Treatment Of Post-stroke Depression Research Articles

Post-stroke depression and related factors analysis

Objective To investigate the incidence of post-stroke depression (PSD) and its risk factors, so as to provide the theoretical reference for the prevention of community PSD. Methods A total of 300 stroke patients hospitalized in the department of neurology in the First Bethune Hospital of Jilin University from July 2016 to May 2017 were selected and assessed by Self-rating Depression Scale (SDS) and Hamilton Depression Scale (HAMD) on their depression. The incidence of PSD was analyzed and after controlling the confounding factors, the relation between PSD and relevant influencing factors were indicated by the Odds Ratio (OR) and 95% Confidence Interval (CI) . Results The incidence of PSD was 31.6% (95/300) in the 300 stroke patients. After controlling the confounding factors, it was found that marital status, occupational status, decreased activity ability, muscle strength, neurological impairment and diabetes were closely related to PSD (P<0.05) . Conclusions The prevalence of PSD is high and closely related to marital status, occupational status, decreased activity ability, muscle strength, neurological impairment and diabetes. Understanding the risk factors of PSD is necessary to provide intervention for the prevention and treatment of PSD, which has a certain effects in reducing PSD and improving the PSD patients' physical function. Key words: Stroke; Depression; Prevalence; Related factors

Treatment of Post-Stroke Depression.

This review presents a critical appraisal of current therapeutic strategies for patients with post-stroke depression (PSD). We present the reader with the most recent evidence to support pharmacological, psychosocial, and neuromodulation interventions in PSD. We also discuss the relevance of using antidepressants and psychotherapy to prevent PSD and discuss evidence that antidepressant treatment may reduce mortality after stroke. Neuroinflammation and decrease neurogenesis and plasticity may play an important role in the mechanism of PSD. The strongest predictors of PSD are stroke severity, early physical disability, and severity of loss of functioning. Nevertheless, populations at risk for PSD are yet to be identified. Recent meta-analysis examined the efficacy of pharmacotherapy and psychotherapy. There is consensus that antidepressants such as escitalopram and paroxetine produce a significantly greater response and remission rate of PSD than placebo. Randomised controlled trials (RCTs) using psychotherapy are fewer, but recent meta-analysis tend to suggest efficacy for this treatment modality. Neuromodulation using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS), as well as novel psychosocial interventions are potentially useful treatments in need of further research. Pharmacological therapy with antidepressants and psychotherapy should be considered as first line of treatment for PSD. The most effective antidepressants are the selective serotonin reuptake inhibitors escitalopram and paroxetine, whereas cognitive behavioural therapy is the most effective psychotherapeutic intervention.

Upregulation of aryl hydrocarbon receptor nuclear translocator 2 in the hippocampi of post-stroke depression rats.

Aryl hydrocarbon receptor nuclear translocator protein 2 (ARNT2), a member of the basic helix-loop-helix superfamily of transcription factors, may serve a vital role in neuronal survival and cell proliferation via formation of heterodimers with hypoxia-inducible factor-1α. Previous studies indicated that ARNT2 levels were elevated in the brains of ischemic rats; however, the involvement of ARNT2 in post-stroke depression (PSD) rats is not well understood. Therefore, the present study aimed to investigate the levels of ARNT2 in the hippocampi of PSD rats, and to clarify the potential association between ARNT2 and behavioral performance. A PSD rat model was established by middle cerebral artery occlusion (MCAO) followed by a 4-week chronic unpredictable mild stress (CUMS) regimen. A sucrose preference test and open field test (OFT) were conducted, and body weight was measured. In addition, reverse transcription-polymerase chain reaction and immunohistochemistry were performed to measure ARNT expression. Results indicated that MCAO+CUMS rats had lower weight gain, consumed less sucrose and moved less compared with controls. Furthermore, the mRNA and protein levels of ARNT in MCAO+CUMS rats were increased compared with in controls. The sucrose preference index and horizontal movement distance in the OFT were positively correlated with ARNT mRNA level. Thus, from these findings it was suggested that ARNT2 may be positively associated with improvement of cognitive impairment, and therefore may be a potential target in PSD treatment.

