Intervention Review

Interventions for treating depression after stroke

  1. Maree L Hackett1,*,
  2. Craig S Anderson1,
  3. Allan House2,
  4. Jun Xia3

Editorial Group: Cochrane Stroke Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 25 MAY 2008

DOI: 10.1002/14651858.CD003437.pub3


How to Cite

Hackett ML, Anderson CS, House A, Xia J. Interventions for treating depression after stroke. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD003437. DOI: 10.1002/14651858.CD003437.pub3.

Author Information

  1. 1

    The George Institute for International Health, Department of Neurological and Mental Health, Sydney, NSW, Australia

  2. 2

    University of Leeds, Leeds Institute of Health Sciences, Leeds, UK

  3. 3

    Bridge House, Cochrane Schizophrenia Group, Leeds, UK

*Maree L Hackett, Department of Neurological and Mental Health, The George Institute for International Health, PO Box M201, Missenden Road, Sydney, NSW, 2050, Australia. mhackett@george.org.au.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 8 OCT 2008

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Depression is an important consequence of stroke that impacts on recovery yet is often not detected or inadequately treated. This is an update of a Cochrane review first published in 2004.

Objectives

To determine whether pharmaceutical, psychological, or electroconvulsive treatment (ECT) of depression in patients with stroke can improve outcome.

Search methods

We searched the trials registers of the Cochrane Stroke Group (last searched October 2007) and the Cochrane Depression Anxiety and Neurosis Group (last searched February 2008). In addition, we searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2008), MEDLINE (1966 to May 2006), EMBASE (1980 to May 2006), CINAHL (1982 to May 2006), PsycINFO (1967 to May 2006) and other databases. We also searched reference lists, clinical trials registers, conference proceedings and dissertation abstracts, and contacted authors, researchers and pharmaceutical companies.

Selection criteria

Randomised controlled trials comparing pharmaceutical agents with placebo, or various forms of psychotherapy or ECT with standard care (or attention control), in patients with stroke, with the intention of treating depression.

Data collection and analysis

Two review authors selected trials for inclusion and assessed methodological quality; three review authors extracted, cross-checked and entered data. Primary analyses were the prevalence of diagnosable depressive disorder at the end of treatment. Secondary outcomes included depression scores on standard scales, physical function, death, recurrent stroke and adverse effects.

Main results

Sixteen trials (17 interventions), with 1655 participants, were included in the review. Data were available for 13 pharmaceutical agents, and four trials of psychotherapy. There were no trials of ECT. The analyses were complicated by the lack of standardised diagnostic and outcome criteria, and differing analytic methods. There was some evidence of benefit of pharmacotherapy in terms of a complete remission of depression and a reduction (improvement) in scores on depression rating scales, but there was also evidence of an associated increase in adverse events. There was no evidence of benefit of psychotherapy.

Authors' conclusions

A small but significant effect of pharmacotherapy (not psychotherapy) on treating depression and reducing depressive symptoms was found, as was a significant increase in adverse events. More research is required before recommendations can be made about the routine use of such treatments.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for treating depression after stroke

Antidepressant drugs may be useful in treating depression after stroke, but also cause side effects. Depression is common after stroke and may be treated with antidepressant medication or psychological therapy. This review of 16 trials, including 1655 participants, found that antidepressant drugs may produce recovery or improve depression symptoms. However they also increase side effects. These drugs should be used with caution in people with persistent depressive symptoms after stroke, as little is known about the risks, especially of seizures, falls, and delirium. We found no evidence for the benefit of psychotherapy. Future research should include a broader group of stroke patients.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對於中風後憂鬱症的介入治療

憂鬱症是中風的重要後果之一,然而卻時常未被發現或者沒有獲得適當的治療。本篇為最初發表在2004年的Cochrane回顧之更新。

目標

為了確定憂鬱症的藥物、心理,或是電痙攣(ECT)療法在中風病人中是否能改善預後。

搜尋策略

我們搜查了the trials registers of the Cochrane Stroke Group (搜尋至2007年10月)以及 the Cochrane Depression Anxiety and Neurosis Group (搜尋至2008年2月)。此外,我們搜尋了Cochrane Central Register of Controlled Trials (The Cochrane Library,2008年第1期)、 MEDLINE (1966年至2006年5月)、EMBASE (1980年至2006年5月)CINAHL (1982年至2006年5月)、PsycINFO (1967年至2006年5月)以及其他資料庫。我們還搜尋參考文獻、臨床試驗資料庫、研討會摘要手冊及論文摘要,並聯絡作者、研究者與藥廠。

選擇標準

比較不同種類的藥劑與安慰劑,或各種心理治療或ETC加上標準照護(或注意力控制)的隨機對照試驗(randomised controlled trials)於中風病人且具有明確治療憂鬱症的意向者。

資料收集與分析

兩位文獻回顧作者挑選納入之試驗,並且評估其研究方法的品質,3位作者擷取、交叉比對並輸入數據。初始分析為治療末了時可診斷的憂鬱疾患的盛行率。次級結果包括標準量表中的憂鬱分數、身體功能、死亡、再發性中風,以及不良事件。

主要結論

16個試驗(17個介入治療),共計1655人被收納在本篇回顧當中。從13種藥劑以及4個心理治療的試驗中獲得資料。並沒有使用ECT的試驗。分析因為缺乏標準化的診斷與預後標準,以及不同的分析方法,而變得複雜。有一些證據顯示藥物治療在完全緩解憂鬱症及降低(改善)憂鬱分級量表之分數上具有效益,但同時也也有證據顯示可能會增加不良事件發生。並沒有心理治療是有效益的證據。

作者結論

我們發現藥物治療(並非心理治療)在治療憂鬱症以及減低憂鬱症狀上具有微小但是顯著的效果,同時也顯著增加不良事件的發生。在推薦該療法作為例行性使用之前,我們需要有更多的研究。

翻譯人

本摘要由奇美醫院陳軾正翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

抗憂鬱藥物可能有助於治療中風後憂鬱症,但同時會引起副作用。憂鬱症常見於中風之後,並且可使用抗憂鬱藥物或心理治療。這篇回顧16個試驗,共計1655人的文獻發現抗憂鬱藥物可能恢復或改善憂鬱症狀。不過,他們也增加副作用。這些藥物應謹慎使用於中風後有持續性憂鬱症狀的病患,因為對於其風險所知甚少,特別是癲癇發作、跌倒和譫妄。我們沒有發現心理治療益處的證據。未來的研究應包含更廣泛的中風病患族群。