Interventions for management of post-stroke depression: A bayesian network meta-analysis of 23 randomized controlled trials

Deng, Liangliang; Qiu, Shi; Wang, D.; Liu, M.

doi:10.1016/j.jns.2017.08.478

Cited by 10 publications

(14 citation statements)

References 23 publications

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“…A more recent systematic review,19 that limited inclusion to participants without a diagnosis of depression at baseline, concluded that antidepressants may reduce the likelihood of depression developing poststroke, but that the optimal timing and duration of treatment were not clear. There is also evidence to suggest that pharmacological treatments can have modest benefits in the treatment of depression poststroke 20–23. However, antidepressants have side effects and may have undesirable interactions with other medications and/or comorbidities 20–23…”

Section: Introductionmentioning

confidence: 99%

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HeART of Stroke: randomised controlled, parallel-arm, feasibility study of a community-based arts and health intervention plus usual care compared with usual care to increase psychological well-being in people following a stroke

et al. 2019

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IntroductionPeople often experience distress following stroke due to fundamental challenges to their identity.ObjectivesTo evaluate (1) the acceptability of ‘HeART of Stroke’ (HoS), a community-based arts and health group intervention, to increase psychological well-being; and (2) the feasibility of a definitive randomised controlled trial (RCT).DesignTwo-centre, 24-month, parallel-arm RCT with qualitative and economic components. Randomisation was stratified by centre and stroke severity. Participant blinding was not possible. Outcome assessment blinding was attempted.SettingCommunity.ParticipantsCommunity-dwelling adults ≤2 years poststroke recruited via hospital clinical teams/databases or community stroke/rehabilitation teams.InterventionsArtist-facilitated arts and health group intervention (HoS) (ten 2-hour sessions over 14 weeks) plus usual care (UC) versus UC.OutcomesThe outcomes were self-reported measures of well-being, mood, capability, health-related quality of life, self-esteem and self-concept (baseline and 5 months postrandomisation). Key feasibility parameters were gathered, data collection methods were piloted, and participant interviews (n=24) explored the acceptability of the intervention and study processes.ResultsDespite a low recruitment rate (14%; 95% CI 11% to 18%), 88% of the recruitment target was met, with 29 participants randomised to HoS and 27 to UC (57% male; mean (SD) age=70 (12.1) years; time since stroke=9 (6.1) months). Follow-up data were available for 47 of 56 (84%; 95% CI 72% to 91%). Completion rates for a study-specific resource use questionnaire were 79% and 68% (National Health Service and societal perspectives). Five people declined HoS postrandomisation; of the remaining 24 who attended, 83% attended ≥6 sessions. Preliminary effect sizes for candidate primary outcomes were in the direction of benefit for the HoS arm. Participants found study processes acceptable. The intervention cost an estimated £456 per person and was well-received (no intervention-related serious adverse events were reported).ConclusionsFindings from this first community-based study of an arts and health intervention for people poststroke suggest a definitive RCT is feasible. Recruitment methods will be revised.Trial registration numberISRCTN99728983.

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Section: Introductionmentioning

confidence: 99%

“…There is also evidence to suggest that pharmacological treatments can have modest benefits in the treatment of depression poststroke 20–23. However, antidepressants have side effects and may have undesirable interactions with other medications and/or comorbidities 20–23…”

Section: Introductionmentioning

confidence: 99%

HeART of Stroke: randomised controlled, parallel-arm, feasibility study of a community-based arts and health intervention plus usual care compared with usual care to increase psychological well-being in people following a stroke

et al. 2019

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“…Several rTMS protocols are effective for the treatment of unipolar depression (Brunoni et al, 2017a;Mutz et al, 2018). In post-stroke depression, rTMS has replicated RCT level evidence of moderate quality demonstrating efficacy with comparable antidepressant effect sizes to medications (Deng et al, 2017;Shen et al, 2017). Conversely, in depression with PD, results have been mixed with rTMS (Zhou et al, 2018).…”

Section: Brain Stimulation and Convulsive Therapies In The Medically Illmentioning

confidence: 99%

Depression in the medically ill

Rosenblat

Kurdyak

Cosci

et al. 2019

Aust N Z J Psychiatry

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Background: Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. Methods: Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. Results: Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug–drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. Limitations: Non-systematic review of the literature. Conclusion: Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.

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“…A meta-analysis showed that citalopram shows a faster action than the other SSRIs, though their efficacy on PSD treatment is similar [112]. Besides SSRIs, noradrenaline reuptake inhibitor and tricyclic antidepressant are also associated with decrease of PSD [113]. Kang et al [114] found that increased levels of IL-6 and IL-18 were correlated with depression within 2 weeks and 1 year following stroke.…”

Section: Potential Treatment Of Psf and Depressionmentioning

confidence: 99%

Inflammatory Signaling in Post-Stroke Fatigue and Depression

et al. 2018

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Background: In the United States, stroke continues to be the cause for long-term disability. Of the patients with a first stroke, up to 75% will experience post-stroke fatigue (PSF) in the first year following stroke. PSF is one of the most disabling symptoms in stroke survivors; it decreases quality of life, increases mortality, and is a barrier to stroke rehabilitation. Given the incidence of stroke and the prevalence and detrimental impact of PSF on quality of life, independent living, and overall survival, efficient management of PSF must be a priority in stroke rehabilitation. The cause of PSF remains unknown. The burden of fatigue in stroke survivors is influenced by other stroke-related symptoms, most notably post-stroke depression (PSD). It is well known that stroke induces a systemic inflammatory response that is the trigger for sickness behavior, of which fatigue and depression are predominant symptoms. Summary: To date, only a handful of studies have sought to explore the relationship between stroke-induced inflammation and PSF and PSD. In this review, we describe this evidence, highlight the strengths and weaknesses of these existing studies, and suggest further experiments that may further support the association between stroke-related inflammatory processes and stroke-related symptoms. Key Messages: The current concept and further research are important for a more specific therapeutic intervention for PSF and PSD.

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Interventions for management of post-stroke depression: A bayesian network meta-analysis of 23 randomized controlled trials

Cited by 10 publications

References 23 publications

HeART of Stroke: randomised controlled, parallel-arm, feasibility study of a community-based arts and health intervention plus usual care compared with usual care to increase psychological well-being in people following a stroke

HeART of Stroke: randomised controlled, parallel-arm, feasibility study of a community-based arts and health intervention plus usual care compared with usual care to increase psychological well-being in people following a stroke

Depression in the medically ill

Inflammatory Signaling in Post-Stroke Fatigue and Depression

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