Reliability and Validity of the Patient Health Questionnaire-9 as a Screening Tool for Poststroke Depression.

Screening for poststroke depression (PSD) using a valid and reliable tool is recommended for all stroke survivors. This literature review identifies the specificity, sensitivity, and appropriateness of the 9-item Patient Health Questionnaire (PHQ-9) to screen stroke patients for PSD. Relevant databases were searched using the following selection criteria: (1) peer-reviewed primary research, (2) published from 2012 to 2018 (to evaluate the most recent research using this tool), and (3) examined the specificity and sensitivity of the PHQ-9 for screening stroke survivors for PSD. Six studies, with an overall level of evidence grade of "B," representing an overall total sample size of 930 participants (851 given a diagnosis of stroke and 49 given a diagnosis of transient ischemic attacks) met criteria for inclusion in the review. Only 2 studies reported data on all of the components necessary to determine the robustness of this tool to screen for depression in stroke survivors. Evidence regarding the sensitivity and specificity of the PHQ-9 to screen stroke patients for PSD is inconclusive. Additional research is needed to address the appropriateness of the PHQ-9 as a depression screening tool in this population. Clinicians should validate the results of PHQ-9 screening of ischemic stroke patients for PSD with the Structured Clinical Interview for DSM-5, the standard for diagnosing depression, before initiating treatment of PSD.

The effect of pyruvate on the development and progression of post-stroke depression: A new therapeutic approach

Post-stroke depression (PSD) is a common and serious complication following stroke. Both stroke and depression have independently been associated with pathologically elevated glutamate levels in the brain's extra-cerebral fluid (ECF). Here we evaluate an alternative therapeutic approach to PSD with pyruvate. Rats were randomly assigned into one of 3 groups: Middle Cerebral Artery Occlusion (MCAO) plus pyruvate treatment, MCAO plus placebo treatment, and sham operated rats. Post-MCAO depressive and anxiety-like behavior was assessed, along with neurological status, brain infarct zone, brain edema, blood brain barrier (BBB) breakdown, cerebrospinal fluid and blood glutamate levels. Anxiety-like behavior and levels of blood alanine and α-ketoglutarate were measured in naïve rats treated with pyruvate, as a control. Post-stroke neurological deficit with concurrent elevation in glutamate levels were demonstrated, with peak glutamate levels 24 h after MCAO. Treatment with pyruvate led to reduced glutamate levels 24 h after MCAO and improved neurologic recovery. Pyruvate treatment reduced lesion volume, brain edema and the extent of BBB permeability 24 h post-MCAO. Naïve rats treated with pyruvate showed increased levels of α-ketoglutarate. Rats demonstrated post-stroke depressive behavior that was improved by the administration of pyruvate. There was less anxiety-like behavior in post-stroke rats treated with placebo in comparison to the post-stroke rats treated with pyruvate or sham operated rats. Glutamate scavenging with pyruvate appears to be an effective as a method in providing neuroprotection following stroke and as a therapeutic option for the treatment of PSD by reducing the consequent elevations in CNS glutamate levels.

Application of functional near-infrared spectroscopy to explore the neural mechanism of transcranial direct current stimulation for post-stroke depression

