Treatments to manage post stroke depression

This study looked at different methods to treat post stroke depression. The authors concluded that patients treated with norepinephrine reuptake inhibitors had the greatest reduction in depression scores.

Depression is a common side effect after stroke. This can be linked with decreased quality of life and increased suicide and natural death rates. Depression in stroke patients negatively affects rehabilitation and recovery. Several treatments for post-stroke depression (PSD) have been examined, including both drug-based and non-drug-based treatments. The most effective therapy however is still debated among practitioners.

This study aimed to determine the most effective treatment type for PSD. The meta-analysis includes studies which looked at drug based treatments, non-drug based treatments and combination treatments for PSD. A total of 23 trials including 1542 participants were included.

The treatments examined in this trial are common anti-depressant treatments used. Drug based treatments included serotonin reuptake inhibitors (SSRIs), tricyclic anti-depressants (TCA), serotonin norepinephrine reuptake inhibitors (SNRIs), norepinephrine reuptake inhibitors (NRIs) and nimodipine. Non-drug based treatments included traditional Chinese medicine (TCM), repetitive transcranial magnetic stimulation (rTMS) and psychotherapy.

Depression was measured using the Hamilton rating score (HAMD) which involves a questionnaire that provides a score that indicates depression.

Patients treated with NRIs had the highest reduction in HAMD score compared to control groups of patients. This was followed by patients treated with TCAs, then those treated with psychotherapy and anti-depressants, and those treated with SSRIs.

In terms of odds of responding to treatment, rTMS had a nearly 10-fold increase in odds of responding compared to control groups (no active treatments). This was followed by patients treated with TCAs, who had an 8-fold increase, and patients treated with nimodipine and anti-depressants who had a 5-fold increase. TCM, SSRIs and psychotherapy and anti-depressants were also more effective compared to control groups.

In terms of odds of remission of PSD, rTMS had a 12-fold increas in the odds of remission compared to control groups. This was followed by patients treated with TCAs who had an 7.55-fold increase and patients treated with nimodipine and anti-depressants who had an 8-fold increase. Patients treated with SSRIs and psychotherapy and anti-depressants also had improved response rates compared to control groups.

The authors concluded that NRIs, SSRIs and TCAs resulted in a reduced HAMD compared to control groups. They also state that rTMS could be considered as a therapeutic approach for managing PSD.