Therapeutic effect of Chinese herbal medicines for post-stroke depression: A meta-analysis of randomized controlled trials

Yi-Nao-Jie-Yu Prescription Relieves Post-Stroke Depression by Mitigating Ferroptosis in Hippocampal Neurons Via Activating the Nrf2/GPX4/SLC7A11 Pathway

Post-stroke depression (PSD) poses a serious impact on patients' life quality. Effective drugs to treat this annoying disease are still being sought. Yi-nao-jie-yu (YNJY) prescription has been found to relieve PSD; however, the underlying mechanisms remain unelucidated. This work elucidated the therapeutic effects and mechanisms underlying YNJY prescription in PSD. PSD rat model was treated with YNJY prescription and ML385. Depression-like behaviors of rats was appraised. Hematoxylin-eosin, Nissl, and NeuN immunofluorescence staining were performed to observe hippocampal neuronal damage. Transmission electron microscopy was used to assess hippocampal mitochondrial damage. Commercial kits and western blotting were adopted to research ferroptosis-related factors and Nrf2/GPX4/SLC7A11 signals. In vitro experiments were performed using rat hippocampal neurons to explore the mechanism by which YNJY prescription relieves PSD. In PSD rats, YNJY prescription relieved depression-like behaviors, attenuated hippocampal neuronal damage, mitigated hippocampal ferroptosis and mitochondrial damage, and activated hippocampal Nrf2/GPX4/SLC7A11 pathway. By in vitro experiments, erastin treatment exacerbated hippocampal neuronal damage, ferroptosis, mitochondrial damage, and lipid peroxidation; however, YNJY prescription abolished these erastin-induced effects. In the erastin-treated hippocampal neuronal model of PSD, ML385 treatment increased ferroptosis, hippocampal neuronal damage, and lipid peroxidation; however, YNJY prescription counteracted these ML385-induced effects. By in vivo study, ML385 reversed the relief of YNJY prescription on depressive-like behaviors of PSD rats, and the inhibition on ferroptosis in PSD rats' hippocampus. YNJY prescription relieves PSD by blocking ferroptosis via activating the Nrf2/GPX4/SLC7A11 pathway. It may be a promising agent for treating PSD clinically.

Analysis of online prescription patterns in Chinese patients with sequelae of cerebral infarction: a real-world study

Cerebral infarction (CI) is a common cerebrovascular disease worldwide, and the burden caused by the sequelae of CI has increased significantly. However, current treatment guidelines lack standardized recommendations for pharmacotherapy of sequelae of CI. This retrospective study collected and analyzed 1.98 million prescriptions concerning sequelae of CI from patients admitted to Zhiyun Health Internet Hospital in 2022. The mean age of patients was 66.2 ± 11.4 years, and 52.40% were male. 79.73% had one or more comorbidities. For treatment, the prescriptions of 1-, 2- and ≥ 3-drug accounted for 64.55%, 23.77% and 11.68% respectively. Chinese patent medicine (CPM) prescriptions, western medicine (WM) prescriptions, and CPM and WM combined (CPM + WM) prescriptions accounted for 53.81%, 27.33%, and 18.86% respectively. In CPM prescriptions, the most frequently prescribed medications were Salvia miltiorrhiza (34.81%), Ginkgo biloba (24.96%), Panax notoginseng (20.67%), Gastrodia (7.15%) and Ligusticum Wallichii (4.90%). For WM prescriptions, the most commonly prescribed agents were anti-hypertensive (32.82%), anti-thrombotic (16.06%), vasodilator (15.70%), anti-dementia (10.88%), and lipid-lowering (9.58%) drugs. Among CPM + WM prescriptions, 72.61% had CPM/WM = 1, 21.20% had CPM/WM < 1, and 6.19% had CPM/WM > 1. This research utilized real-world data extracted from internet hospitals in China to present valuable evidence of online prescription patterns among patients experiencing sequelae of CI.

Analysis of medical service utilization for post-stroke sequelae in Korea between 2016 and 2018: a cross-sectional study

In this retrospective cross-sectional observational study, the medical service utilization of post-stroke sequelae patients was examined using a national patient sample. The Korean Health Insurance Review and Assessment Service-National Patients Sample database was used to investigate the medical service utilization of 19,562 patients, diagnosed with post-stroke sequelae of cerebrovascular disease (I69) in Korea between January 2016 and December 2018. We compared the demographic characteristics, diagnosis code subtypes, frequency of healthcare utilization, medical costs, and comorbidities of standard care (SC) and Korean medicine (KM) users. Overall, patients aged ≥ 65 years accounted for the highest percentage, and utilization of medical services increased among patients aged ≥ 45 years. Outpatient care was higher among SC (79.23%) and KM (99.38%) users. Sequelae of cerebral infarction accounted for the highest percentage of diagnosis subtypes. Physical therapy and rehabilitation therapy were most frequent in SC, whereas injection/procedure and acupuncture were most frequent in KM. Cerebrovascular circulation/dementia drugs were prescribed most frequently in SC. Circulatory, digestive, endocrine, and metabolic disorders were the most common comorbidities in SC, whereas musculoskeletal and connective tissue disorders were most common in KM. Overall, SC and KM users showed differences in the number of medical service claims, cost of care, and comorbidities. Our findings provide basic research data for clinicians, researchers, and policy makers.