ABSTRACTObjectives: We investigated the neural mechanism of transcranial direct current stimulation (tDCS) in the treatment of post-stroke depression (PSD) using functional near-infrared spectroscopy (fNIRS).Methods: Twenty-six patients with PSD were randomly divided into an experimental group receiving tDCS and a control group receiving sham stimulation. The anode and cathode were placed on the left and right dorsolateral prefrontal cortex (PFC). Patients underwent fNIRS before and after treatment, combined with an emotional face sex judgment task and a ‘1-back’ working memory task to assess reaction times and relative concentration changes of oxyhemoglobin (Oxy-Hb) in the PFC.Results: Reaction times for faces showing positive emotions decreased after treatment in the experimental group (P < 0.05). For faces showing negative emotions, relative Oxy-Hb concentration changes in the PFC were higher after treatment (P < 0.05), but there was no significant difference between the experimental and the control group. Reaction times during the working memory task in the experimental group were shorter after treatment (P < 0.05), and there was a significant difference between the groups (P < 0.05). Relative Oxy-Hb concentration changes in the left PFC were significantly higher after treatment in the experimental group (P < 0.05), and concentration changes in the right PFC after treatment were significantly higher in the experimental than in the control group (P < 0.05).Discussion: tDCS may improve the processing of negative emotions and working memory in patients with PSD by enhancing aerobic metabolism in the PFC, thereby improving depressive symptoms.

Novel susceptibility genes were found in a targeted sequencing of stroke patients with or without depression in the Chinese Han population

BackgroundBoth stroke and depression are multi-factorial diseases, with both genetic and environmental factors likely to participate in their pathogenesis. Post stroke depression (PSD) is a common complication after stroke leading to poor functional outcome, increased physical disability and mortality. Although several genes have been associated with PSD, the genetic basis of PSD remains poorly understood. MethodA 2-stage candidate gene study by targeted sequencing was conducted involving stroke patients with or without depression and health controls. In the discovery stage (121 PSD, 131 non-PSD and 639 HC), logistic regression was used to test associations respectively in PSD and non-PSD groups. In the replication stage (200 PSD, 218 non-PSD and 983 HC), 54 selected SNPs were again genotyped in an independent cohort. Fixed-effects inverse variance-weighted meta-analysis was used in the combined samples. ResultsThe study identified 2 novel genes associated with PSD [HTR3D (rs55674402, p = 0.002512, odds ratio (OR) = 0.7431); NEUROG3 (rs144643855, p = 0.00325, OR = 0.6523)] and 3 risk SNPs in one risk gene associated with non-PSD [PIK3C2B (rs17406271, p = 0.0006801, OR = 1.446; rs2271419, p = 0.0005836, OR = 1.497; rs2271420, p = 0.001031, OR = 1.431)] in the Chinese sample. NEUROG3 shows highest expression level in hippocampus. Functional enrichment analysis shows that susceptibility genes for PSD are mostly enriched in chemical synaptic transmission and regulation of lipid synthetic process. LimitationsThe sample size was not sufficient to reach a genome-wide p value level. To overcome this shortage, some unique strategies were applied during the selection of SNPs for replication. Secondly, the age, gender composition and depressive severity between two stages were not well-matched. Different sample sources should be blamed, and to minimizing the influence, gender was corrected as co-variant in logistic regression. ConclusionThis study identified that HTR3D and NEUROG3 were linked with the susceptibility of PSD and PIK3C2B with stroke in the Chinese Han population. Further replication of these findings in a larger and better matched sample is warranted. Functional analysis suggests that the pathogenesis of PSD may be implicated in 5-HT synaptic transmission, neural plasticity and lipid metabolism, and therapeutic interventions targeting these pathways may be effective approaches for PSD treatment.

The effectiveness of acupuncture therapy in patients with post-stroke depression: An updated meta-analysis of randomized controlled trials.

