Mechanisms associated with post-stroke depression and pharmacologic therapy

Zhan, Qingyang; Kong, Fanyi

doi:10.3389/fneur.2023.1274709

Cited by 3 publications

(1 citation statement)

References 122 publications

(85 reference statements)

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“…It is a frequent complication ( 1 ). A comprehensive global epidemiological survey indicates that PSD prevalence ranges from 17 to 34.3% ( 2 ). The mechanisms underlying PSD remain unclear, though proposed theories include neurobiological aspects like the stroke focal mechanism hypothesis, neurotransmitter disruptions, reduced cerebral trophic factor activity, glutamate toxicity, and psychosocial factors ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Acupuncture combined with repetitive transcranial magnetic stimulation for the treatment of post-stroke depression: a systematic evaluation and meta-analysis based on a randomised controlled trial

Xiao,

Li,

et al. 2024

Front. Neurol.

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ObjectiveThis study aimed to systematically assess the efficacy of combining acupuncture with repetitive transcranial magnetic stimulation (rTMS) in treating post-stroke depression (PSD).MethodsWe conducted a comprehensive search of eight major domestic and international databases, including the China Knowledge Network, from inception until December 2023. Included were randomized controlled trials that investigated acupuncture combined with rTMS for PSD. The screening process adhered to predetermined inclusion and exclusion criteria, and study quality was assessed using Cochrane Handbook 5.1 guidelines. Meta-analysis was conducted using RevMan 5.4 software.ResultsTwelve studies involving 800 patients were included in the analysis. The meta-analysis showed that acupuncture combined with rTMS significantly improved the clinical effectiveness rate (RR = 1.19, 95% CI: 1.12 to 1.27, p < 0.00001) and reduced scores on several scales: Hamilton Depression Scale (HAMD) (MD = −3.35, 95% CI: −3.79 to −2.90, p < 0.00001), Self-Depression Scale (SDS) (MD = −9.57, 95% CI: −12.26 to −6.89, p < 0.00001), Chinese Medicine Symptom Score (MD = −3.34, 95% CI: −3.76 to −2.91, p < 0.00001), Pittsburgh Sleep Quality Scale (MD = −3.91, 95% CI: −4.58 to −3.25, p < 0.00001), and National Institutes of Health Stroke Scale (NIHSS) (MD = −2.77, 95% CI: −3.21 to −2.32, p < 0.00001). Furthermore, acupuncture combined with rTMS treatment improved cognitive functioning (MMSE, MoCA scores) (p < 0.00001) and ability to perform activities of daily living scores (MD = 10.40, 95% CI: 9.53 to 11.28, p < 0.00001). Additionally, it was found to reduce interleukin 6, tumor necrosis factor alpha, interleukin 1β, and increase 5-hydroxytryptamine and brain-derived neurotrophic factor levels (p < 0.001).ConclusionAcupuncture combined with rTMS therapy is recommended for treating PSD, as it effectively improves clinical outcomes, alleviates depressive symptoms, enhances cognitive function, and daily living capabilities, and modulates inflammatory responses and neurotransmitter levels. However, it is important to note that the limitations of the sample size and quality of the included studies warrant the need for more high-quality research to validate these conclusions.Systematic review registrationINPLASY, Identifier INPLASY202430085.

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Section: Introductionmentioning

confidence: 99%

Acupuncture combined with repetitive transcranial magnetic stimulation for the treatment of post-stroke depression: a systematic evaluation and meta-analysis based on a randomised controlled trial

Xiao,

Li,

et al. 2024

Front. Neurol.

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Post-stroke emotionalism: Diagnosis, pathophysiology, and treatment

Broomfield,

Blake,

Gracey

et al. 2024

International Journal of Stroke

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Post-stroke emotionalism affects 1 in 5 stroke sufferers 6 months after their stroke, but despite its frequency remains a poorly understood stroke symptom. The literature is limited, especially compared to other frequently observed neurological conditions such as aphasia and visual neglect. This narrative review presents a summary of this literature, to inform clinical practice and future research. We cover discussion of definitions, prevalence, neurobiology, predisposing and precipitating factors, and treatment. Increasing evidence suggests that damage to specific areas functionally linked to emotion expression or regulation processes, disruption to structural pathways, and disruption to related serotonin production and modulation individually or in concert give rise to emotionalism-type presentations. A range of emotionalism measurement tools have been used in research contexts making between study comparisons difficult. The Testing for Emotionalism after Recent Stroke – Questionnaire (TEARS-Q), has recently been developed to allow standardised assessment. Treatment options are limited and there have been few adequately powered treatment trials. Antidepressants may reduce severity, but more trial data are required. There have been no randomised controlled trails of non-pharmacological interventions. More research is needed to improve recognition and treatment of this common and disabling symptom. We conclude with research priorities and recommendations for the field.

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Relationship between oxidative balance score and post-stroke depression: insights from the NHANES 2005–2018 cross-sectional study

Li,

Gao,

Yan

et al. 2024

Front. Neurol.

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IntroductionThe Oxidative Balance Score (OBS) represents an integrated measure of oxidative-reductive homeostasis. Despite the established role of oxidative stress in the development of post-stroke depression (PSD), the association between OBS and PSD in the general population remains unclear. This study aims to explore this relationship using data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005–2018.MethodsThe OBS was calculated using validated methods that incorporate dietary and lifestyle factors, whereas PSD status was determined using self-reported data and the Patient Health Questionnaire-9 (PHQ-9) scores. Multivariable logistic regression was employed to evaluate the associations of total OBS, dietary OBS, and lifestyle OBS with PSD prevalence, adjusting for potential confounders. Dose–response relationships were further assessed using restricted cubic splines (RCS).ResultsAmong the 26,668 participants included in the analysis, 201 were diagnosed with PSD. After adjusting for confounding variables, higher total OBS, dietary OBS, and lifestyle OBS were each significantly associated with reduced odds of PSD. The adjusted odds ratios (OR) and 95% confidence intervals (CI) for the highest versus lowest quartiles were 0.31 (95% CI: 0.15–0.67) for total OBS, 0.45 (0.27–0.73) for dietary OBS, and 0.28 (0.13–0.60) for lifestyle OBS. RCS analyses indicated a linear dose–response relationship for all three OBS categories with PSD risk. In sex-stratified analyses, significant inverse associations were observed between all OBS categories and PSD in females, whereas only lifestyle OBS was significantly associated with PSD in males.ConclusionHigher OBS was associated with reduced odds of PSD, with a particularly pronounced effect in females. These findings suggest that adherence to an antioxidant-rich diet and lifestyle may mitigate PSD risk.

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Mechanisms associated with post-stroke depression and pharmacologic therapy

Cited by 3 publications

References 122 publications

Acupuncture combined with repetitive transcranial magnetic stimulation for the treatment of post-stroke depression: a systematic evaluation and meta-analysis based on a randomised controlled trial

Acupuncture combined with repetitive transcranial magnetic stimulation for the treatment of post-stroke depression: a systematic evaluation and meta-analysis based on a randomised controlled trial

Post-stroke emotionalism: Diagnosis, pathophysiology, and treatment

Relationship between oxidative balance score and post-stroke depression: insights from the NHANES 2005–2018 cross-sectional study

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