Pharmacological and Psychotherapeutic Interventions for Management of Post-stroke Depression: A Bayesian Network Meta-analysis of 27 Randomized Controlled Trials

Abstract

Introduction: Poststroke depression (PSD) constitutes an important complication of stroke, leading to great disability as well as increased mortality. Since which treatment for PSD should be preferred are still matters of controversy, we are aiming to compare and rank these pharmacological and nonpharmacological interventions.Methods and analysis: We will employ a network meta-analysis to incorporate both direct and indirect evidence from relevant trials. We will search PubMed, the Cochrane Library Central Register of Controlled Trials, Embase, and the reference lists of relevant articles for randomized controlled trials (RCT) of different PSD treatment strategies. The characteristics of each RCT will be summarized, including the study characteristics, the participant characteristics, the outcome measurements, and adverse events. The risk of bias will be assessed by means of the Cochrane Collaboration's risk of bias tool. The primary outcome was change in Hamilton Depression Scale (HAMD) score. Secondary outcomes involve patient response rate (defined as at least a 50% score reduction on HAMD), and remission rate (defined as no longer meeting baseline criteria for depression). Moreover, we will assess the acceptability of treatments according to treatment discontinuation. We will perform pairwise meta-analyses by random effects model and network meta-analysis by Bayesian random effects model. Conclusion:Formal ethical approval is not required as primary data will not be collected. Our results will help to reduce the uncertainty about the effectiveness and safety of PSD management, which will encourage further research for other therapeutic options. The review will be disseminated in peer-reviewed publications and conference presentations. PROSPERO registration number: CRD42016049049Abbreviations: DSM = Diagnostic and Statistical Manual of Mental Disorders, HAMD = Hamilton Depression Rating Scale, PSD = poststroke depression, RCT = randomized controlled trial, SSRI = selective serotonin reuptake inhibitor, TCM = traditional Chinese medicine.Keywords: Bayesian network meta-analysis, Hamilton depression scale, pharmacological, poststroke depression, psychotherapeutic XJS and LHD contributed equally as the first authors.Ethics and dissemination: No ethical approval is required. The NMA will be conducted in conformity to the PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions guideline and findings from this systematic will be submitted to a peer-reviewed scientific journal. We also plan to present results in future conferences. This is a fundamental step in a broader research program aimed to understand the ideal structure of target population and methods for PSD management.Authorship: XJS and ML conceptualized and designed the study. XJS and LHD drafted the manuscript. SQ, XT, DRW, and ML critically reviewed the protocol and manuscript as submitted. All the authors read and approved the final manuscript.Provenance and peer review: N...

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

“…This systematic review is reported according to PRISMA statement extension for NMA (Appendix 1) 36 and conducted according to a priori-established protocol registered with PROSPERO (CRD42016049049) 37 .…”