Key result
Antidepressants show robust evidence for preventing post-stroke depression across ~63% of pharmacological studies.
Why the study?
Post-stroke depression affects one-third of stroke survivors and impairs recovery, prompting a review of evidence on pharmacological and non-pharmacological preventive strategies.
Do pharmacological and non-pharmacological interventions prevent post-stroke depression in stroke survivors?
Systematic Review
Do pharmacological and non-pharmacological interventions prevent post-stroke depression in stroke survivors?
Antidepressants show the most robust evidence for preventing post-stroke depression, but integrative strategies combining personalized non-pharmacological support and pharmacological treatments may offer the most promising approach.
Supports prophylactic antidepressants after stroke to curb PSD incidence; extends RCT evidence by quantifying preventive effects across intervention types.
PURPOSE: Post-stroke depression (PSD) occurs in one-third of stroke survivors, leading to a substantial decrease in quality of life as well as delayed functional and neurological recovery. Early detection of patients at risk and initiation of tailored preventive measures may reduce the medical and socioeconomic burden associated with PSD. We sought to review the current evidence on pharmacological and non-pharmacological prevention of PSD. MATERIALS AND METHODS: We conducted a systematic review using PubMed/MEDLINE and bibliographies of identified papers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including randomized controlled studies. Eligible studies were included when performed within 1 year after the index cerebrovascular event. Animal and basic research studies, studies lacking a control group, review papers, and case reports were excluded. RESULTS: Out of 150 studies screened, 37 met our criteria. Among the strategies identified, administration of antidepressants displayed the most robust evidence for preventing PSD, whereas non-pharmacological interventions such as psychotherapy appear to be the most frequently used approaches to prevent depression after stroke. Research suggests that the efficacy of PSD prevention increases with the duration of preventive treatment. Seven out of 11 studies (63%) that used pharmacological and eight out of 16 (50%) that used non-pharmacological interventions reported a positive preventive effect on PSD. CONCLUSION: Overall, the current literature on PSD prevention shows heterogeneity, substantiating a need for well-designed randomized controlled trials to test the safety and efficacy of pharmacological as well as non-pharmacological and composite prevention regimens to minimize the risk of PSD in stroke survivors. Integrative strategies combining personalized non-pharmacological interventions such as educational, mental, and physical health support, and pharmacological strategies such as SSRIs may be the most promising approach to prevent PSD.
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Woranush et al. (2021) conducted a systematic review in Post-stroke depression. Pharmacological and non-pharmacological interventions vs. Control, usual care, or placebo was evaluated on New depression occurrence or depression scale scores. Administration of antidepressants displayed robust evidence for preventing post-stroke depression, with 63% of pharmacological and 50% of non-pharmacological studies reporting a positive preventive effect.
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