Treatment Of Post-stroke Depression Research Articles

Complementary and alternative therapies for poststroke depression: A protocol for systematic review and network meta-analysis.

Background:Poststroke depression (PSD) is an important complication of stroke, resulting in increased disability and mortality, which is a great threat to stroke survivors and public health. Complementary and alternative medicine (CAM) therapies is widely used in the treatment of PSD, However, the selection strategies of different CAM approaches in clinical practice is still not clear, and the purpose of this protocol is to compare the efficacy and acceptability of different CAM therapies using systematic review and network meta-analysis.Methods:According to the strategy, the authors will retrieve a total of seven electronic databases by August 2020, including PubMed, the Cochrane Library, EMbase, China National Knowledge Infrastructure, China Biological Medicine, Chinese Scientific Journals Database, and Wan-fang databases. The network meta-analysis will be performed using Aggregate Data Drug Information System 1.16.8 and Stata 13.0 software. In addition, the Cochrane Collaboration's tool is employed for the methodological quality, and the quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation system.Results:This study will provide a reliable evidence for the selection strategy of CAM therapies for PSD.Conclusion:The results of this study will provide references for evaluating the effects of different CAM therapies on PSD, and provide decision-making references for clinical practitioners, patients, and health policy makers.Ethics and dissemination:This study does not require ethical approval. the results will be disseminated through a peer-reviewed publication.OSF registration number:DOI 10.17605/OSF.IO/TNGH6.

Vitamin D3/vitamin D receptor signaling mitigates symptoms of post-stroke depression in mice by upregulating hippocampal BDNF expression

Elucidation of the pathogenic mechanisms underlying post-stroke depression (PSD) could aid in the development of effective treatments. The present study explored whether Vitamin D3 (VitD3) can function as an antidepressant in PSD model mice and whether the effect is mediated by upregulation of brain-derived neurotrophic factor (BDNF). Mice were subjected to middle cerebral artery occlusion (MCAO) combined with chronic unpredicted mild stress (CUMS) to established the PSD model. For the mice in each group, Longa and Berderson behavioral tests were performed to evaluate motor function, sucrose preference and forced swimming tests were conducted to assess the cardinal depression-like behaviors anhedonia and helplessness, and western blot and immunohistochemistry were conducted to measure the levels of vitamin D receptor (VDR) and BDNF expression levels in mouse hippocampus. Compared to MCAO alone, subsequent CUMS aggravated motor dysfunction and depression-like behaviors, whereas injection of calcitriol (VitD3) enhanced expression levels of VDR and BDNF in the hippocampus as well as ameliorated both motor dysfunction and depression-like behaviors of PSD model mice, with optimal efficacy at 25 μg/kg. Injection of a BDNF-binding protein (TrkB-IgG) almost completely reversed the antidepressant and neuroprotective effects of VitD3, strongly suggesting that VitD3 improved motor dysfunction and depression-like behaviors in PSD model mice by promoting hippocampal BDNF signaling. Modulation of hippocampal BDNF by VitD3 treatment could be an effective strategy for prevention and treatment of PSD.

Acupuncture plus rehabilitation for post-stroke depression: A protocol for systematic review and meta-analysis.

Background:Post-stroke depression (PSD) is a common stroke complication that is characterized by hopelessness, anxiety, disordered sleep, and lowered responsiveness. Rehabilitation and acupuncture treatments are often combined to treat PSD; however, there has been no meta-analysis on their synergistic effect. Therefore, we aim to perform a systematic review and meta-analysis to estimate the effectiveness of acupuncture and rehabilitation in PSD treatment.Methods:We will search the following electronic databases: PubMed, the Cochrane Library, EMBASE, the China National Knowledge Infrastructure, the Chinese Biomedical Literature Database, China Science and Technology Journal Database, and Wan Fang databases. We will include studies published between the database initiation and May 2020. Two reviewers will separately conduct study selection, data extraction, and risk of bias assessment. Disputes will be settled by consulting a third reviewer. Review Manager Software 5.3 will be employed for this meta-analysis.Results:This systematic review will assess whether acupuncture combined with rehabilitation treatment is more effective than rehabilitation alone in the management of PSD.Conclusion:This systematic review will provide evidence regarding the synergistic effect of acupuncture and rehabilitation treatment for PSD.