Background:To assess the effectiveness of acupuncture in patients with post-stroke depression (PSD).Methods:The Cochrane Library, CINAHL, EMBASE, PubMed, SCOPUS, Web of Science, and 4 Chinese databases were electronically searched for articles published between January 1, 2010 and May 31, 2018. Randomized controlled trials (RCTs) investigating the effects of acupuncture on PSD were included. The quality of all included trials was assessed according to guidelines published by the Cochrane Collaboration.Results:Seven trials compared the effectiveness of acupuncture therapy with that of control in alleviating the symptoms of PSD. Pooled analysis demonstrated that patients in the acupuncture intervention group experienced a significantly higher treatment effect than controls (RR 1.16 [95% CI 1.08–1.24]; P < .0001), with low study heterogeneity (I2 = 4%). Based on intervention methods, further analysis revealed a statistically significant difference in effectiveness between the acupuncture alone and medicine groups (RR 1.25 [95% CI 1.11 1.41]; Z = 3.78; P = .0002). There was no statistically significant difference in efficacy between the acupuncture combined with medicine and medicine groups (RR 1.07 [95% CI 0.98–1.17]; P = .11).Conclusions:This meta-analysis provides evidence supporting the viewpoint that acupuncture is an effective and safe treatment for PSD. Subgroup analyses further revealed that acupuncture alone resulted in better outcomes than drug therapy in improving depressive symptoms. Further high-quality RCTs are needed to systematically evaluate the effectiveness of acupuncture for PSD and develop standardized acupuncture protocols.

Antidepressant-like effects of paeoniflorin on post-stroke depression in a rat model

ABSTRACT Background: Post-stroke depression (PSD) is one of the most prevalent emotional disorders after stroke and often results in poor outcomes. However, the underlying physiopathologic mechanism and effective treatment of PSD remain poorly elucidated. Objective: To investigate whether paeoniflorin has antidepressant-like activity in a rat model of PSD. Methods: Rats were randomly divided into four groups: sham-operated control (Sham), PSD, paeoniflorin (with PSD) and fluoxetine group(with PSD). PSD was developed by the right middle cerebral artery occlusion followed 21 days chronic unpredictable mild stress combined (CUMS) with raised alone. Tests of sucrose preference and open field were used to assess the depression-like behavior. Neurological function was evaluated by neurological deficit score and beam balance test. Expression of phosphorylated CREB (p-CREB) and brain-derived neurotrophic factor (BDNF) in the CA1 region of the hippocampal complex was evaluated by western blot and immunofluorescence. Results: Te depressive-like behaviors markedly improved after paeoniflorin and fluoxetine treatment. Furthermore, paeoniflorin treatment significantly increased BDNF and p-CREB expression in the CA1 region. Conclusions: Observed results suggested that paeoniflorin could ameliorate the symptoms and improve the functional capability of PSD rats, similar to the effect of fluoxetine. Abbreviations: PSD: post-stroke depression; CUMS: chronic unpredictable mild stress stimulation; MCAO: middle cerebral artery occlusion; OFT: open field test; SPT: sucrose preference test, NDS: neurological deficit score, BBT: beam balance test; BDNF: brain-derived neurotrophic factor protein; p-CREB: phosphorylated Cyclic-AMP responsive element binding protein

Clinical significance and possibilities of therapy of post-stroke depression

Depression often complicates the course of the post-stroke period, adversely affecting the functional recovery and quality of life of patients, and is associated with an increased risk of mortality. Over the recent years, the role of inflammatory processes, genetics, white matter damage, cerebrovascular reactivity disorders, changes in the level of monoamines and cortisol, impaired neuroplasticity and glutamate neurotransmission in the pathophysiological mechanisms of post-stroke depression (PSD) is increasingly discussed. Randomized clinical trials (RCTs) have shown that antidepressants are highly effective in the treatment and prevention of PSD. The action of antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), can be directed to the main pathophysiological processes of post-stroke depression. Treatment of PSD with antidepressants not only reduces the severity of depression, but also improves the functional state, rehabilitation and quality of life of patients.

