Therapy In Post-stroke Depression Research Articles

Application of noninvasive neuromodulation and light therapy in post-stroke depression: a narrow review

Post-stroke depression is closely related to the poor prognosis of stroke, resulting in prolonged hospital stay, neurological dysfunction, and increased mortality. Post-stroke depression has a complex pathogenesis, and cannot be explained by a single pathophysiological mechanism; therefore, no treatment is definitely effective. Currently, the commonly used treatment methods include drug therapy, psychotherapy and noninvasive neuromodulation therapy, such as repetitive transcranial magnetic stimulation, and transcranial direct current stimulation. However, simple drugs have poor efficacy and are often accompanied by side effects. Although repetitive transcranial magnetic stimulation and transcranial direct current stimulation combined with drug therapy enhance drug efficacy, their application is limited in some cases. Light therapy can regulate the central nervous system through the light-sensitive retinal nerve pathway, which has been proven to have therapeutic effects in patients with depression. Light therapy has the advantages of no obvious side effects and a wider range of adaptation. This review summarizes the current research status of noninvasive neuromodulation and light therapy in post-stroke depression and explores the possibility of widespread application of physical factors modulation for post-stroke depression.

Oxidative Stress and Poststroke Depression

Objective. To study the use of combined therapy of poststroke depression using antidepressants and an antioxidant. Materials and methods. The dynamics of the clinical status of poststroke depression and parameters of oxidative stress were studied in 60 patients with poststroke depression before and after threemonth courses of treatment with fluvoxamine 100 mg/day and Cytoflavin 10 mg/day by i.v. infusion diluted in 200 ml of 5% glucose solution (or physiological saline in patients with diabetes mellitus) in the mornings for 10 days with subsequent transfer to the tableted form (two tablets in the morning and two in the evening for 90 days). Results. The data obtained here on the comparative efficacy of the treatment of poststroke depression with fluvoxamine monotherapy and with the combination of fluvoxamine and Cytoflavin confirmed the high efficacy of combined treatment, such that this should be regarded as an option in developing novel treatment regimes for poststroke depression and that the need to prescribe antidepressants and antioxidants must be determined on the basis of individual assessment of the severity of depressive disorder and measures of oxidative stress in terms of the activity of endogenous antioxidants in each individual poststroke patient.

Role of functional pharmacological therapy in post-stroke depression: a narrative review.

ObjectiveWe conducted a narrative review to investigate whether antidepressant therapy, including the use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) or the use of supportive drugs (i.e., citicoline or choline alfoscerate) as a substitute for antidepressant therapy, reduces depression in patients with cerebrovascular diseases.MethodsA systematic search of the PubMed and Web of Science databases was performed, including review articles and other studies to identify additional citations. Only 4 of 1566 publications met the inclusion/exclusion criteria and were selected.ResultsStudies showed that post-stroke depression (PSD) could be treated with antidepressant therapy, as well as supportive drugs such as citicoline or choline alfoscerate, which may have antidepressant effects.ConclusionsThe findings support the efficacy of citicoline as a treatment for depression. Studies aimed to discover the characteristics of these psychostimulants in relation to PSD treatment should be performed.

Pharmacological therapy of post-stroke depression

Pharmacological therapy of post-stroke depression

Therapy of post-stroke depression – a systematic review

SummaryWe performed a systematic review of randomized placebo-controlled pharmacological and non-pharmacological trials for the therapy and prevention of post-stroke depression that have been published between 1980 and 2011. We initially identified 2 260 records of which 28 studies were finally included into this review. A meta-analytic approach was hampered by considerable differences regarding the kinds of therapeutic regimens and the study durations. Modest effects favoring treatment of post-stroke depression could be found for pharmacological treatment as well as repetitive transcranial magnetic stimulation. For the prevention of post-stroke depression, antidepressant pharmacotherapy showed promising results. However, large-scale studies with better standardized study populations, optimized placebo control procedures in non-pharmacological studies, and replication in larger follow-up studies are still necessary to find the optimal therapeutic regimens to prevent and treat post-stroke depression.

AGONIST OF V2 VASOPRESSIN RECEPTOR REDUCES DEPRESSIVE DISORDERS IN POST-STROKE PATIENTS

Poststroke depression is one of the common psychiatric complications after stroke. Thus, the research of new ways for treatment depressed mood after stroke is actual. The previous researches revealed vasopressin to be effective in patients with memory, speech and motor function disorders after stroke. The purpose of the study was to investigate influence of vasopressin on depression after stroke. Fourteen patients with affective disorders have been treated with subendocrine doses of 1-desamino-8-D-arginin-vasopressin (DDAVP) daily by intranasal application during 1,5-2 months. Vasopressin was effective in correcting both apatoadinamic and anxious depression. Treatment effect was durable, lasts for 0,5-1 year after the first course of therapy. The results of this pilot study demonstrate perspective of using selective agonist of vasopressin V2 receptors, DDAVP, in therapy of post-stroke depression.