Melatoninergic antidepressants in the treatment of post-stroke depression

The article presents data aboutthe impactof the drug Melitor (agomelatine) on the psycho-emotional activity, cerebral hemodynamics, bioelectric activity ofthe brain and their intersystem connectionsinpatients with post-stroke depression. 30 patients with post-stroke depression have been takena dose of Melitor25 mg per day for 2 months. It has been established that Melitor has a positive effect on psycho-emotional activity, improves cerebral hemodynamics, harmonizes the structure of bioelectric activity of the braininpatients with post-stroke depression.Melitor has more strong effect on cerebral hemodynamics and bioelectric activity of the brain inpatients with right-sided stroke than among thepatients with left-sided stroke. Melitor's multimodal influencejustifies the use of the drug during the rehabilitationtreatment of post-stroke patients for the improvementboth functional and psycho-emotional state.

Stroke and Depression

Depression is a frequent complication of stroke and develops in about one third of survivors. It degrades the course of poststroke neurological impairments, increases the physical helplessness of patients, and decreases their quality of life, significantly reducing the efficacy of therapeutic and rehabilitation measures and increasing the risk of lethal outcomes. Antidepressants eliminate or decrease the symptoms of depression, promote reductions in neurological disorders, improve cognitive functions and patient’s overall status, increase the efficacy of treatment and rehabilitation, decrease the risk of repeat stroke, and decrease lethality. Preference in the treatment of poststroke depression is given to selective serotonin reuptake inhibitors; data have been obtained on the efficacy of other contemporary antidepressants, as well as tricyclic antidepressants. Unresolved aspects of this problem requiring further suitably designed controlled studies include the tolerance of antidepressants by elderly patients, selection of the appropriate drugs, and choice of treatment duration.

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.

Resilience is associated with post-stoke depression in Chinese stroke survivors: A longitudinal study

BackgroundOptimal strategies for prevention and treatment for post-stroke depression (PSD) remain unclear and a greater understanding of effect of resilience on PSD is promising. The aim was to examine the association between baseline resilience and depression at 1, 3, and 6 months after discharge, which contributes to early detection and management of PSD. MethodsA total of 217 ischemic stroke survivors were recruited in two tertiary hospitals in Shanghai, China from February 2017 to January 2018. The Chinese version of Connor-Davidson Resilience Scale (CD-RISC) was used to assess resilience at acute hospitalization. Hospital Anxiety and Depression Scale (HADS) was employed to ascertain baseline anxiety, baseline depression, and post-discharge depression. Social-demographic and disease-related information were obtained from participants’ self-report and medical records. Logistic regression analysis was used to determine which factors were independently associated with PSD. ResultsThe prevalence of depression at baseline was 21.2% and at 1, 3, and 6 months after discharge was 34.4%, 33.2%, and 29.2%, respectively. Logistics regression analyses indicated that resilience may independently predict PSD at 1 month (OR: 0.22, 95%CI: 0.097, 0.518), 3 months (OR:0.302, 95%CI: 0.151, 0.607), and 6 months (OR: 0.03, 95%CI: 0.006, 0.153) after controlling for social-demographics, disease-related characteristics, baseline anxiety, and baseline depression. LimitationsNon-multicenter survey and mild stroke severity may affect the generalization of these findings. Moreover, response bias should be acknowledged because some participants were read questionnaires out aloud. ConclusionResilience is independently associated with PSD at different timepoints. Our findings reveal the important role of resilience as a protective factor against PSD.

