A comprehensive overview of post-stroke depression treatment options

Treatment options for depression in Parkinson's disease: a mini-review

Depression is a common comorbidity in Parkinson's disease (PD), significantly reducing patients' quality of life. This mini-review examines pharmacological and nonpharmacological therapies for managing depression in PD, analyzing their benefits, and limitations. Pharmacological options include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), levodopa, dopaminergic agonists, and monoamine oxidase B inhibitors. Nonpharmacological strategies involve brief psychodynamic therapy, cognitive-behavioral therapy (CBT), physical exercise, phytomedicine, massage therapy, music therapy, phototherapy, yoga, repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, electroconvulsive therapy (ECT), and deep brain stimulation. SSRIs, SNRIs, and some dopamine agonists have shown effectiveness and good tolerability, especially when combined with CBT or rTMS. For severe or refractory cases, ECT remains a viable option. Although many of these therapies show promise, the limited number and scale of studies for each treatment restrict the strength of current evidence. Further large-scale, multicenter randomized-controlled trials are essential to validate these preliminary findings and establish evidence-based guidelines. In addition, the potential benefits of social support and brief psychodynamic therapy in the context of PD-related depression require further exploration to provide holistic care strategies for this population.

Acupuncture therapies for post-stroke depression: the evidence mapping of clinical studies

Background

Acupuncture-related therapies have been widely used in previous studies, of which the ones for post-stroke depression (PSD) is on the rise. This study aims to map the current clinical research landscape and identifies gaps to provide direction and information for future research.

Methods

Eight databases were searched on acupuncture-related therapies for PSD from inception until April 2024. The publication profile, study objects, intervention categories, outcome indexes were graphically displayed. The Cochrane Collaboration's bias risk assessment tool was used to independently assess randomized controlled trials (RCTs) quality, and the methodological quality of the systematic reviews were assessed using the AMSTAR 2 checklist.

Results

A total of 666 clinical studies and 34 systematic reviews/Meta-analyses (SRs/MAs) were included in the evidence map, and the earliest report was found in 1996. The studies were mostly from China, and 89% of the evidence of the studies were of the RCTs. Body acupuncture and electroacupuncture were the most commonly used interventions. Most of the intervention durations were 2-4 weeks, and few patients were followed up. The main outcome was measured by effective rate and the Hamilton Rating Scale for Depression (HAMD). Evidences from clinical studies and SRs/MAs suggest that acupuncture has significant advantages in improving PSD, but the overall quality of studies could be improved.

Conclusions

Acupuncture-related therapies have great prospect in relieving the clinical symptoms of PSD, although there are some design and methodological defects in the current studies. In the future, the quality of research needs to be improved for the robustness of clinical evidence.

Symptom clusters and networks analysis in acute-phase stroke patients: a cross-sectional study

The symptoms of stroke jeopardize patients' health and increase the burden on society and caregivers. Although the traditional symptom cluster research paradigm can enhance management efficiency, it fails to provide targets for intervention, thereby hindering the development of patient-centered precision medicine. However, the symptom network paradigm, as a novel research approach, addresses the limitations of traditional symptom management by identifying core symptoms and determining intervention targets, thereby enhancing the efficiency and precision of symptom management. This study. aims to explore the symptom network and core symptoms of acute-phase stroke patients. A convenience sample of 505 stroke patients was selected for this study. Symptoms were assessed by the Stroke Symptom Experience Scale.Exploratory factor analysis was utilized to extract symptom clusters, and network analysis was conducted to construct the symptom network and characterize its nodes. In this study, four symptom clusters were extracted through exploratory factor analysis. Based on the results of node predictability(re) and node centrality such as strength centrality (rs), it was found that the symptoms of "No interest in surroundings" (rs = 1.299, re = 1.081), "Be disappointed about future" (rs = 0.922, re = 0.901), and "Unable to maintain body balance" (rs = 0.747, re = 0.744) had the highest centrality and predictability values, indicating their core positions within the symptom network. No interest in surroundings, Be disappointed about future, and Unable to maintain body balance are core symptoms in the symptom network. In the future, intervention methods for core symptoms can be constructed and validated for their intervention effects to further demonstrate the benefits of core symptoms.

Irritability in stroke: a protocol for a prospective study

Background

Poststroke irritability (PSI) is common among stroke survivors and can lead to a poor quality of life, difficulties in social interactions, criticism from caregivers, and caregiver stress. The planned study will evaluate the clinical, neuropsychological, and magnetic resonance imaging (MRI) correlates of PSI in a cohort of stroke survivors. In addition, the study will examine the 15-month progression of PSI.

Methods

This will be a prospective cohort study that will recruit 285 participants. Participants and their caregivers will undergo detailed assessments at a research clinic at 3, 9, and 15 months after stroke onset (T1/T2/T3). The irritability/lability subscale of the Chinese version of the Neuropsychiatric Inventory (CNPI) will be completed by caregivers. Potential covariates will also be measured. Patients will undergo MRI, including diffusion-weighted imaging, within 1 week of stroke onset. A stepwise logistic regression will be performed to evaluate the importance of lesions in the regions of interest (ROIs) along with other significant variables identified in univariate analyses. These analyses will be repeated for patients with and without PSI at T2 and T3. Repeated measures analysis of covariance (ANCOVA) will be used to assess changes in CNPI scores for the entire sample. In ANCOVA analyses, the frequency of infarcts in the ROIs will be treated as the predictor.

Discussion

This will be the first MRI study on PSI in stroke survivors. The findings will provide insights into the association of the orbitofrontal cortex, anterior cingulate cortex, anterior temporal lobe, insula, amygdala, thalamus, and basal ganglia lesions with the risk of PSI.