草酸艾司西酞普兰治疗卒中后抑郁疗效的Mate分析

草酸艾司西酞普兰治疗卒中后抑郁疗效的Mate分析

Thoughts of Zhuang Li-Xing’s Mind-Regulating Acupuncture Therapy for Treatment of Post-Stroke Depression

PSD affected the rehabilitation of limb function in stroke patients seriously and it is necessary to adopt effective approaches to treat PSD in clinic to enhance life quality of patients with stroke. The theories and practices for the treatment of post-stroke depression (PSD) with mind-regulating acupuncture therapy by Professor Zhuang Lixing were summarized. Professor Zhuang who has been a doctor for more than 30 years and now is a highly ranked and famous Chinese medicine practitioner, and Dr. Zhuang is an expert in treating PSD by using the mind-regulating acupuncture therapy and this therapy has the exact curative effectiveness. The pathogenesis of PSD is due to the disorder of qi flowing and internal retention of phlegm as well as the blood stasis caused by stroke, which result in the deficiency of nutrition and the failed shelter of spirit in brain. For improving the overall mental function of the patients with PSD, Professor Zhuang accurately locates the “spirit” and stimulates the optimal acupuncture points of Sishenzhen, Zhisanzhen, Yintang (EX-HN3), Shenmen (HT7), and Sanyinjiao (SP6) by electroacupuncture and points modification to induce qi from the spirit and relieve the depression by activating qi flow. Clinical practice of Professor Zhuang provides evidence for the treatment of PSD with acupuncture therapy.

Repetitive Transcranial Magnetic Stimulation Improves Depressive Symptoms and Quality of Life of Poststroke Patients—Prospective Case Series Study

Background:Poststroke depression (PSD) is a serious psychiatric complication often reported after a stroke. Nearly a third of stroke survivors experience depressive symptoms at some point, affecting their functional recovery and quality of life. In recent years, repetitive transcranial magnetic stimulation (rTMS) has been studied by many researchers and found to be a safe supporting tool for the treatment of PSD.Objective:We aim to evaluate the effects of rTMS on PSD and on the quality of life of poststroke patients.Method:A prospective clinical case series, performed at CRER Rehabilitation, Brazil, between June 2016 and May 2017. A nonprobabilistic sample (n = 15) was divided into 2 groups (excitatory stimulation in F3, n = 8; inhibitory stimulation in F4, n = 7) and underwent 20 sessions of rTMS. Individuals were assessed according to the 17-item Hamilton Depression Rating Scale (HAM-D17) and World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) questionnaire at 3 different moments: baseline, at the end of the treatment, and in a 1-month follow-up meeting.Results:Both groups presented a significant change in the score of all WHOQOL-BREF domains and in HAM-D17. In the group that received inhibitory stimulation (F4), score changes were continuous and gradual, comparing the 3 moments. In the excitatory stimulated (F3) group, however, the improvement in scores was more expressive between baseline and the second moment, without significant changes in the follow-up.Conclusions:The findings of this clinical study suggest that rTMS can be a promising tool, capable of relieving depressive symptoms and helping in the improvement of poststroke patients’ quality of life.

Traditional Chinese medicine for post-stroke depression: A systematic review and network meta-analysis (Protocol).

Post-stroke depression (PSD) is common in stroke survivors, with significantly negative effects and serious impairments in terms of personal and social functioning. While both pharmacological and traditional Chinese medicine (TCM) interventions have been administered for PSD, there is still uncertainty about the balance between these and what treatment strategy should be preferred in clinical practice. Therefore, we aim to compare and rank, describing the protocol of a systematic review and network meta-analysis (NMA), the commonly used TCM interventions for PSD. We will search CENTRAL (the Cochrane Central Register of Controlled Trials), CINAHL, Embase, PubMed, CBM and PsycINFO, the US National Institutes of Health and the World Health Organisation International Trials Registry Platform search portal from inception to November 2018. There will be no restrictions on language, publication year or publication type. Only randomized clinical trials (RCTs) accessing any TCM treatments against active comparator or other controls for PSD will be included. The primary outcomes will be efficacy (the total number of participants, declining more than 50% on the total score between baseline) and acceptability of treatment (dropout rate due to any cause). A Bayesian NMA will be performed to compare all relative outcome of different TCM interventions. we will conduct the network meta-regression meta-analyses of data on the sex ratio, the types of stroke and the treatment duration of TCM interventions. Potential explanations in extra subgroup analyses according to the results of heterogeneity and inconsistency will be explored, and sensitivity analyses will be conducted to assess the robustness of the findings. PROSPERO CRD42018082400. Our study will generate evidence for TCM in the treatment of PSD and help to reduce the uncertainty about the effectiveness of PSD management, which will encourage further suggestions for TCM clinical practice or guideline.