Pro-inflammatory cytokines are associated with the development of post-stroke depression in the acute stage of stroke: A meta-analysis

ABSTRACT Background: Pro-inflammatory cytokines may be associated with post-stroke depression (PSD); however, results from different studies are inconsistent. Objectives: To investigate whether pro-inflammatory cytokines are associated with the development of PSD in acute stroke. Methods: PubMed, Embase, and Web of science were searched for relevant literature. Meta-analyzes were performed to determine whether the baseline blood concentrations of pro-inflammatory cytokines differed between acute stroke patients with and without depression. Sensitivity analyzes and regression analyzes were conducted to explore sources of heterogeneity. Results: We included 889 acute stroke patients from eight original studies, 312 of whom developed PSD and 577 did not. The serum concentrations of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were higher in the PSD group, compared with the non-PSD group (IL-6: SMD = 1.26, 95% CI = [0.55, 1.97], P < 0.001; TNF-α: SMD = 0.61, 95% CI = [0.13, 1.10], P = 0.010). Conclusions: This study indicates IL-6 and TNF-α as potential biomarkers of PSD in the acute stage of stroke and provides theoretical support for the early prevention and treatment of PSD.

Interleukin-18 from neurons and microglia mediates depressive behaviors in mice with post-stroke depression

Post-stroke depression (PSD) is a common and serious complication that is affecting one thirds of stroke patients which leaves them with a poor quality of life, high mortality rate, high recurrent rate, and slow recovery. Recent studies showed that serum interleukin-18 (IL-18) level is a biomarker for patients with PSD. However, the role of IL-18 in the pathology of PSD is still unclear. In this study, we demonstrated that the IL-18 level in the ischemic brain significantly increased in mice with depression-like behaviors that were caused by the combined use of chronic spatial restraint stress and middle cerebral artery occlusion. Interestingly, IL-18 expression was mainly found in neurons at early phase and in microglia at a later phase. Injection of the exogenous IL-18 into the amygdala, but not the hippocampus or the striatum caused severe depression-like behaviors. On the contrary, the blockage of endogenous IL-18 by IL-18 binding protein, a specific antagonist of IL-18, repressed depressive phenotypes in SIR mice. IL-18 KO mice exhibited the resistance to spatial restraint stress and cerebral ischemia injury. Finally, we found that IL-18 mediated depressive behaviors by the interaction of IL-18 receptor and NKCC1, a sodium-potassium chloride co-transporter that is related to GABAergic inhibition. Administration of NKCC1 antagonist bumetanide exerted a therapeutic effect on the in IL-18-induced depressive mice. In conclusion, we demonstrated that increased IL-18 in the brain causes depression-like behaviors by promoting the IL-18 receptor/NKCC1 signaling pathway. Targeting IL-18 and its downstream pathway is a promising strategy for the prevention and treatment of PSD.

Effect of acupoint massage combined with high frequency repetitive transcranial magnetic stimulation on post-stroke depression and quality of life

Objective To investigate the effects of acupoint massage combined with high-frequency repetitive transcranial magnetic stimulation on post-stroke depression and quality of life. Methods A total of 169 patients with post-stroke depression who were admitted to the Department of Neurological Intensive Care Unit of Zhengzhou University First Affiliated Hospital from June 2017 to June 2019 were selected as the research subjects. The patients were divided into observation group (85 cases) and control group (84 cases) by random number table method. The control group was treated with high frequency repetitive transcranial magnetic stimulation, and the observation group was treated with high frequency repetitive transcranial magnetic stimulation combined with acupoint massage, high frequency repetitive transcranial magnetic stimulation 5 times a week, 28 minutes each time, 8 weeks of intervention, acupoint massage once a day, 1-2 minutes each acupoint, 8 weeks of intervention. The state of depression and the improvement of quality of life were observed, and the adverse reactions were recorded. Results The total effective rate of depressive symptoms improvement in the observation group was 83.53% (71/85), which was higher than that of the control group 70.24% (59/84), the difference was statistically significant (χ2 value was 4.204, P 0.05). Conclusions Acupoint massage combined with high-frequency repetitive transcranial magnetic stimulation has a effective in the treatment of post-stroke depression, which can significantly improve the depression status and quality of life. Key words: Acupoint massage; High frequency repetitive transcranial magnetic needling; Stroke; Depression; Quality of life

