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Li Y, Wang Y, Gao L, Meng X, Deng Q. Effect of nonpharmacological interventions on poststroke depression: a network meta-analysis. Front Neurol 2024; 15:1376336. [PMID: 38645742 PMCID: PMC11027129 DOI: 10.3389/fneur.2024.1376336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose To investigate the effects of nonpharmacological interventions (NPIs) on poststroke depression (PSD) in stroke patients. Methods Computer searches were conducted on the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang databases from their establishment to December 2023. The selection was made using the inclusion and exclusion criteria, and 40 articles were included to compare the effects of the 17 NPIs on patients with PSD. Results Forty studies involving seventeen interventions were included. The network findings indicated that compared with conventional therapy (COT), superior PSD improvement was observed for cognitive behavioral therapy (CBT) + acupoint acupuncture (CBTA) (mean difference [MD], -4.25; 95% CI, -5.85 to -2.65), team positive psychotherapy (MD, -4.05; 95% CI, -5.53 to -2.58), music therapy (MT) + positive psychological intervention (MD, -2.25; 95% CI, -3.65 to -0.85), CBT (MD, -1.52; 95% CI, -2.05 to -0.99), mindfulness-based stress reduction (MD, -1.14; 95% CI, -2.14 to -0.14), MT (MD, -0.95; 95% CI, -1.39 to -0.52), acupoint acupuncture + MT (AAMT) (MD, -0.69; 95% CI, -1.25 to -0.14). Furthermore, CBT (MD, -3.87; 95% CI, -4.57 to -3.17), AAMT (MD, -1.02; 95% CI, -1.41 to -0.62), acupressure + MT (MD, -0.91; 95% CI, -1.27 to -0.54), and narrative care + acupressure (MD, -0.74; 95% CI, -1.19 to -0.29) demonstrated superior Pittsburgh Sleep Quality Index (PSQI) improvement compared with COT. Conclusion Evidence from systematic reviews and meta-analyses suggests that CBTA improves depression in patients with PSD. Moreover, CBT improves sleep in these patients. Additional randomized controlled trials are required to further investigate the efficacy and mechanisms of these interventions.
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Affiliation(s)
- Ying Li
- College of Sports Science, Jishou University, Jishou, China
| | - Yuanyuan Wang
- Cardiac Care Unit, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Lei Gao
- School of Nursing, Dalian University, Dalian, China
| | - Xiaohan Meng
- College of Sports Science, Jishou University, Jishou, China
| | - Qidan Deng
- Department of Intensive Care Unit, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan, China
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Devereux N, Berns AM. Evaluation & Treatment of Psychological Effects of Stroke. Dela J Public Health 2023; 9:62-69. [PMID: 37701469 PMCID: PMC10494802 DOI: 10.32481/djph.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Strokes are a common medical condition in the United States, including in Delaware. An under-recognized effect of stroke is the impact on mood that often occurs. Many individuals develop depression, anxiety, PTSD, and other psychological sequelae. These disorders can significantly affect their lives and their relationships. The emotional effects of stroke pose a public health problem for our residents, leading to devastating decreases in the quality of life for the patient and the family. These challenges negatively impact the community due to the associated healthcare and economic burdens. The population of the State of Delaware is growing, and the proportion of senior residents, who are also at greater risk for strokes, is also increasing. Strokes will remain an ongoing important clinical concern for our healthcare providers. Emotional changes after a stroke will occur in many Delaware residents who suffer a stroke. The emotional sequelae of stroke are under-treated. It is critical for healthcare professionals to be trained to recognize, assess, and treat the psychological disorders that can result from having a stroke. This article provides an overview of the major psychological effects of stroke, recommended assessment tools, promising treatment trends, and directions for further research. Improving our ability to detect and treat these difficult emotional challenges can facilitate effective treatment and prevention strategies and increase quality of life for stroke survivors, their loved ones, and their communities.