Death-associated Protein Kinase 1 Impairs the Hippocampo-prefrontal Cortical Circuit and Mediates Post-stroke Depression

Post-stroke depression (PSD) is a common and complex post-stroke neuropsychiatric disorder, which not only delays functional recovery but also increases mortality, and which currently lacks effective drug therapy. The pathogenesis of PSD is associated with impairment of the subcortical neural circuits and alterations of synaptic plasticity and neurotransmitters, but the exact mechanisms of PSD remain unknown. Our previous work indicates that the death-associated protein kinase 1 (DAPK1) mediates neuronal death after stroke. Genetic deletion of DAPK1 gene or blocking DAPK1 signal in the PSD mouse model can not only alleviate cerebral ischemic injury but also relieve PSD-like behaviors. Our previous work has also demonstrated the following results. First, the neural circuit of dorsal CA1 (dCA1) to medial prefrontal cortex (mPFC) (dCA1-mPFC) is selectively impaired after stroke. Second, the DAPK1 signal is involved in the impairment of dCA1-mPFC neural circuit after stroke. Third, genetic deletion of the DAPK1 gene or blocking of the DAPK1 signal alleviates the injury of dCA1-mPFC neural circuit after stroke and improves PSD-like behaviors. In conclusion, we hypothesize that activated DAPK1 signal after stroke induces apoptosis in the hippocampal dCA1 neurons, leading to loss of the dCA1-mPFC glutamatergic projections, synaptic injury, decrease of glutamate release, inhibition of mPFC neurons, and finally onset of PSD. We hope to further replenish the mechanisms of PSD and provide new insights for PSD treatment.

Effects of gastrodin on 5-HT and neurotrophic factor in the treatment of patients with post-stroke depression.

Effects of gastrodin on 5-HT and neurotrophic factor in the treatment of patients with post-stroke depression (PSD) were investigated. A total of 78 PSD patients were selected in Binzhou City Center Hospital from September 2013 to December 2016. Patients were randomly divided into the control group and experimental group, 39 patients in each group. Patients in the control group were treated with conventional drug fluoxertine hydrochloride for 2 months, and patients in the experimental group were treated with gastrodin. The levels of 5-HT and neurotrophic factors in blood were measured using the enzyme-linked immunosorbent assay (ELISA) kit before, and at 1 and 2 months after treatment. The Hamilton Depression Scale (HAMD), Activities of Daily Living (ADL) scale, NIH Stroke Scale/Score (NIHSS) and Stroke Impact Scale (SIS) were used to evaluate the efficacy of treatment. Treatment efficacy was compared between the two groups. The levels of 5-HT and neurotrophic factors were significantly higher in the experimental group than those in the control group at 1 and 2 months after treatment (P<0.05), and HAMD, ADL, NIHSS and SIS scores were all better in the experimental group than in the control group (P<0.05). In addition, significantly less side effects were found in the experimental group than that in the control group, and treatment efficacy in the experimental group was significantly better than that in the control group (P<0.05). Gastrodin is effective in the treatment of PSD and should be popularized.