Experience with vortioxetine in the treatment of post-stroke depression

Post-stroke depression significantly impairs functional recovery in patients and their quality of life. Objective : to evaluate the efficacy of vortioxetine in correcting depressive symptoms in the early recovery period of ischemic stroke, as well as its effect on the cognitive functions of patients. Patients and methods. The investigation enrolled 60 patients with ischemic stroke in the carotid bed with symptoms of mild and moderate depression according to the Montgomery-Asberg Depression Rating Scale (MADRS). Group 1 (a study group) included 30 patients who received vortioxetine 10 mg/day for 8 weeks; Group 2 (a comparison group) consisted of 30 patients who refused to take an antidepressant. The investigators evaluated the severity of focal neurological deficit using the US National Institutes of Health Stroke Scale (NIHSS), the degree of functional deficit with the modified Rankin Scale (mRS) and the Functional Independence Measure (FIM). The diagnosis of poststroke depression was established according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria; the authors analyzed the severity of depression using the Hospital Anxiety and Depression Scale (HADS) and MADRS and cognitive functions with the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). For evaluation of higher mental dysfunctions, they used a set of neuropsychological techniques developed by A.R. Luria and his followers, by applying the classic stimulus materials. Results and discussion. At 8-week follow-up, in Group 1 there were no patients with symptoms of moderate depression, only 14 (46.7%) patients had symptoms of mild depression, and the remaining 16 (53.3%) patients did not have emotional disturbances. At the same time, in Group 2, 14 (46.7%) patients were observed to have signs of moderate depressive disorder and 15 (50%) had symptoms of mild depression; 1 (0.3%) patient had symptoms of major depressive disorder. During treatment with vortioxetine, there was a considerable decrease in the severity of depressive symptoms according to the total MADRS score (U=87.0; p<0.0001) and a better functional recovery after a stroke, as shown by FIM (U=296.0, p= 0.023) and NIHSS scores (p<0.05). Analyzing the MoCA subtest scores revealed that Group 1 patients statistically significantly better coped with attention tasks (U=237.0; p<0.001). Conclusion. Vortioxetine significantly reduces the severity of depressive symptoms, has an obvious positive effect on the cognitive status of patients, by improving neurodynamic functions and memory in patients in the early recovery period of ischemic stroke.

Long noncoding RNA GAS5 enhanced by curcumin relieves poststroke depression by targeting miR-10b/BDNF in rats.

The treatment for post-stroke depression (PSD) is mainly based on a therapeutic strategy combining anti-stroke and anti-depressant drugs. In the present study, the therapeutic effect of curcumin on rats with PSD was detected by open field tests and tail suspension tests, as well as the examination of corticosterone and corticotropin-releasing hormone (CRH) levels in the serum and neurotransmitter 5-hydroxytryptamine (5-HT), 5-hydroxyindoleacetic acid (5-HIAA) and dopamine (DA) levels in the hippocampus. Curcumin notably alleviated depression compared to the controls. Furthermore, long noncoding RNA growth arrest-specific transcript 5 (GAS5) enhanced by curcumin contributed to activation of the BDNF/Trkβ signaling pathway to promote the expression of synaptic-related proteins. GAS5 was demonstrated to function as a sponge of miR-10b. GAS5 upregulation by curcumin could reduce miR-10b to compromise the BDNF mRNA levels. Taken together, these results revealed a novel mechanism of curcumin on PSD through the GAS5/miR-10b/BDNF regulatory axis.

Abstract TMP103: Meditation for Post-Stroke Depression: A Pilot Randomized Controlled Trial

