BackgroundPost-traumatic stress disorder (PTSD) is prevalent in children, adolescents and adults. It can occur alone or in comorbidity with other disorders. A broad range of psychotherapies such as cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) have been developed for the treatment of PTSD.AimThrough quantitative meta-analysis, we aimed to compare the efficacy of CBT and EMDR: (i) relieving the post-traumatic symptoms, and (ii) alleviating anxiety and depression, in patients with PTSD.MethodsWe systematically searched EMBASE, Medline and Cochrane central register of controlled trials (CENTRAL) for articles published between 1999 and December 2017. Randomized clinical trials (RCTs) that compare CBT and EMDR in PTSD patients were included for quantitative meta-analysis using RevMan Version 5.ResultsFourteen studies out of 714 were finally eligible. Meta-analysis of 11 studies (n = 547) showed that EMDR is better than CBT in reducing post-traumatic symptoms [SDM (95% CI) = -0.43 (-0.73 – -0.12), p = 0.006]. However, meta-analysis of four studies (n = 186) at three-month follow-up revealed no statistically significant difference [SDM (95% CI) = -0.21 (-0.50 – 0.08), p = 0.15]. The EMDR was also better than CBT in reducing anxiety [SDM (95% CI) = -0.71 (-1.21 – -0.21), p = 0.005]. Unfortunately, there was no difference between CBT and EMDR in reducing depression [SDM (95% CI) = -0.21 (-0.44 – 0.02), p = 0.08].ConclusionThe results of this meta-analysis suggested that EMDR is better than CBT in reducing post-traumatic symptoms and anxiety. However, there was no difference reported in reducing depression. Large population randomized trials with longer follow-up are recommended to build conclusive evidence.

Depression is the most frequently seen neuropsychiatric manifestation in stroke patients. It hampers the ability to undergo therapy and impairs their functional outcome. Depression also increases the risk of suicide in stroke patients, therefore, increasing mortality. The etiology of post-stroke depression (PSD) is complex and reported to be multi-factorial in origin. It also depends on the size and location of the infarct. In addition, family history or prior history of depressive disorders makes them prone to be affected with depression following a stroke. In this article, we will mention various aspects of PSD, as well as the prevalence and the different screening assessment tools used in literature studies. Although there are many available testing tools, little consistency was seen in them being valid or reliable. We will also discuss the pathophysiology of depression in stroke patients with various available options for managing the condition. We will briefly review the use of alternative treatment such as Electroconvulsive therapy (ECT) and Transcranial Magnetic Stimulation (TMS) as well. However, we need further evidence-based research exploring the screening tool; i.e. universally acceptable for PSD and implementing an effective, non-invasive treatment modality impacting the prognosis. Also, we require further investigations to identify the role of antidepressants in the recovery of stroke patients. Keywords:Stroke, Post-stroke depression, Stroke location, Assessment and Treatment, Post-stroke Depression, Prevalence of PSD, Pathology in PSD, Mood disorders in PSD, Symptoms and diagnosis criteria in PSD, Assessment scales in PSD, Pharmacotherapy and other treatments in PSD, Depression in stroke survivors MethodologyA search for relevant published literature was performed using PubMed, Google Scholar. The keywords and phrases used included: Stroke lesion, post stroke depression, major depression, Post stroke symptoms, assessment and treatment. Other relevant studies were found by a review of the primary studies obtained in the search as well as reference tracing of selected articles. The inclusion and exclusion criteria were: Any articles that reported the symptomatology, pathophysiology, evaluation and treatment of post stroke depression. All research studies which were published in English language from Neuropsychiatry (London) (2017) 7(6) 907 Review Ali Mahmood Khan PrevalenceOn average for every 40 seconds, there is a stroke case in the United States -around 600.000 new stroke cases are evident every year [12,13]. Based on the literature studies, there is variability in data reported about PSD prevalence. These differences are usually due to the variations in criteria used to diagnose PSD and the difference in age of patients studied. The higher prevalence was seen in hospital-based settings rather than community-based settings [14].While several clinicians use DSM-III and DSM-IV criteria to reach the diagnosis of PSD, some use a different kind of scales or questionnaires. Also, different clin...

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Background: Patients who suffer from major depressive episodes and bipolar disorder often exhibit pharmaco-resistance. Therefore, novel treatment methodologies are being proposed to treat the disease or provide symptomatic relief. VNS and DBS are two such techniques, both of which utilize neurostimulation to achieve therapeutic relief. However, it is necessary to establish the comparative efficacies of these methods in treating MDD in patients. Objective: To assess the relative difference in the efficacy of VNS versus DBS for treatment of Major Depressive Disorder and bipolar depression and to provide evidence for the superior technique. Methods: To compare the efficacy of VNS versus DBS for the reduction of depressive symptoms in patients who meet the criteria for a major depressive episode, we conducted a meta-analysis of studies of the subject. Twenty-six studies were selected, consisting of 1160 patients who were treated with either VNS (Mean age = 47.75 years old, mean duration of illness = 22.86 years) or DBS (Mean age = 33.11 years old, mean duration of illness = 9.9 years) treatment arms and analyzed them to determine the amount of improvement in mood. The primary outcome measures were evaluated in terms of change between pre-test and post-test scores over a period of three months, as measured by HDRS and MADRS rating scales. Results: A comparison of the summary effect size produced by VNS (HDRS = 1.247, MADRS = 1.110) to that produced by DBS (HDRS = 2.063, MADRS = 1.996) seems to demonstrate that DBS is the more effective treatment. The effect size for VNS was lower than that of DBS groups, indicating that DBS is more effective than VNS. The finding is corroborated by the tests of heterogeneity; while the VNS group of studies indicated a high level of heterogeneity Vs. DBS group indicated insignificant level of heterogeneity. Conclusion: Current meta-analysis demonstrates that Deep Brain Stimulation (DBS) is a better treatment modality for Major Depressive Disorder and Bipolar Depression than Vagus Nerve Stimulation (VNS). However, as the VNS and DBS groups differed concerning the clinical profiles of the patients (both in terms of age and regarding the duration of the illness. Research studies with larger, synchronous sample sizes and control groups are required for a meta-analysis to draw a steadfast conclusion.