Two New Susceptibility Genes Were Identified by Targeted Sequencing for Post-Stroke Depression in the Chinese Han Population

Background: Post stroke depression (PSD) is a common complication characterized by depressed mood, lack of interest or pleasure after stroke and leads to increased physical disability, poor functional outcome and raised mortality of stroke patients. Although several genes have been associated with PSD, the genetic basis of PSD remains poorly understood. In addition, no genome-wide association study (GWAS) has been carried out for PSD patients in China. Method: A 2-stage genome-wide association study was conducted involving 671 cases (321 PSD patients and 349 non-PSD patients) and 1746 non-stroke health controls. In the discovery stage (121 PSD, 131 non-PSD and 639 HC), logistic regression was used to test associations respectively in PSD and non-PSD groups, and analysis was restricted to sequenced single nucleotide polymorphisms (SNPs) and short indels. In the replication stage (200 PSD, 218 non-PSD and 983 HC), the selected SNPs were again genotyped in an independent cohort. Fixed-effects inverse variance-weighted meta-analysis was used in the combined discovery and replication samples. SNPs were functionally annotated by Annovar according to their location and expected effect on encoded gene products on the basis of information from the RefSeq, UCSU and eQTL database. In addition, functional network analysis and GO pathway enrichment analysis were performed to find the common biological processes mediated by the novel candidate genes. Results: The study identified 2 novel susceptibility genes for PSD [HTR3D (rs55674402, p=0.002512, odds ratio (OR)=0.7431); NEUROG3 (rs144643855, p=0.00325, OR=0.6523)] and 3 risk SNPs in one risk gene for non-PSD [PIK3C2B (rs17406271, p=0.0006801, OR=1.446; rs2271419, p=0.0005836, OR=1.497; rs2271420, p=0.001031, OR=1.431)] in two stages and meta-analysis. In addition, 2 previously studied genes [CREB1 (rs139164200, p=0.0001165, OR=2.281); SLC6A4 (rs25533, p=0.03166, OR=0.5293)] were identified in the discovery stage though they were not replicated in the second stage. No significant SNP showed evidence of heterogeneity between the 2 stages. HTR3D and NEUROG3 are both found expressed in central nervous system, while NEUROG3 shows highest expression level in hippocampus compared with other regions of body. HTR3D encodes the D subunit of type 3 serotonin receptor and is found to be associated with neuro-gastrointestinal dysfunctions. NEUROG3 encodes a transcription factor critical for the development of central nervous system and is found to associated with the neural and synaptic plasticity of hippocampus. PIK3C2B encodes the β isoform of the class II PI3K which involves in the intracellular signaling pathway related to the neuron survival and inflammatory process after stroke. Furthermore, GO pathway enrichment analysis shows that these susceptibility genes for PSD, including 2 novel genes identified in this study and those previously published, are involved in chemical synaptic transmission and regulation of lipid synthetic process. Conclusion: This study identified 2 novel susceptibility genes for PSD and 1 novel susceptibility genes for stroke. The association with 5-HT synaptic transmission, neural plasticity, neuron survival, lipid metabolism and inflammatory process of susceptibility genes suggest that the pathogenesis of PSD may be implicated in these pathways and therapeutic interventions targeting these pathways may be effective approaches for PSD treatment. Trial Registation Number: ChiCTR-OCH-13003133 Funding: This work was supported by Jiangsu Provincial Special Program of Medical Science (BL2012025, Yonggui Yuan). Declaration of Interest: There are no conflicts of interest. Ethical Approval: This study has been approved by IEC for clinical research of Zhongda Hospital, Affiliated to Southeast University. Approved No. of ethic committee2013ZDSYLL011.0

Behavioral intervention in the prevention and treatment of post stroke depression

Post stroke depression has a huge impact on the rehabilitation and recurrence of patients with stroke.Its specific pathogenesis is unknown.Monoamine transmitters, inflammatory cytokines, hypothalamic pituitary adrenal axis function and neural plasticity are involved.Because of the uncertainty and side effects of drug therapy, non-drug therapy, especially behavioral intervention, is attracting more and more attention from clinicians.At present, behavioral intervention methods commonly used in clinical practice include: cognitive behavioral therapy, motivational interviewing, sports, music, and so on.Although a large number of clinical studies have shown that behavioral intervention has a clear therapeutic effect on post stroke depression, there is still no high level of recommendation for the prevention and treatment of post-stroke depression due to the lack of large sample and high quality multicenter randomized controlled studies. Key words: Post stroke depression; Behavioral intervention; Prevention; Treatment

