Intervention Review

Interventions for preventing depression after stroke

  1. Maree L Hackett1,*,
  2. Craig S Anderson1,
  3. Allan House2,
  4. Christina Halteh3

Editorial Group: Cochrane Stroke Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 2 MAR 2008

DOI: 10.1002/14651858.CD003689.pub3

How to Cite

Hackett ML, Anderson CS, House A, Halteh C. Interventions for preventing depression after stroke. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD003689. DOI: 10.1002/14651858.CD003689.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

    University of Sydney, NHMRC Clinical Trials Research Centre, Camperdown, NSW, Australia

*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@thegeorgeinstitute.org.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 16 JUL 2008

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Abstract

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

Background

Depression is an important consequence of stroke that impacts on recovery yet often is not detected or is inadequately treated.

Objectives

To determine if pharmaceutical or psychological interventions can prevent depression and improve physical and psychological outcomes in patients with stroke.

Search methods

We searched the Trials Registers of the Cochrane Stroke Group (October 2007) and the Cochrane Depression Anxiety and Neurosis Group (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), Applied Science and Technology Plus (1986 to May 2006), Arts and Humanities Index (1991 to September 2002), Biological Abstracts (1969 to September 2002), BIOSIS Previews (2002 to May 2006), General Science Plus (1994 to September 2002), Science Citation Index (1992 to May 2006), Social Sciences Citation Index (1991 to May 2006), SocioFile (1974 to May 2006) ISI Web of Science (2002 to February 2008), reference lists, trial registers, conference proceedings and dissertation abstracts, and contacted authors, researchers and pharmaceutical companies.

Selection criteria

Randomised controlled trials comparing pharmaceutical agents with placebo, or psychotherapy against standard care (or attention control) to prevent depression in patients with stroke.

Data collection and analysis

Two review authors independently selected trials, extracted data and assessed trial quality. Primary analyses were the proportion of patients who met the standard diagnostic criteria for depression applied in the trials at the end of follow up. Secondary outcomes included depression scores on standard scales, physical function, death, recurrent stroke and adverse effects.

Main results

Fourteen trials involving 1515 participants were included. Data were available for 10 pharmaceutical trials (12 comparisons) and four psychotherapy trials. The time from stroke to entry ranged from a few hours to seven months, but most patients were recruited within one month of acute stroke. The duration of treatment ranged from two weeks to one year. There was no clear effect of pharmacological therapy on the prevention of depression or other endpoints. A significant improvement in mood and the prevention of depression was evident for psychotherapy, but the treatment effects were small.

Authors' conclusions

A small but significant effect of psychotherapy on improving mood and preventing depression was identified. More evidence is required before recommendations can be made about the routine use of such treatments after stroke.

 

Plain language summary

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

Interventions for preventing depression after stroke

The role of interventions for preventing depression after stroke is unclear. Depression is a common and important complication of stroke that is often missed or poorly managed. Little is known about whether treatment started early after stroke will reduce the risk of depression and improve recovery. This review of 14 trials, involving 1515 participants, found no evidence that antidepressant drugs prevent depression or improve physical recovery after stroke. Two trials showed that psychological therapy could improve patients' mood and prevent depression, but did not improve other outcomes. The generalisability of these findings to all stroke survivors is limited due to the small proportion of survivors who are eligible to participate in these clinical trials. More well-designed clinical trials are needed that test practical interventions for preventing depression across all stroke survivors.

 

摘要

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

背景

預防中風後憂鬱症的介入性治療

憂鬱症是中風導致的重要臨床結果,它會影響到中風的復原。然而,憂鬱症通常並沒有被察覺或是適當地治療。

目標

為了確認對於中風的病人,是否藥物或心理的介入性治療可以預防憂鬱症的發生並改善身體及心理的臨床結果。

搜尋策略

我們搜尋了Trials Registers of the Cochrane Stroke Group (2007年10月) 以及Cochrane Depression Anxiety and Neurosis Group (2008年2月)。此外,我們搜尋了Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2008)、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)、Applied Science and Technology Plus (1986年至2006年5月) 、 Arts and Humanities Index(1991年至2002年9月)、Biological Abstracts (1969年至2002年9月)、 BIOSIS Previews(2002年至2006年5月)、General Science Plus (1994年至2002年9月) 、 Science Citation Index (1992年至2006年5月)、 Social Sciences Citation Index (1991年至2006年5月)、 SocioFile (1974年至2006年5月)、 ISI Web of Science(2002年至2008年2月)、參考文獻目錄、試驗登錄、會議記錄和論文摘要、並與作者、研究人員、以及製藥公司取得聯繫。