Background and Purpose: Despite the high prevalence of post-stroke depression (PSD) and negative impact on stroke survivors (SS) and their informal caregivers ([IC]; e.g., unpaid spouses), treatment of PSD is inadequate. Meditation has been associated with improved psychological outcomes. The purpose of this study was to establish the feasibility and acceptability of a 12-week randomized controlled trial (RCT) of a meditation intervention with SS and IC. Secondary objectives were to explore the effects of the intervention on symptoms of PSD, anxiety, and pain. Methods: Participants were randomized to the 4-week meditation intervention (n=27 SS; n=16 IC) or expressive writing control (n=14 SS; n=7 IC). Descriptive statistics were used to examine feasibility. Acceptability data included interviews and field notes. Repeated measures analysis with linear mixed models were used to test for change over time in Center for Epidemiological Studies Depression Scale (CES-D), State-Trait Anxiety Inventory (STAI), and Brief Pain Inventory (BPI) Severity and Intensity subscale scores. Results: Of the 92 eligible, 71 (77%) enrolled. Of the 64 randomized (7 were lost-to-follow-up or withdrawn due to ineligibility prior to randomization), 25 (39%) completed the study. The mean intervention attendance rate was 55%. Assessment completion rate for the intervention was 96%. For intervention SS, BPI severity scores were significantly lower at 8 weeks (p=.0270), while non-significant reductions across CES-D and STAI scores were noted. For intervention IC, a significant reduction in STAI-Trait scores was noted at 4 weeks (p=.0262). Data indicated distance was a primary barrier; however, the majority voiced favorable responses to the meditation. Conclusions: A meditation RCT in the post-stroke environment is acceptable; however, consideration needs to be given to the feasibility of an in-person, multiple-visit intervention. Further efficacy testing is needed in a larger RCT.

Network Pharmacological Study of Yiyi-Fuzi-Baijiang powder in Treating Colorectal Cancer

This investigation dealt with the analysis of the active ingredients of Yiyi-Fuzi-Baijiang powder in the treatment of colorectal cancer using computer network pharmacology technology to predict the mechanism of action. The chemical constituents and targets of Yiyi-Fuzi-Baijiang powder were obtained from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and the common targets in the treatment of colorectal cancer were obtained from Online Mendelian Inheritance in Man, Therapeutic Target Database and PharmGkb database. Excel was used to screen the molecular target and Cytoscape software was used to establish the network of Chinese medicine components target of Yiyi-Fuzi-Baijiang powder. The gene function and metabolic pathway were analyzed using the biological information annotation database. Nineteen components of Yiyi-Fuzi-Baijiang powder were found to interact with 121 target proteins of colorectal cancer, including progesterone receptor, prostaglandin G/H synthase 2, gamma-aminobutyric acid receptor subunit alpha-1, prostaglandin G/H synthase 1, nuclear receptor co-activator 2, beta-2 adrenergic receptor, sodium channel protein type 5 subunit alpha, alpha-1B adrenergic receptor. It is the target of Chaihushugansan in the treatment of post-stroke depression, mainly involving in neuroactive ligand-receptor interaction, endocrine regulated calcium reabsorption, TGF-β signaling pathway, Hedgehog signaling pathway, inflammatory mediator regulation transient receptor potential channels, cholinergic synapse, through the regulation of the nervous system, cell cycle, apoptosis, inflammatory regulation, cell communication and other biological processes to treat colorectal cancer. The possible mechanism of Yiyi-Fuzi-Baijiang powder in treating colorectal cancer was revealed by network pharmacological study, which laid a foundation for further elucidation of its action target.

Diagnosis and treatment of post-stroke depression in China: a cross-sectional survey of 350 senior clinicians in neurology, geriatrics, and rehabilitation departments

Diagnosis and treatment of post-stroke depression in China: a cross-sectional survey of 350 senior clinicians in neurology, geriatrics, and rehabilitation departments

Role of Transcranial Direct Current Stimulation in the Management of Post-Stroke Depression