Ecosystem focused therapy in poststroke depression: a preliminary study

Poststroke depression (PSD) occurs in the context of abrupt, often catastrophic disability that finds the patient and his or her family unprepared. We developed the ecosystem focused therapy (EFT), a systematic intervention aimed to increase the PSD patient's and his or her ecosystem's abilities to address the "psychosocial storm" of PSD and utilize available treatments effectively and efficiently. This is a preliminary study of its efficacy. A total of 24 PSD patients were randomly assigned to receive weekly sessions of EFT or a comparison condition consisting of systematic Education on Stroke and Depression and their treatment for 12 weeks. Ecosystem Focused Therapy may be more efficacious than Education on Stroke and Depression in reducing depressive symptoms and signs, in leading to a higher remission rate, and in ameliorating disability in PSD. Reduction of disability in the early part of the trial mediated later improvement in depressive symptomatology. Similarly, reduction in depressive symptoms and signs early on mediated later improvement in disability. These encouraging findings require replication. Beyond its potential direct benefits in PSD, EFT may provide an appropriate context for efficient and timely administration of pharmacotherapy and of physical, speech, and occupational therapy thus maximizing their efficacy.

Terapia medicamentosa na depressão pós-acidente vascular encefálico

OBJETIVO: Este estudo visa realizar uma revisão de literatura sobre a terapia farmacológica na depressão pós-AVE. MÉTODO: Foi feita uma revisão nos bancos de dados MedLine e SciELO, utilizando-se como descritores primários "stroke", "depression" e "treatment", incluindo artigos publicados entre 1996 e 2008. RESULTADOS: Treze artigos foram selecionados. Foram encontrados dez artigos que apresentaram terapias farmacológicas eficazes no tratamento da depressão pós-AVE e três em que as terapias farmacológicas utilizadas não trouxeram benefício para a depressão dos grupos em estudo. CONCLUSÃO: O manejo farmacológico da DPAVE pode ser realizado de maneira profilática ou terapêutica. Em ambas as modalidades, os inibidores de recaptação seletiva são as medicações mais adequadas, destacando-se a fluoxetina e, em pacientes adequadamente selecionados, a reboxetina e o citalopram. A nortriptilina, antidepressivo tricíclico, é uma alternativa com relativa eficácia na conduta da DPAVE.

Antidepressant therapy in post-stroke depression

Background: About 40% of patients with stroke will develop depression at some stage after the acute event. Post-stroke depression (PSD) is associated with a poor prognosis. Depressed patients have more severe deficits in activities of daily living, a worse functional outcome, more severe cognitive deficits and increased mortality as compared to stroke patients without depression. Objective: This review will focus on available controlled trials of treatment for PSD. Methods: An unsystematic review of recent studies for the treatment of PSD. Results: Randomized controlled trials have demonstrated the efficacy of sertraline, citalopram and nortriptyline to treat post-stroke depression. Whether antidepressant medication may help to prevent post-stroke depression and decrease post-stroke mortality will require further controlled studies.

Epidemiology and treatment of post-stroke depression

Mood depression is a common and serious complication after stroke. According to epidemiological studies, nearly 30% of stroke patients develop depression, either in the early or in the late stages after stroke. Although depression may affect functional recovery and quality of life after stroke, such condition is often ignored. In fact, only a minority of patients is diagnosed and even fewer are treated in the common clinical practice. Moreover, the real benefits of antidepressant (AD) therapy in post-stroke depression have not been fully clarified. In fact, controlled studies on the effectiveness of ADs in post stroke depression (PSD) are relatively few. Today, data available suggest that ADs may be generally effective in improving mood, but guidelines for the optimal treatment and its length are still lacking.

Depression after stroke: a review of the evidence base to inform the development of an integrated care pathway. Part 2: Treatment alternatives.

Depression is a common complication of stroke, leading to increased morbidity and mortality. It can impede the process of rehabilitation, and has been associated with poorer outcomes and increased length of stay in hospital. This systematic review was undertaken as a preliminary step to the development of an evidence-based integrated care pathway (ICP) for the management of post-stroke depression (PSD) in a rehabilitation setting, and is divided into two parts. In part 1 we reviewed the frequency of depression in stroke, its impact on functional recovery and the different methods for assessment. In part 2, we discuss the rationale for treatment of PSD, appraise the evidence for effectiveness of the different antidepressant drugs, and consider whether we can identify a recommended first-line treatment for use in our ICP. Data sources comprised a computer-aided search of published studies on depression in stroke and references to literature used in reviews. From the few controlled trials of anti-depressant therapy in PSD, both tricyclics and selective serotonin re-uptake inhibitors (SSRIs) appear to be effective, but the latter may be preferable in stroke because of their prompt action and better side-effect profiles. Within the group of SSRIs there is currently no direct evidence to guide the choice of agent. In the absence of firm guidance, sertraline was chosen on theoretical grounds as one of the most potent with minimal sedative effects and no reported interaction with warfarin. Citalopram may offer an appropriate second choice. A suggested regimen for the use of sertraline in PSD was put forward. Development of an ICP may help to establish a more consistent approach to assessment and treatment of PSD, and form a basis for future comparison of different treatments as they become available.