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Richter D, Ebert A, Mazul-Wach L, Ruland Q, Charles-James J, Gold R, Tsivgoulis G, Juckel G, Krogias C. Prognostic markers of post-stroke depression (PROMoSD): study protocol of a prospective single-center observational study on raphe hypoechogenicity as a predictor of post-stroke depression. Neurol Res Pract 2022; 4:59. [PMID: 36494874 PMCID: PMC9733096 DOI: 10.1186/s42466-022-00225-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Post-stroke depression (PSD) is an important and frequent non-motor complication after a stroke. As valid prediction of PSD occurrence is still not possible, the unselective use of preventive therapy in stroke patients has risen a questionable risk-to-benefit consideration. Therefore, there is a need to increase the prediction probability of PSD to identify patients at very high risk of a depressive complication who might benefit from preventive therapy. In this context, a brainstem raphe hypoechogenicity (BRH) in transcranial sonography (TCS) has previously been associated with depressive symptoms in a broad spectrum of diseases. BRH might therefore represent a valid maker of vulnerability for depressive symptoms that could be of interest in the risk assessment of PSD occurrence. METHODS In the prognostic markers of post-stroke depression (PROMoSD) study, a prospective, observational, single-center, investigator-initiated study, we aim to include 100 patients with acute ischemic stroke (AIS). Besides data on clinical characteristics and baseline psychiatric assessment, we conduct a TCS examination to identify patients with BRH. The primary outcome is the incidence of PSD three months after inclusion, determined by a blinded investigator according to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria. PERSPECTIVE The results of PROMoSD will answer the question of whether screening of BRH after AIS improves the prediction of PSD occurrence. A positive result of this study could have direct consequences on psychiatric support after AIS by streamlining diagnostic and therapeutic algorithms. Trial registration ClinicalTrials.gov identifier no. NCT05580198.
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Affiliation(s)
- Daniel Richter
- grid.5570.70000 0004 0490 981XDepartment of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Andreas Ebert
- grid.5570.70000 0004 0490 981XDepartment of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Lisa Mazul-Wach
- grid.5570.70000 0004 0490 981XDepartment of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Quirin Ruland
- grid.5570.70000 0004 0490 981XDepartment of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Jeyanthan Charles-James
- grid.5570.70000 0004 0490 981XDepartment of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Ralf Gold
- grid.5570.70000 0004 0490 981XDepartment of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791 Bochum, Germany ,grid.5570.70000 0004 0490 981XMedical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Georgios Tsivgoulis
- grid.5216.00000 0001 2155 08002nd Department of Neurology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Georg Juckel
- grid.5570.70000 0004 0490 981XDepartment of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany ,grid.5570.70000 0004 0490 981XMedical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Christos Krogias
- grid.5570.70000 0004 0490 981XDepartment of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Gudrunstr. 56, 44791 Bochum, Germany ,grid.5570.70000 0004 0490 981XMedical Faculty, Ruhr University Bochum, Bochum, Germany
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Richter D, Charles James J, Ebert A, Katsanos AH, Mazul-Wach L, Ruland Q, Gold R, Juckel G, Krogias C. Selective Serotonin Reuptake Inhibitors for the Prevention of Post-Stroke Depression: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10245912. [PMID: 34945207 PMCID: PMC8704665 DOI: 10.3390/jcm10245912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/25/2022] Open
Abstract
There are controversial data on the efficacy and safety profile of selective serotonin reuptake inhibitors (SSRIs) to prevent post-stroke depression (PSD). We performed a systematic search in MEDLINE and SCOPUS databases to identify randomized-controlled trials questioning the use of early SSRI therapy in the post-stroke population and its effect on PSD incidence. We included 6 studies with 6560 participants. We extracted the data on PSD occurrence in association with the treatment arm (SSRI versus placebo), as reported by each study. For safety analysis, we extracted the information on adverse events. A random-effects model was used to calculate the pooled relative risk estimates. Early SSRI therapy was associated with a significant reduction of PSD occurrence compared to placebo (10.4% versus 13.8%; relative risk: 0.75 [95% CI, 0.66–0.86]; absolute risk reduction: 3.4%). SSRI therapy increases the risk of bone fracture (RR 2.28 [95% CI, 1.58–3.30]) and nausea (RR 2.05 [95% CI, 1.10–3.82]) in the post-stroke population. Considering the risk-benefit ratio of early SSRI therapy in the post-stroke population, future research should identify high-risk patients for PSD to improve the risk-benefit consideration of this therapy for use in clinical practice.
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Affiliation(s)
- Daniel Richter
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, 44791 Bochum, Germany; (J.C.J.); (L.M.-W.); (Q.R.); (R.G.); (C.K.)
- Correspondence: ; Tel.: +49-234-509-0
| | - Jeyanthan Charles James
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, 44791 Bochum, Germany; (J.C.J.); (L.M.-W.); (Q.R.); (R.G.); (C.K.)
| | - Andreas Ebert
- Department of Psychiatry, Ruhr-University Bochum, LWL-Klinik, 44791 Bochum, Germany; (A.E.); (G.J.)
| | - Aristeidis H. Katsanos
- Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON L8S 3L8, Canada;
| | - Lisa Mazul-Wach
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, 44791 Bochum, Germany; (J.C.J.); (L.M.-W.); (Q.R.); (R.G.); (C.K.)
| | - Quirin Ruland
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, 44791 Bochum, Germany; (J.C.J.); (L.M.-W.); (Q.R.); (R.G.); (C.K.)
| | - Ralf Gold
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, 44791 Bochum, Germany; (J.C.J.); (L.M.-W.); (Q.R.); (R.G.); (C.K.)
- Medical Faculty, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr-University Bochum, LWL-Klinik, 44791 Bochum, Germany; (A.E.); (G.J.)
- Medical Faculty, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Christos Krogias
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, 44791 Bochum, Germany; (J.C.J.); (L.M.-W.); (Q.R.); (R.G.); (C.K.)
- Medical Faculty, Ruhr-University Bochum, 44801 Bochum, Germany
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