Study Objectives: Stroke is a major neurological disease significantly threatening the human health and life with a high morbidity, disability, and mortality. Post-stroke depression (PSD) is one of the common complications of stroke. PSD has been a major factor hindering the recovery of neurological functions and daily activities in stroke patients and is closely related to the social avoidance and increased mortality of stroke patients. Although antidepressant drug treatment has improved during the last decades, symptoms in about 20% of the patients are not in remission two years after initiation of pharmacological intervention. Nowadays, non-invasive brain stimulation; techniques; transcranial direct current stimulation (tCDS) has gained an important interest in the treatment of many neuropsychiatric disorders which might be of some help in treatment of PSD. The goal of the current study is to evaluate the beneficial short term role of tDCS on post-stroke depression. Study Design: This was a randomized double blind placebo-controlled clinical trial included forty hemiparetic patients with post-stroke depression from outpatient clinic of Faculty of Physical Therapy, Cairo University, in the period between June 2018 to June 2019. All patients diagnosed as having a PSD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Depression was evaluated by Hamilton Depression Rating Scale (HAM-D) pre and post treatment and quality of life was evaluated by the Stroke Specific Quality Of Life scale (SS-QOL). Patients were assigned randomly into two groups: the study group A and the control group B. Both groups received antidepressant medication in addition to physical therapy program. Group A received tCDS for 30 minutes, three times per week for one month, while the group B received sham transcranial direct current stimulation. Results: Active tDCS was significantly superior to sham with significant improvement in depression and Stroke Specific Quality Of Life in treated group in comparison to group B, p = 0.000. Conclusion: tDCS was effective for post- stroke depression and might be a favorable option for treating post-stroke patients.

Emerging Non-Pharmacological Therapies for Post-stroke Depression and its Future Aspects: A Review

Abstract: Post-Stroke Depression (PSD) is a psychiatric disorder associated with stroke which has an adverse effect on the cognitive function and survival. It usually develops in 40% of the stroke survivors within 3 months. We performed a thorough literature review using PsychInfo, PubMed, Science Direct and PLOS databases for the non-pharmacological treatment of PSD. Early rehabilitation and psychological therapies are effective in treating depression in PSD while physiotherapy and music therapy improves both cognitive and movement disability. Transcranial stimulation and electroconvulsive therapy are invasive procedures used to treat cognitive impairment in PSD. Computerized therapy helps, enhance the attention, memory and executive functioning. DepReT stroke is a package which addresses patients along with their caregiver to have a better understanding of the depression. Robot assisted rehabilitation along with traditional rehabilitation is effective in treating motor function associated with PSD. Early assessment, treatment and rehabilitation are the most effective ways to prevent depression in stroke survivors and thereby improving their quality of life. Non-pharmacological treatment for post-stroke depression seem to be efficacious as antidepressants in improving depressive symptoms with minimal side effects. Key words: Caregiver, Cognitive Impairment, Non-Pharmacological Treatment, Post- Stroke Depression, Quality of Life, Rehabilitation.

Efficacy and safety of Sihogayonggolmoryeo-tang (Saikokaryukotsuboreito, Chai-Hu-Jia-Long-Gu-Mu-Li-Tang) for post-stroke depression: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to analyze the efficacy and safety of Sihogayonggolmoryeo-tang (SGYMT), a classical herbal medicine consisting of 11 herbs, for treatment of post-stroke depression (PSD). Thirteen databases were comprehensively searched from their inception dates until July 2019. Only randomized controlled trials (RCTs) using SGYMT as a monotherapy or adjunctive therapy for PSD patients were included. Where appropriate data were available, meta-analysis was performed and presented as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs). We assessed the quality of RCTs using the Cochrane risk of bias tool and the Jadad scale. The quality of evidence for each main outcome was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Twenty-one RCTs with 1,644 participants were included. In the comparison between the SGYMT and antidepressants groups, the SGYMT group scored significantly lower on both the Hamilton Depression Scale (HAMD) (8 studies; MD −2.08, 95% CI −2.62 to −1.53, I2 = 34%) and the National Institutes of Health Stroke Scale (NIHSS) (2 studies; MD −0.84, 95% CI −1.40 to −0.29, I2 = 19%), and significantly higher on the Barthel index (3 studies; MD 4.30, 95% CI 2.04 to 6.57, I2 = 66%). Moreover, the SGYMT group was associated with significantly fewer adverse events (6 studies; RR 0.13, 95% CI 0.05 to 0.37, I2 = 0%) than the antidepressants group. In the subgroup analysis, SGYMT treatment consistently reduced HAMD scores within the first 8 weeks of treatment, but thereafter this difference between groups disappeared. Comparisons between SGYMT combined with antidepressants, and antidepressants alone, showed significantly lower scores in the combination group for both HAMD (7 studies; MD = −6.72, 95% CI = −11.42 to −2.01, I2 = 98%) and NIHSS scores (4 studies; MD −3.03, 95% CI −3.60 to −2.45, I2 = 87%). In the subgroup analysis, the reductions of HAMD scores in the SGYMT combined with antidepressants group were consistent within 4 weeks of treatment, but disappeared thereafter. The quality of RCTs was generally low and the quality of evidence evaluated by the GRADE approach was rated mostly “Very low” to “Moderate.” The main causes of low quality ratings were the high risk of bias and imprecision of results. Current evidence suggests that SGYMT, used either as a monotherapy or an adjuvant therapy to antidepressants, might have potential benefits for the treatment of PSD, including short-term reduction of depressive symptoms, improvement of neurological symptoms, and few adverse events. However, since the methodological quality of the included studies was generally low and there were no large placebo trials to ensure reliability, it remains difficult to draw definitive conclusions on this topic. Further well-designed RCTs addressing these shortcomings are needed to confirm our results.