Efficacy and safety of high-frequency repetitive transcranial magnetic stimulation for post-stroke depression: A systematic review

Objective To evaluate the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke depression (PSD). Methods The Cochrane Library, Medline, EMbase and CBMdisc were electronically searched for reports of randomized and controlled trials (RCTs) of high-frequency rTMS in the treatment of PSD before October 2017. Two researchers screened the reports independently, extracted data and assessed the risk of bias in the included studies. The meta-analysis was performed using version 5.1 of the RevMan software. Results A total of 26 RCTs were included, covering 1810 patients with PSD. The meta-analysis showed that the remission rate [relative risk (RR)=2.15, 95%CI (1.64, 2.83)] and the effectiveness [RR=1.66, 95%CI (1.28, 2.15)] of high-frequency rTMS group were significantly higher than in the control groups. Compared with the control group, the average Hamilton depression rating scale (HAMD) score of the high-frequency rTMS groups was significantly lower than in the control groups. There was no significant difference in withdrawal between the two groups after treatment [RR=0.55, 95%CI (0.18, 1.65)]. The incidence of headaches was significantly higher in the high-frequency rTMS group than among the controls. Conclusion High-frequency rTMS has a good curative effect and better acceptability for PSD patients, but attention should be given to headaches and other adverse reactions. Due to the limited number of studies and their quality, these conclusions still need to be verified in better-quality studies. Key words: High-frequency magnetic stimulation; Transcranial magnetic stimulation; Magnetic stimulation; Depression; Stroke

Prevalence and influencing factors of post-stroke depression among middle aged and elderly stroke patients in Mongolia and Han nationality

Objective To explore the prevalence and analyze the related risk factors for post-stroke depression among middle-aged and elderly stroke patients of Mongolia and Han nationality in Inner Mongolia Autonomous Region. Methods A stratified multistage random cluster sampling method was used to investigate the prevalence of stroke in the population aged ≥45 years in different areas of Inner Mongolia Autonomous Region. A total of 11 088 people were investigated and 498 were stroke patients among them. A set of scale assessment and the general situation were used to investigate stroke patients and 443 patients completed the whole survey. Results The total prevalence of post-stroke depression (PSD) was 41.08% in 443 stroke patients, among which the prevalence rate was 40.57% for Mongolian population and 41.85% for Han population, and no significant difference was found between Mongolian and Han nationality(χ2=1.372, P=0.504). There were significant differences in the types of stroke between the Mongolian and Han nationality (χ2=7.347, P=0.025). The age (t=4.321, P=0.000), educational level (χ2=27.036, P=0.001) and economic burden (χ2=27.877, P=0.000) were statistically significant between Mongolian and Han nationality. The differences of frequency of stroke (χ2=6.545, P=0.011), economic burden (χ2=16.148, P=0.001), cognitive dysfunction (χ2=9.065, P=0.003), daily living ability (χ2=34.466, P=0.000), alcohol consumption history(χ2=4.516, P=0.034)were statistically significant. Logistic regression analysis showed that alcohol consumption history, economic burden, the frequency of stroke, and cognitive dysfunction were the influencing factors of PSD. Conclusion PSD is one of the important factors affecting the post-stroke psychological burden in Inner Mongolia Autonomous Region. There is no national difference in the prevalence of PSD among Mongolian and Han people, which provides a theoretical basis for the treatment and intervention of PSD. Key words: Post-stroke depression depression; Mongolian; Prevalence; Risk factors; Middle aged and elderly