospital EMR was used to obtain information regarding this patient and her course of treatment. Results The patient suffered a left MCA infarct in March 2015 which resulted in transcortical motor aphasia. After rehabilitation, she was unable to return to her job as a physical therapist. She experienced worsening depression and suicidal ideation (SI) and required inpatient level psychiatric care, her first psychiatric hospitalization. She was treated with mirtazapine, trazodone, and methylphenidate. Two years later in 2017, she had another depressive episode. During this hospitalization, the patient complained of generalized weakness, diffuse body pain, and inability to move. This resulted in medical hospitalization for malnourishment, complicated by a pulmonary embolus due to immobility. She required PEG tube placement for nourishment, and was continued on mirtazapine, methylphenidate and started on risperidone and venlafaxine. About one year later, in August 2018, she had another depressive episode with catatonia. She refused food and water and refused anticoagulation and other oral medications. Similar to her previous hospitalization, she complained of generalized weakness and chronic pain but denied feelings or symptoms of depression. She was started on unilateral frontal ECT for several sessions and then switched to bitemporal (BT) placement. After about 5 sessions of BT ECT, she began to show improvement and started eating and accepting medications. This patient would have three additional hospitalizations with similar presentations: depression with SI and catatonia-like symptoms with refusal to eat or accept oral medications. She would also complain of pain and generalized weakness as the main reason why should could not move or eat. During these subsequent hospitalizations, ECT was initiated sooner with bitemporal placement which resulted in a more rapid improvement in depression and catatonia. It was determined to start maintenance ECT to prolong the beneficial effects and prevent relapse. Conclusions Post-stroke depression is a common sequalae of cerebrovascular accidents and may not respond adequately to psychopharmacology alone. In the patient presented above, PSD caused life-threatening symptoms: she became suicidal, malnourished, and refused anti-coagulation therapy. After initiation of ECT, symptoms improved, and she became more communicative and less depressed. Due to multiple relapses, maintenance ECT was initiated which helped to prolong duration of time between relapses. This case exemplifies the importance for geriatric providers to recognize weakness and pain as potential symptoms of geriatric depression, specifically PSD and CPSP. As evidenced by our patient, ECT should be more readily considered as symptoms are often refractory to pharmacotherapy alone and ECT maintenance can better prevent relapse of significant depressive symptoms. While additional studies are needed, ECT is safe and should be considered along with pharmacotherapy in PSD patients. This research was funded by: Not applicable

Effectiveness of Paroxetine for Poststroke Depression: A Meta-Analysis

Objective: The purpose of our study is to evaluate the efficacy of paroxetine in poststroke depression (PSD) patients by conducting a meta-analysis. Methods: We searched Web of Science (science and social science citation index), PubMed, the Cochrane Central Register of Controlled Trials, Embase up to August 2019. Randomized controlled trials that paroxetine compared to other antidepressants or control treatments as monotherapy for patients with PSD. Results: This review identified a total of 4 studies including 212 patients. This meta-analysis presented that paroxetine exhibits beneficial efficacy than routine treatment in PSD patients in terms of the reducing score of Hamilton Depression Scale (HAMD). Control treatment is more effective than paroxetine. No significant advantage was found with paroxetine. Conclusions: The efficacy of paroxetine maybe not very significant compared to other pharmacological and nonpharmacological interventions. Further high quality and large sample size studies are needed to evaluate the efficacy and safety of paroxetine in treating PSD in future.

The effects of mindfulness-based intervention on quality of life and poststroke depression in patients with spontaneous intracerebral hemorrhage in China.

Spontaneous intracerebral hemorrhage (sICH) is a devastating disease that can lead to poststroke depression (PSD) and greatest impact on the quality of life (QOL) of patients. Mindfulness meditation was viewed as one of the effective ways to reduce PSD in patients with cancer. The present study tried to investigate whether mindfulness meditation has potential benefits in PSD and QOL for sICH patients in China. Two hundred and two patients in West China Hospital, Sichuan University, enrolled from January 2017 to December 2018 were included in a randomized controlled trial. After removing missing values, there were 67 in control group and 67 in intervention group. Patients in intervention group received 2-month mindfulness-based cognitive therapy, and patients in control group received stress management education (ie, an active control). The results suggested that the significant differences of depression, trait mindfulness, social well-being, emotional well-being, and total score of QOL were found in intervention group from time 1 to time 2. Physical well-being and the score of NIH stroke scale experienced significant changes in both control group and intervention group over time. Mindfulness-based intervention has positive effects on sICH patients' depression, social well-being, and emotional well-being. However, the change of trait mindfulness over time could not explain these positive effects. Future studies could explore the mechanism of mindfulness-based intervention on sICH patients' depression and QOL and clarify the boundaries of the positive effects of mindfulness-based intervention.

Evaluation of Post-Stroke Depression in Patients with Cerebral Vascular Disorder

During the period effective rehabilitation and occurrence of depressive symptoms overlap in patients with cerebral vascular disorder. This study was conducted to clarify the medical professionals’ responses to such cases by determining the state of depression. This study involved qualitative analysis of free response questionnaire data. The study includes patients with a history of cerebral vascular disorder. The questionnaire authors reviewed all questions intended for free response before inclusion in the questionnaire. Questionnaires were handed off to patients between May 15 and July 15, allowing them 2 weeks to reply. The deadline for return was July 31, 2019. The recovery rate was 64.1%. A total of 245 words and 21 subcategories were extracted. Major categories of One’s own feelings (44.9%), Interaction with people (32.2%), and Uncertainty about the future (22.9%) were identified. Because the recovery of physical functions can aid in the recovery from depressive symptoms, medical professionals must be indirectly involved in the recovery from depressive symptoms.

Altered gray matter volumes in post-stroke depressive patients after subcortical stroke.

Stroke survivors are known to suffer from post-stroke depression (PSD). However, the likelihood of structural changes in the brains of PSD patients has not been explored. This study aims to extract changes in the gray matter of these patients and test how these changes account for the PSD symptoms. High-resolution T1 weighted images were collected from 23 PSD patients diagnosed with subcortical stroke. Voxel-based morphometry and support vector machine analyses were used to analyze the data. The results were compared with those collected from 33 non-PSD patients. PSD group showed decreased gray matter volume (GMV) in the left middle frontal gyrus (MFG) when compared to the non-PSD patients. Together with the clinical and demographic variables, the MFG's GMV predictive model was able to distinguish PSD from the non-PSD patients (0•70 sensitivity and 0•88 specificity). The changes in the left inferior frontal gyrus (61%) and dorsolateral prefrontal cortex (39%) suggest that the somatic/affective symptoms in PSD is likely to be due to patients' problems with understanding and appraising negative emotional stimuli. The impact brought by the reduced prefrontal to limbic system connectivity needs further exploration. These findings indicate possible systemic involvement of the frontolimbic network resulting in PSD after brain lesions which is likely to be independent from the location of the lesion. The results inform specific clinical interventions to be provided for treating depressive symptoms in post-stroke patients.