選擇標準

比較藥物治療劑與安慰劑,或心理治療與標準治療(或注意控制),於預防中風患者發生憂鬱症的隨機對照試驗。

資料收集與分析

兩位回顧作者獨立選擇試驗、擷取數據並評估試驗品質。主要分析是於追蹤結束時,試驗當中符合憂鬱症標準診斷準則之患者的比例。次級結果包括標準評分表上的憂鬱指數,身體機能,死亡,再中風和不良反應。

主要結論

我們收錄了包括1515位參加者的14個試驗。10個藥物治療試驗(12組比較)和4個心理治療試驗的數據是可以取得的。從中風發生到加入試驗的時間從幾個小時到7個月之間不等,但大部分的病人在急性中風發生後的1個月內加入試驗。治療期間在2週到1年之間不等。以藥物治療來預防憂鬱症或其他臨床結果並沒有明確的效果。心理治療對於心情上明顯的改善以及預防憂鬱症的療效是明顯的,但這種治療效果並不大。

作者結論

心理治療對於改善情緒與預防憂鬱症有著微小但顯著的療效,在這篇回顧論文中得以確認。在做出關於中風後常規性採用這些治療的建議之前,我們還更多的證據。

翻譯人

本摘要由奇美醫院張偉倫翻譯。

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

總結

中風後採用介入性治療以預防憂鬱症的角色是不明確的。憂鬱症是中風後常見且重要,卻又通常被忽略或處理不當的合併症。關於是否於中風後及早治療可以降低發生憂鬱症的危險性並改善臨床恢復所知甚少。這篇包括1515位參與者共14個試驗的回顧論文,發現並沒有證據顯示於中風後使用抗憂鬱藥物能預防憂鬱症或改善身體復原。有兩個試驗顯示,心理治療能改善患者的情緒並預防憂鬱症,但並不能改善其他臨床結果。由於只有一小部分的中風生還者符合參加這些臨床試驗的資格,所以這些發現對於所有中風生還者的一般適用性是有限的。需要更多設計良好的臨床試驗來檢測在所有的中風生還者中能預防憂鬱症之實用的介入性治療。

 

Plain language summary

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

Intervencije za sprječavanje depresije nakon moždanog udara

Intervencije za sprječavanje depresije nakon moždanog udara

Uloga intervencija za sprječavanje depresije nakon moždanih udara nije jasna. Depresija je česta i važna posljedica moždanog udara, koja se često zanemaruje ili loše liječi. Malo se zna o tome hoće li terapija koja započne rano nakon moždanog udara smanjiti rizik od depresije i poboljšati oporavak. Ovaj sustavni pregled uključio je 14 studija i 1515 ispitanika. Nisu pronađeni dokazi da antidepresivi sprječavaju depresiju ili poboljšavaju fizički oporavak nakon moždanog udara. Dva ispitivanja su pokazala da psihološka terapija možda može poboljšati raspoloženje pacijenata i spriječiti depresiju, ali nije poboljšala druge ishode. Ovi rezultati se ne mogu primjeniti na sve pacijente koji su preživjeli moždani udar zbog malog udjela preživjelih koji mogu sudjelovati u ovakvim kliničkim ispitivanjima. Potrebno je više dobro osmišljenih kliničkih ispitivanja za testiranje praktičnih intervencija za sprječavanje depresije u svih preživjelih nakon moždanog udara.

Translation notes

Translated by: Croatian Branch of the Italian Cochrane Centre
Translation Sponsored by: Ministry of Education, Science and Sports