Poststroke depression and risk of recurrent stroke: A meta-analysis of prospective studies.

Background:Conflicting results have been reported on the association of poststroke depression with recurrent stroke events. This meta-analysis of prospective studies aims to evaluate whether poststroke depression is an independent predictor of stroke recurrence among stroke patients.Methods:A systematic search of articles in PubMed and Embase databases from their inception to October 2018 was conducted. Prospective studies reporting risk estimates of stroke recurrence by depression status in stroke patients were included and pooled risk ratio (RR) with 95% confidence intervals (CIs) of stroke recurrence was calculated for patients with or without poststroke depression.Results:Six studies with 4648 stroke patients were finally included, and the prevalence of poststroke depression was found to from 15.9% to 40.5%. The pooled adjusted RR for stroke recurrence in patients suffering from poststroke depression was 1.48 (1.22–1.79) in a fixed-effect model. Subgroup analyses indicated that poststroke depression significantly increased stroke recurrence (RR 1.64; 95% CI, 1.28–2.10) among ischemic stroke patients but not in total stroke patients (RR 1.28; 95% CI, 0.96–1.73).Conclusions:This meta-analysis suggests that poststroke depression may be an independent predictor of stroke recurrence among ischemic stroke patients. Further studies are required to investigate whether treatment of poststroke depression can reduce the risk of stroke recurrence.

Depression

Poststroke depression (PSD) affects about one third of stroke survivors and is of importance as individuals with PSD are at a higher risk for poorer recovery, recurrent vascular events, lower quality of life, and mortality. The most consistent predictors of PSD are physical disability, stroke severity, history of depression, and cognitive impairment. However, further studies are needed to develop a better understanding of predictors of PSD. Several trials have suggested that antidepressant or other medications may be effective in treating PSD; however, further research is needed in more representative samples of stroke survivors to determine optimal timing, threshold, and medications for treatment. Brief psychosocial interventions may be useful and effective in treatment of PSD but whether antidepressant medication is a necessary or beneficial adjuvant cannot be established from these trials because of a lack of placebo controls. A number of trials have suggested that psychosocial therapies may prevent the development of PSD; however, the studies are not generalizable to all stroke survivors, given their narrow inclusion and exclusion criteria. Further research with more rigorous methods is needed to assess the effect of psychotherapy on the prevention of PSD. Early identification and intervention have been shown to improve functional outcomes. However, there is no consistency in the tools used to measure PSD, and the assessment of confounders in studies that assess PSD. Clinical and epidemiological studies should harmonize the use of screening tools and optimal timepoints to assess PSD in order to facilitate collaborative studies. PSD likely involves a combination of biological and psychosocial factors. There needs to be a greater understanding of the relationship of patient, social and stroke related factors, and their contributions to the development of PSD in order to facilitate the development of targeted interventions for prevention and treatment.