Efficacy and safety of Buyang Huanwu Decoction in the treatment of post-stroke depression: A systematic review and meta-analysis of 15 randomized controlled trials

Background

Post-stroke depression is the most common neuropsychiatric disorder after stroke, which seriously affects patients' post-stroke recovery and quality of life, and is prone to recurrence of stroke and death. Buyang Huanwu Decoction is effective in treating post-stroke depression, but there is a lack of scientific systematic review and meta-analysis.

Objective

To evaluate the efficacy and safety of Buyang Huanwu Decoction in treating post-stroke depression.

Methods

A total of eight databases were searched by two investigators from Embase, PubMed, The Cochrane Library, Web of Science, Wanfang, CNKI, VIP, and CBM to collect randomized controlled trials that applied BHD to PSD from the time of database construction to May 2022. Data analysis was performed using Review mange5.4.

Results

A total of 15 studies with 1,242 patients were included. Meta-analysis showed that compared with the antidepressant drug control group, the change value of the HAMD scale in the Buyang Huanwu Decoction group was significantly lower [p < 0.00001, SMD = −0.85, 95% CI (−1.10, −0.61)]; after subgroup analysis, the effect of BHD for 4 weeks was the most significant; the total clinical effective rate was significantly increased [p = 0.001, RR = 1.33, 95% CI (1.12, 1.57)]; neurological deficit score [p = 0.002, SMD = −1.03, 95% CI (−1.67, −0.39)], the incidence of adverse reactions [p = 0.02, RR = 0.42, 95% CI (0.20, 0.89)], and adverse reaction scale scores [p < 0.00001, MD = −3.58, 95%CI (−4.09, −3.08)] were significantly lower.

Conclusion

Compared with antidepressants, the Buyang Huanwu Decoction is more effective and safer in the treatment of post-stroke depression patients. However, more high-quality studies are needed to further support the above conclusion.

The efficacy of therapies for post-stroke depression in aging: An umbrella review

Post-stroke depression (PSD) is a common complication after stroke. PSD is associated with emotional disorders and psychological dependence, which are potential risk factors for stroke recurrence and suicidality. This study aimed to perform an umbrella review of therapies for PSD through a comprehensive literature search. A systematic search was conducted in the PubMed and Web of Science by two independent authors. We examined the Hamilton Depression Scale (HAMD), Activities of daily living (ADL), Neurologic function as efficacy endpoints, and the incidence of adverse events as safety profiles. Seventeen eligible studies, including 267 clinical trials were included in this study. The results showed that High-Frequency Repetitive Transcranial Magnetic Stimulation (HfrTMS), Acupuncture/EA+conventional treatment, Escitalopram, Modified Sini San, Moxibustion, Xiaoyao Formula, Paroxetine, Chinese herbal medicine, Exercise, Citalopram, and Cognitive behavioral therapy are beneficial for improving the depression symptoms of patients with PSD. HfrTMS and Sertraline may have an impact on slowing the scores of activities of daily living or neurologic function. In addition, Acupuncture/EA+conventional, Escitalopram, Citalopram, Sertraline, and Fluoxetine showed no serious adverse events in PSD patients. Our study demonstrated that 11 treatment methods can effectively improve the condition of PSD patients.

Natural Products for the Treatment of Post-stroke Depression

Post-stroke depression (PSD) is the most frequent and important neuropsychiatric consequence of stroke. It is strongly associated with exacerbated deterioration of functional recovery, physical and cognitive recoveries, and quality of life. However, its mechanism is remarkably complicated, including the neurotransmitters hypothesis (which consists of a monoaminergic hypothesis and glutamate-mediated excitotoxicity hypothesis), inflammation hypothesis, dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, and neurotrophic hypothesis and neuroplasticity. So far, the underlying pathogenesis of PSD has not been clearly defined yet. At present, selective serotonin reuptake inhibitors (SSRIs) have been used as the first-line drugs to treat patients with PSD. Additionally, more than SSRIs, a majority of the current antidepressants complied with multiple side effects, which limits their clinical application. Currently, a wide variety of studies revealed the therapeutic potential of natural products in the management of several diseases, especially PSD, with minor side effects. Accordingly, in our present review, we aim to summarize the therapeutic targets of these compounds and their potential role in-clinic therapy for patients with PSD.

Depression, Anxiety, and Suicide After Stroke: A Narrative Review of the Best Available Evidence

Depression and anxiety each affect around 1 in 3 people during the first year after a stroke. Suicide causes the death of about 3 to 4/1000 stroke survivors during the first 5 years. This narrative review describes the best available evidence for the epidemiology of depression, anxiety, and suicide; their prevention; and the treatment of anxiety and depression. We conclude with directions for future research.