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Affiliation(s)
- Nancy Devereux
- Clinical Neuropsychologist, ChristianaCare; Delaware Stroke System of Care Subcommittee
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Terrill AL. Mental Health Issues Poststroke: Underrecognized and Undertreated. Stroke 2023; 54:1528-1530. [PMID: 37216452 DOI: 10.1161/strokeaha.123.042585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Alexandra L Terrill
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City
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Xie J, Geng X, Fan F, Fu X, He S, Li T. The efficacy of therapies for post-stroke depression in aging: An umbrella review. Front Aging Neurosci 2022; 14:993250. [PMID: 36081895 PMCID: PMC9446482 DOI: 10.3389/fnagi.2022.993250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Post-stroke depression (PSD) is a common complication after stroke. PSD is associated with emotional disorders and psychological dependence, which are potential risk factors for stroke recurrence and suicidality. This study aimed to perform an umbrella review of therapies for PSD through a comprehensive literature search. A systematic search was conducted in the PubMed and Web of Science by two independent authors. We examined the Hamilton Depression Scale (HAMD), Activities of daily living (ADL), Neurologic function as efficacy endpoints, and the incidence of adverse events as safety profiles. Seventeen eligible studies, including 267 clinical trials were included in this study. The results showed that High-Frequency Repetitive Transcranial Magnetic Stimulation (HfrTMS), Acupuncture/EA+conventional treatment, Escitalopram, Modified Sini San, Moxibustion, Xiaoyao Formula, Paroxetine, Chinese herbal medicine, Exercise, Citalopram, and Cognitive behavioral therapy are beneficial for improving the depression symptoms of patients with PSD. HfrTMS and Sertraline may have an impact on slowing the scores of activities of daily living or neurologic function. In addition, Acupuncture/EA+conventional, Escitalopram, Citalopram, Sertraline, and Fluoxetine showed no serious adverse events in PSD patients. Our study demonstrated that 11 treatment methods can effectively improve the condition of PSD patients.
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Affiliation(s)
- Jinlu Xie
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang, School of Medicine, Huzhou Central Hospital, Huzhou University, Huzhou, China
| | - Xiwen Geng
- Experimental Centre, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Fangcheng Fan
- School of Pharmacy, Minzu University of China, Beijing, China
| | - Xuyan Fu
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang, School of Medicine, Huzhou Central Hospital, Huzhou University, Huzhou, China
| | - Shuaibing He
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang, School of Medicine, Huzhou Central Hospital, Huzhou University, Huzhou, China,*Correspondence: Shuaibing He
| | - Tao Li
- Key Laboratory of Vector Biology and Pathogen Control of Zhejiang, School of Medicine, Huzhou Central Hospital, Huzhou University, Huzhou, China,Tao Li
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Zhang C, He L, Li Z, Qiu H, Wang X, Zhang Y. Effectiveness of non-pharmacological interventions for treating post-stroke depression: Study protocol of an umbrella review of systematic reviews and meta-analyses. Medicine (Baltimore) 2021; 100:e28370. [PMID: 34941157 PMCID: PMC8702277 DOI: 10.1097/md.0000000000028370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Many systematic reviews and meta-analyses have evaluated the effectiveness of non-pharmacological therapies to improve symptoms of post-stroke depression (PSD) and reduce disability and mortality in patients with PSD. However, no research has appraised the credibility of the evidence. This study aims to summarize and evaluate the current evidence for non-pharmacological treatment of PSD and to seek effective treatment with reference to reliable evidence. METHODS We searched the electronic databases EMBASE, MEDLINE, Cochrane Central, PubMed, PROSPERO, Web of Science, and CINAHL. We will search articles from the above database for all published meta-analyses to December 2021 to evaluate the effect of non-pharmacological treatment of PSD. Two reviewers will extract the general characteristics of the included articles, as well as participants, interventions, outcome measures, and conclusions. The quality evaluation of each systematic review will be conducted with reference to the AMSTAR 2 tool. The effect size of each review will be recalculated using either a fixed-effects or a random-effects model. Cochrane's Q test and I2 statistics will be used to evaluate the heterogeneity between studies. To determine whether a systematic review had small study effects, we will use the Egger test. We expect to extract valid evidence and classify it from strong to weak. RESULTS The findings of this umbrella review will provide effective evidence for the non-pharmacological treatment of PSD. CONCLUSION Our research conclusion will provide clinical staff and PSD patients with appropriate treatment recommendations. ETHICS AND DISSEMINATION As the data were obtained from published materials, there is no need for ethical approval for this umbrella review. The findings of this umbrella review will be published in a peer-reviewed journal. INPLASY REGISTRATION NUMBER INPLASY2021100083.
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Affiliation(s)
| | - Lianyi He
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Zhendong Li
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Hangjian Qiu
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Xiaoqian Wang
- Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Yuejuan Zhang
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
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Chun HYY, Ford A, Kutlubaev MA, Almeida OP, Mead GE. Depression, Anxiety, and Suicide After Stroke: A Narrative Review of the Best Available Evidence. Stroke 2021; 53:1402-1410. [PMID: 34865508 DOI: 10.1161/strokeaha.121.035499] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression and anxiety each affect around 1 in 3 people during the first year after a stroke. Suicide causes the death of about 3 to 4/1000 stroke survivors during the first 5 years. This narrative review describes the best available evidence for the epidemiology of depression, anxiety, and suicide; their prevention; and the treatment of anxiety and depression. We conclude with directions for future research.
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Affiliation(s)
| | - Andrew Ford
- University of Western Australia, Australia (A.F., O.P.A.)
| | | | | | - Gillian E Mead
- University of Edinburgh, United Kingdom (H.-Y.Y.C., G.E.M.)
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Woranush W, Moskopp ML, Sedghi A, Stuckart I, Noll T, Barlinn K, Siepmann T. Preventive Approaches for Post-Stroke Depression: Where Do We Stand? A Systematic Review. Neuropsychiatr Dis Treat 2021; 17:3359-3377. [PMID: 34824532 PMCID: PMC8610752 DOI: 10.2147/ndt.s337865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/04/2021] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Post-stroke depression (PSD) occurs in one-third of stroke survivors, leading to a substantial decrease in quality of life as well as delayed functional and neurological recovery. Early detection of patients at risk and initiation of tailored preventive measures may reduce the medical and socioeconomic burden associated with PSD. We sought to review the current evidence on pharmacological and non-pharmacological prevention of PSD. MATERIALS AND METHODS We conducted a systematic review using PubMed/MEDLINE and bibliographies of identified papers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including randomized controlled studies. Eligible studies were included when performed within 1 year after the index cerebrovascular event. Animal and basic research studies, studies lacking a control group, review papers, and case reports were excluded. RESULTS Out of 150 studies screened, 37 met our criteria. Among the strategies identified, administration of antidepressants displayed the most robust evidence for preventing PSD, whereas non-pharmacological interventions such as psychotherapy appear to be the most frequently used approaches to prevent depression after stroke. Research suggests that the efficacy of PSD prevention increases with the duration of preventive treatment. Seven out of 11 studies (63%) that used pharmacological and eight out of 16 (50%) that used non-pharmacological interventions reported a positive preventive effect on PSD. CONCLUSION Overall, the current literature on PSD prevention shows heterogeneity, substantiating a need for well-designed randomized controlled trials to test the safety and efficacy of pharmacological as well as non-pharmacological and composite prevention regimens to minimize the risk of PSD in stroke survivors. Integrative strategies combining personalized non-pharmacological interventions such as educational, mental, and physical health support, and pharmacological strategies such as SSRIs may be the most promising approach to prevent PSD.
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Affiliation(s)
- Warunya Woranush
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Institute of Physiology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mats Leif Moskopp
- Institute of Physiology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Vivantes Klinikum im Friedrichshain, Charité Academic Teaching Hospital, Klinik für Neurochirurgie, Berlin, Germany
| | - Annahita Sedghi
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Isabella Stuckart
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thomas Noll
- Institute of Physiology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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